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Predictors of Cancer-related Pain Improvement over 12 Months

Predictors of Cancer-related Pain Improvement over 12 Months. Hsiao- Lan Wang, PhD, RN, CMSRN, HFS Assistant Professor University of South Florida September, 2012. Team. School of Medicine, Indiana University Kurt Kroenke, MD Jingwei Wu, MS Wanzhu Tu, PhD

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Predictors of Cancer-related Pain Improvement over 12 Months

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  1. Predictors of Cancer-related Pain Improvement over 12 Months Hsiao-Lan Wang, PhD, RN, CMSRN, HFS Assistant Professor University of South Florida September, 2012

  2. Team • School of Medicine, Indiana University • Kurt Kroenke, MD • Jingwei Wu, MS • Wanzhu Tu, PhD • Community Cancer Care and Community Health Network • Dale Theobald, MD, PhD • School of Nursing, Indiana University • Susan M Rawl, PhD, RN, FAA

  3. Acknowledgment • National Cancer Institute grant awarded to Dr. Kronenke (R01 CA115369) • National Institute of Nursing Research grant awarded to Dr. Wang (T32 NR007066), Indiana University .

  4. IntroductionCancer-related Pain • 1.6 million new cases of cancer in 2012 • 64% experienced cancer-related pain. • 82% reported pain was undertreated by analgesia .

  5. IntroductionFactors related to Pain • In addition to analgesics, other factors that may influence pain include: age, gender, race, socioeconomic status, comorbid conditions type of cancer, and phase of cancer. • The relationship between pain and depression is well known.

  6. Introduction A need to analyze in a longitudinal dataset • Indiana Cancer Pain and Depression (INCPAD) Study • A randomized clinical trial to test a 12-month telephone care management intervention targeted to improve pain and/or depression • Enrolled cancer survivors from 16 urban/rural outpatient oncology clinics, IN (03/06 – 08/08). • Moderate pain improvement among patients being treated for cancer-related pain and/or depression Reference: Kroenke K, Theobald D, Wu J, Norton K, Morrison G, Carpenter J, Tu W. Effect of telecaremanagement on pain and depression in patients with cancer: a randomized trial. JAMA. 2010; 304:163–71.

  7. Research Question • What are the predictors of pain improvement among patients being treated for cancer-related pain over 12 months?

  8. Methods • Inclusion Criteria • moderately severe cancer-related pain (BPI worst pain severity score ≥ 6) • Pain occurred in the region of the primary tumor or cancer metastases and/or occurring after the onset of cancer treatment. • and/or moderately severe depression (a Patient Health Questionnaire 9-item depression scale [PHQ-9] score ≥ 10, with depressed mood and/or anhedonia).

  9. Methods • Exclusion Criteria • Not speak English • Moderately severe cognitive impairment • Schizophrenia or other psychoses; • A disability claim being adjudicated for pain • Pregnant • Hospice care • Pre-existing non-cancer related pain

  10. MethodsSecondary Analysis • 274 participants who had cancer-related pain (with or without depression) • Intervention Group: 137 • Control Group: 137 • Data were collected at baseline (T0), 1 month (T1), 3 months (T3), 6 months (T6), and 12 months (T12) after enrollment. • Telephone Interviewer were blinded to group assignment.

  11. MethodsOutcome Variables Cancer-related Pain • Continuous Variable: • Brief Pain Inventory (BPI) severity scale (α = 0.79) • A 0 (no pain) to 10 (pain as bad as you can imagine) point scale • Binary Variable • Pain Global Rating of Improvement (PGRI) • 1 as “pain improved” and 0 as “pain not improved”

  12. MethodsPredictor Variables • Demographics • age, gender, race, marital status, and Socioeconomic Disadvantage (SED) Index. • Baseline clinical factors • medical comorbidity, type of cancer, and phase of cancer • Depression • Hopkins Symptom Checklist 20 item (HSCL-20) depression scale (α = 0.79) • 20 items; ascale of 0 to 5

  13. Statistical Anlysis • Repeated measures modeling for the predictive relationship. • Developed a full model by adjusting for • group assignment, • baseline BPI severity, and • time in months since baseline assessment.

  14. Multivariate Predictors of Cancer-related Pain

  15. Discussion • Beneficial association between improvement in depression and pain outcomes in cancer patients over time. • Negative relationship between socioeconomic disadvantage and cancer-related pain improvement.

  16. Discussion • Patients with a greater number of comorbid medical conditions were less likely to report improvement in their cancer-related pain. • Patients with recurrent or progressive cancer had worse pain outcomes over 12 months than those who were newly-diagnosed

  17. Limitations • Selection bias: The INCPAD enrollment criteria. • Only supported a temporal linkage from improvement in depression to lower pain.

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