Survival Patterns in Squamous Cell Carcinoma of the Head and Neck: Pain as an Independent Prognostic Factor for Survival

Abstract

Survival outcomes in patients with squamous cell carcinoma of the head and neck (HNSCC) vary by extent of disease, behavioral, and socioeconomic factors. We assessed the extent to which pre-treatment pain influences survival in 2340 newly diagnosed patients with HNSCC, adjusting for disease stage, symptoms, pain medications, comorbidities, smoking, alcohol consumption, age, sex, and race/ethnicity. Patients rated their pain at presentation to the cancer center (0= ‘no pain’ and 10= ‘pain as bad as you can imagine’). Survival time was calculated from the date of diagnosis to the date of death of any cause or last follow-up. Five year overall survival was calculated for all the variables assessed in the study. Severe pain (≥7) was most prevalent among those with oral cancer (20.4%; pharynx=18.8%; larynx=16.1%) and significantly varied by tumor stage, fatigue severity, smoking status, comorbid lung disease, and race (all p<0.05) across cancer diagnoses. Overall 5 year survival varied by pain for oral (severe pain=31% versus non-severe=52%; p<0.001) and pharyngeal cancer (severe pain=33%, versus non-severe=53%; p<0.001). Multivariable analyses showed that pain persisted as an independent prognostic factor for survival. Pain reported prior to treatment should be considered in understanding survival outcomes in HNSCC patients. Perspective Pre-treatment pain was an independent predictor of survival in a large sample of HNSCC patients even after accounting for TNM stage, fatigue, age, race/ethnicity, smoking and alcohol intake. Therefore, symptoms at presentation and pre-cancer treatment are important factors to be considered in understanding survival outcomes in HNSCC patients.

Chronic opioid use in patients undergoing treatment for oropharyngeal cancer

“…In an analysis of 2,340 HNSCC patients, Reyes-Gibby et al found that the presence of severe pretreatment pain in oral and pharyngeal cancers predicted significantly worse 5-year overall survival, even after accounting for disease stage and other relevant clinical factors. 16 Thompson et al showed that pain severity immediately following treatment and 2 years after treatment were significant factors associated with overall survival in patients with HNSCC. 17 In our cohort, opioid use at 3, 6, and 12 months after treatment correlated with worse overall survival (Fig.…”

Cohort study of oncologic emergencies in patients with head and neck cancer

“…A recent study found that HNC patients with lymph node metastases were more likely to report severe pretreatment pain compared to patients without lymph node involvement, and that this was significantly correlated with measures of overall quality of life and increased symptom burden. 4 Pre-treatment pain has been associated with poorer overall survival in patients with HNSCC 18 thus suggesting the need for prompt pain treatment and management.…”

Identifying epigenetic biomarkers of established prognostic factors and survival in a clinical cohort of individuals with oropharyngeal cancer

“…Of particular importance for both incidence (5,8,9) and prognosis of OPC (10) are smoking, alcohol intake and HPV16 infection (via sexual contact, including that of oral sex). Smoking and, to a lesser extent, heavy drinking at the time of diagnosis are both associated with increased incidence and poor prognosis (10)(11)(12). Interestingly, HPV16 infection, while being a risk factor for OPC incidence, has been associated with better prognosis (13)(14)(15), with a population-based study conducted in Boston from December 1999 to December 2003 demonstrating that HPV16 infected cases showed improved overall survival compared to those without an infection (HR: 0.1; 95% CI: 0.02-0.4; N: 448) (16).…”