TY - JOUR
T1 - Temporal characterization of acute pain and toxicity kinetics during radiation therapy for head and neck cancer. A retrospective study
AU - MD Anderson Head and Neck Cancer Symptom Working Group
AU - Salama, Vivian
AU - Youssef, Sara
AU - Xu, Tianlin
AU - Wahid, Kareem A.
AU - Chen, Jaime
AU - Rigert, Jillian
AU - Lee, Anna
AU - Hutcheson, Katherine A.
AU - Gunn, Brandon
AU - Phan, Jack
AU - Garden, Adam S.
AU - Frank, Steven J.
AU - Morrison, William
AU - Reddy, Jay P.
AU - Spiotto, Michael T.
AU - Naser, Mohamed A.
AU - Dede, Cem
AU - He, Renjie
AU - Mohamed, Abdallah S.R.
AU - van Dijk, Lisanne V.
AU - Lin, Ruitao
AU - Roldan, Carlos J.
AU - Rosenthal, David I.
AU - Fuller, Clifton D.
AU - Moreno, Amy C.
N1 - Publisher Copyright:
© 2023 The Authors
PY - 2023/9
Y1 - 2023/9
N2 - Objectives: Pain during Radiation Therapy (RT) for oral cavity/oropharyngeal cancer (OC/OPC) is a clinical challenge due to its multifactorial etiology and variable management. The objective of this study was to define complex pain profiles through temporal characterization of pain descriptors, physiologic state, and RT-induced toxicities for pain trajectories understanding. Materials and methods: Using an electronic health record registry, 351 OC/OPC patients treated with RT from 2013 to 2021 were included. Weekly numeric scale pain scores, pain descriptors, vital signs, physician-reported toxicities, and analgesics were analyzed using linear mixed effect models and Spearman's correlation. Area under the pain curve (AUCpain) was calculated to measure pain burden over time. Results: Median pain scores increased from 0 during the weekly visit (WSV)-1 to 5 during WSV-7. By WSV-7, 60% and 74% of patients reported mouth and throat pain, respectively, with a median pain score of 5. Soreness and burning pain peaked during WSV-6/7 (51%). Median AUCpain was 16% (IQR (9.3–23)), and AUCpain significantly varied based on gender, tumor site, surgery, drug use history, and pre-RT pain. A temporal increase in mucositis and dermatitis, declining mean bodyweight (−7.1%; P < 0.001) and mean arterial pressure (MAP) 6.8 mmHg; P < 0.001 were detected. Pulse rate was positively associated while weight and MAP were negatively associated with pain over time (P < 0.001). Conclusion: This study provides insight on in-depth characterization and associations between dynamic pain, physiologic, and toxicity kinetics. Our findings support further needs of optimized pain control through temporal data-driven clinical decision support systems for acute pain management.
AB - Objectives: Pain during Radiation Therapy (RT) for oral cavity/oropharyngeal cancer (OC/OPC) is a clinical challenge due to its multifactorial etiology and variable management. The objective of this study was to define complex pain profiles through temporal characterization of pain descriptors, physiologic state, and RT-induced toxicities for pain trajectories understanding. Materials and methods: Using an electronic health record registry, 351 OC/OPC patients treated with RT from 2013 to 2021 were included. Weekly numeric scale pain scores, pain descriptors, vital signs, physician-reported toxicities, and analgesics were analyzed using linear mixed effect models and Spearman's correlation. Area under the pain curve (AUCpain) was calculated to measure pain burden over time. Results: Median pain scores increased from 0 during the weekly visit (WSV)-1 to 5 during WSV-7. By WSV-7, 60% and 74% of patients reported mouth and throat pain, respectively, with a median pain score of 5. Soreness and burning pain peaked during WSV-6/7 (51%). Median AUCpain was 16% (IQR (9.3–23)), and AUCpain significantly varied based on gender, tumor site, surgery, drug use history, and pre-RT pain. A temporal increase in mucositis and dermatitis, declining mean bodyweight (−7.1%; P < 0.001) and mean arterial pressure (MAP) 6.8 mmHg; P < 0.001 were detected. Pulse rate was positively associated while weight and MAP were negatively associated with pain over time (P < 0.001). Conclusion: This study provides insight on in-depth characterization and associations between dynamic pain, physiologic, and toxicity kinetics. Our findings support further needs of optimized pain control through temporal data-driven clinical decision support systems for acute pain management.
KW - Acute pain
KW - Dermatitis
KW - Head and neck cancer
KW - Oral Cavity and oropharyngeal cancer
KW - Oral mucositis
KW - Radiation Therapy
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UR - http://www.scopus.com/inward/citedby.url?scp=85180881231&partnerID=8YFLogxK
U2 - 10.1016/j.oor.2023.100092
DO - 10.1016/j.oor.2023.100092
M3 - Article
C2 - 38638130
AN - SCOPUS:85180881231
SN - 2772-9060
VL - 7
JO - Oral Oncology Reports
JF - Oral Oncology Reports
M1 - 100092
ER -