Pain intensity can predict head and neck cancer survival

Researchers at M.D. Anderson Cancer Center assessed the extent to which pain severity influences survival in 2,340 newly diagnosed patients with head and neck cancer. At first presentation, patients rated their pain using a scale in which 0 meant no pain and 10 indicated "pain as bad as you can imagine." Survival time was calculated from diagnosis to death or last follow-up.

Head and neck cancer is the sixth most common malignancy worldwide, and squamous cell cancer is the most prevalent head and neck cancer, which include cancers of the oral cavity, tongue, pharynx and larynx. In the United States, some 54,000 people are diagnosed every year, and five-year survival rates for oral, pharyngeal and laryngeal cancers are 56 percent and 62 percent, respectively.

Pain often is the first sign of head and neck cancer, as a result of destructive lesions and direct tissue and bone involvement. Acute pain from therapy is very common from surgery, chemotherapy and radiation.

Results of the study showed that severe pain was reported by 19 percent of the sample, and was most prevalent in patients with oral cancer (20 percent). Pain intensity varied based on tumor stage, fatigue, smoking status and comorbid lung disease.

Eight hundred twenty eight patients died. Among those with oral cancer, overall five-year survival was 31 percent for patients who reported severe pain and 52 percent for those without severe pain. The survival differentiation was similar in patients with pharyngeal cancer.

The authors concluded that pretreatment pain severity in head and neck cancer patients is an independent predictor of overall five-year survival. They noted that patients who present with severe pain at diagnosis should be closely monitored and promptly treated for pain symptoms.