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Influence of pain duration on pain outcomes following palliative radiotherapy for painful tumors: the sooner the irradiation, the better?

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Abstract

Purpose

The influence of pre-radiotherapy pain duration on post-treatment outcomes was assessed.

Methods

Patients that received palliative radiotherapy were analyzed in a prospective observational study investigating curative and palliative radiotherapy. Brief Pain Inventory data were acquired at baseline and 1, 2, and 3 months after commencing irradiation. The pain response in terms of the index pain (i.e., pain caused by the irradiated tumors) was assessed using the International Consensus Endpoint. Patients were diagnosed with predominance of other pain (POP) if non-index pain of malignant or unknown origin was present and showed a higher pain score than the index pain. Competing risk analyses were performed in which deaths without the pain endpoints were considered as competing events.

Results

Of 229 patients analyzed, 123 (54%) experienced a pain response and 43 (19%) experienced POP. Multivariable analyses using the Fine-Gray model revealed that patients with shorter pain duration (< 1 month) had higher cumulative incidence of pain response (subdistribution hazard ratio, 2.43; 95% confidence interval [CI], 1.35–4.38) and POP (subdistribution hazard ratio, 4.22; 95% CI, 1.30–13.70) compared with patients with longer pain duration (≥ 4 months). For patients with a pain duration of less than 1 month, cumulative incidence of pain response was estimated to be 69% (95% CI, 53–85%) and cumulative incidence of POP was estimated to be 15% (95% CI, 3–28%) at 1‑month follow-up.

Conclusion

Commencing palliative radiotherapy earlier may improve the probability of patients achieving a pain response, although POP may be more frequent.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Arao Municipal Hospital, Kumamoto, Japan

    Tetsuo Saito MD, PhD

  2. Graduate School of Medicine, Kurume University, Fukuoka, Japan

    Tetsuo Saito MD, PhD

  3. Biostatistics Center, Graduate School of Medicine, Kurume University, Fukuoka, Japan

    Kenta Murotani

  4. Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan

    Kohsei Yamaguchi, Ryo Toya, Takahiro Watakabe & Natsuo Oya

  5. Department of Radiation Oncology, Kumamoto Medical Center, Kumamoto, Japan

    Etsushi Tomitaka

  6. Department of Radiation Oncology, Hitoyoshi Medical Center, Hitoyoshi, Japan

    Takahiro Watakabe

Authors
  1. Tetsuo Saito MD, PhD
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  2. Kenta Murotani
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  3. Kohsei Yamaguchi
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  4. Ryo Toya
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  5. Etsushi Tomitaka
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  6. Takahiro Watakabe
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  7. Natsuo Oya
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Contributions

All authors contributed to the study conception and design. All authors were involved in material preparation, data collection, and analyses. The first draft of the manuscript was written by T. Saito and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Tetsuo Saito MD, PhD.

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Conflict of interest

T. Saito, K. Murotani, K. Yamaguchi, R. Toya, E. Tomitaka, T. Watakabe, and N. Oya declare that they have no competing interests.

Ethical standards

The study was conducted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Saito, T., Murotani, K., Yamaguchi, K. et al. Influence of pain duration on pain outcomes following palliative radiotherapy for painful tumors: the sooner the irradiation, the better?. Strahlenther Onkol 197, 916–925 (2021). https://doi.org/10.1007/s00066-021-01760-x

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  • DOI: https://doi.org/10.1007/s00066-021-01760-x

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