Population-based study of the prevalence and management of self-reported high pain scores in patients with non-resected pancreatic adenocarcinoma

Abstract

Background: Pain is a common debilitating symptom in pancreatic adenocarcinoma. This cohort study examined the use of, and factors associated with, pain-directed interventions for a high pain score in patients with non-curable pancreatic adenocarcinoma.Methods: Administrative databases were linked and patients with non-resected pancreatic adenocarcinoma diagnosed between 2010 and 2016, who reported one or more Edmonton Symptom Assessment System (ESAS) score, were identified. A high pain score was defined as an ESAS score of at least 4. Outcomes were pain-directed interventions: opiates (in patients aged 65 years or more with universal drug coverage), nerve block and radiation therapy for a high pain score. Reduction in pain score of at least 1 point after pain-directed intervention was also evaluated. Modified Poisson regression was used to examine factors associated with pain-directed intervention.Results: Among 2623 patients with a median age of 67 years, 1223 (46⋅6 per cent) were women, and 1621 (61⋅8 per cent) reported a high pain score at a median of 38 days after diagnosis. Of those with a high pain score, 75⋅6 per cent (688 of 910) received opiates, 13⋅5 per cent (219 of 1621) radiation and 1⋅2 per cent (19 of 1621) nerve block. The pain score decreased in 62⋅1 per cent of patients after administration of opiates, 73⋅4 per cent after radiation and all patients after nerve block. In multivariable analysis, no patient factor (age, sex, co-morbidity burden, rurality, income quintile) was associated with receipt of non-opiate pain-directed intervention for a high pain score. In patients aged at least 65 years, advanced age was associated with lower odds of opiate use. Conclusion:Opiates are the most common pain-directed intervention for non-curable pancreatic adenocarcinoma, whereas radiation therapy and nerve blocks are seldom used. The lack of association between pain-directed interventions and patient factors points toward practice-driven patterns.