Pain in patients with newly diagnosed or relapsed acute leukemia
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Acute leukemia (AL) is associated with substantial morbidity and mortality. We assessed the prevalence and correlates of pain in patients with newly diagnosed or relapsed AL.
Patients with newly diagnosed or relapsed AL admitted to a comprehensive cancer center completed the Memorial Symptom Assessment Scale (MSAS), which assesses prevalence, severity, and distress associated with pain and other symptoms. Factors associated with severe pain were assessed using logistic regression. Two raters completed chart reviews in duplicate for patients with severe pain (MSAS severity ≥ 3/4) to determine the site of pain.
Three hundred eighteen patients were recruited from January 2008 to October 2013: 245 (77.0%) had acute myeloid or acute promyelocytic leukemia (AML/APL) and 73 (23.0%) had acute lymphoblastic leukemia (ALL); 289 (90.9%) were newly diagnosed and 29 (9.1%) had relapsed disease. Pain was reported in 156/318 (49.2%), of whom 55/156 (35.3%) reported severe pain (≥ 3/4). Pain was associated with all psychological symptoms (all p < 0.005) and some physical symptoms. Severe pain was associated with younger age (p = 0.02), worse performance status (p = 0.04), ALL diagnosis (p = 0.04), and time from onset of chemotherapy (p = 0.03), with pain peaking at 4 weeks after chemotherapy initiation. The most common sites of severe pain were oropharynx (22; 40%), head (12; 21.8%), and abdomen (11; 20%). Only 3 patients (0.9%) were referred to the symptom control/palliative care team during the month prior to or following assessment.
Pain is frequent, distressing, and predictable in patients undergoing induction chemotherapy for AL. Further research is needed to assess the efficacy of early supportive care in this population.
KeywordsCancer Oncology Hematology Acute leukemia Pain
The authors would like to thank our clinical and research staff who contributed to this project, and especially the study participants who gave their time and effort to help us better understand the experience of living with acute leukemia.
Conception and design: AS, CZ, GR.
Administrative support: AR.
Provision of study materials or patients: ADS.
Study implementation, acquisition and/or assembly of data: AS, GP, VBC, AR.
Analysis and interpretation of data: LWL, AS, ADS, CZ, GR.
Manuscript writing: All authors.
Final approval of manuscript to be published: All authors.
Funding for this study was provided by the Canadian Institutes of Health Research (#MOP 84317; GR and CZ, Co-Principal Investigators); the present analysis and write-up were supported in part by the Canadian Cancer Society (grant #702603; GR and CZ, Co-PIs). The research was also supported in part by the Princess Margaret Cancer Centre and Princess Margaret Cancer Foundation, University Health Network, Toronto, Canada, and by the Ministry of Health and Long-term Care. GR holds the University of Toronto/University Health Network Harold and Shirley Lederman Chair in Psychosocial Oncology and Palliative Care; and CZ holds the Rose Family Chair in Palliative Medicine and Supportive Care from the University of Toronto. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
Compliance with ethical standards
This study received approval from the University Health Network (UHN) Research Ethics Board (REB #06-0387-CE). All study participants provided written informed consent.
Conflict of interest
A.D. Schimmer reports personal fees and grants outside this submitted work from Novartis, Takeda Pharmaceuticals, Aeglea Pharmaceuticals, and Trillium Therapeutics. The remaining authors declare no conflicts of interest.
Findings were presented in part at the Multinational Association of Supportive Care in Cancer (MASCC)/ISOO 2017 Annual Meeting on Supportive Care in Cancer, Washington, DC, USA, June 22–24, 2017 (e-poster presentation); early/preliminary findings were presented at the 20th International Congress on Palliative Care, Montreal, Quebec, Canada, September 9–12, 2014 (poster presentation); the MASCC/ISOO 2014 Annual Meeting on Supportive Care in Cancer, Miami, Florida, United States, June 26–28, 2014 (oral presentation); the Hospice Palliative Care Ontario Annual Conference, Toronto, Ontario, Canada, April 27–29, 2014 (oral presentation); and the 9th Annual Advanced Learning in Palliative Medicine Conference, Vancouver, British Columbia, Canada, June 13–15, 2013 (oral presentation).
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