Skip to main content
Log in

Evaluating the relationship between pain presentation and health-related quality of life in outpatients with metastatic or recurrent neoplastic disease

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Because cancer pain can in many cases be intermittent, the presence or absence of pain in ambulatory care patients on any given clinic visit may not be an accurate characterization of the impact of pain on functioning or health-related quality of life (HRQOL). The purpose of this study was to describe the relationship between temporal aspects of pain presentation and HRQOL among 187 stage III/IV cancer patients using the Brief Pain Inventory and the EORTC QLQ-C30. A total of 43% of patients reported pain the previous week, with 22% reporting no pain at the time of assessment. Differences between three pain groups (No Pain, Past Pain, and Current Pain) were significant for global HRQOL and five dimensions of HRQOL. Severity of pain was also associated with each dimension of HRQOL. This study highlights the complex relationship between pain presentation and HRQOL. The findings support the continuing need for detailed pain assessments among cancer patients treated in ambulatory care settings. Specifically, standardized, self-report measures of cancer pain that include ‘frequency’ as well as severity may be the most accurate approach to capture the impact of pain on HRQOL.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Ahles TA, Ruckdeschel JC, Blanchard EB. Cancer-related pain - I. Prevalence in an outpatient setting as a function of stage of disease and type of cancer. J Psychosom Res 1984; 28: 115–119.

    Article  PubMed  CAS  Google Scholar 

  2. Portenoy RK, Miransky J, Thaler HT, et al. Pain in ambulatory patients with lung or colon cancer: prevalence, characteristics, and effect. Cancer 1992; 70: 1616–1624.

    Article  PubMed  CAS  Google Scholar 

  3. Cleeland CS, Gonin R, Hatfield AK, et al. Pain and its treatment in outpatients with metastatic cancer. N Engl J Med 1994; 330: 592–596.

    Article  PubMed  CAS  Google Scholar 

  4. Rhodes DJ, Grossman SA. The Management of cancer pain. Maryland Med J 1997; 46: 141–146.

    CAS  Google Scholar 

  5. Portenoy RK, Hagen NA. Breakthrough pain: definition, prevalence, and characteristics. Pain 1990; 41: 273–281.

    Article  PubMed  CAS  Google Scholar 

  6. Banning A, Sjogren P, Henriksen H. Treatment outcome in a multidisciplinary cancer pain clinic. Pain 1991; 47: 129–134.

    Article  PubMed  CAS  Google Scholar 

  7. Portenoy RK. Treatment of temporal variations in chronic cancer pain. Sem Oncol 1997; 24: S16.7–S16.2.

    Google Scholar 

  8. Aaronson NK, Ahmedzai S, Bergman B, et al. The European organization for research and treatment of cancer QLQ-C30: A quality of life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993; 85: 365–376.

    PubMed  CAS  Google Scholar 

  9. CelIa DF, Tulsky OS, Gray G, et al. The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol 1993; 11: 570–579.

    Google Scholar 

  10. Melzack R, Wall PD. Pain mechanisms: a new theory. Science 1965; 150: 971–979.

    PubMed  CAS  Google Scholar 

  11. Yeager KA, Miaskowski C, Dibble SL, Wallhagen M. Differences in pain knowledge and perception of the pain experience between outpatients with cancer and their family caregivers. Oncol Nurs Forum 1995; 22: 1235–1241.

    PubMed  CAS  Google Scholar 

  12. Breura E, Lawlor P. Cancer pain management. Acta Anaesthesiol Scand 1997; 41: 146–153.

    Article  Google Scholar 

  13. Morris J, Perez D, McNoe B. The use of quality of life data n clinical practice. Qual Life Res 1998; 7: 85–91.

    Article  PubMed  CAS  Google Scholar 

  14. Coates A, Porzsolt F, Osoba D. Quality of life in oncology practice: prognostic value of the EORTC QLQ-C30 scores in patients with advanced malignancy. Eur J Cancer 1997; 33: 1025–1030.

    Article  PubMed  CAS  Google Scholar 

  15. National Comprehensive Cancer Network. NCCN practice guidelines for the management of psychosocial distress. Oncology 1999; 13: 113–147.

    Google Scholar 

  16. Strang P. Emotional and social aspects of cancer pain. Acta Oncol 1992; 31: 323–326.

    PubMed  CAS  Google Scholar 

  17. Ovesen L, Hannibal J, Mortensen EL. The Interrelationship of weight loss, dietary intake, and quality of life in ambulatory patients with cancer of the lung, breast and ovary. Nutr Cancer 1993; 19: 159–167.

    Article  PubMed  CAS  Google Scholar 

  18. Ferrell BR. The Impact of pain on quality of life: a decade of research. Nurs Clin North Am 1995; 30: 609–624.

    PubMed  CAS  Google Scholar 

  19. Heim HM, Oei TPS. Compairson of prostate cancer patients with and without pain. Pain 1993; 53: 159–162.

    Article  PubMed  CAS  Google Scholar 

  20. Portenoy RK, Kornblith AB, Wong G, et al. Pain in ovarian cancer patients: prevalence, characteristics and associated symptoms. Cancer 1994; 74: 907–915.

    Article  PubMed  CAS  Google Scholar 

  21. Barofsky I, Fontaine KR, Chaskin LJ. Pain in the obese: impact on health-related quality of life. Ann Behav Med 1997; 19: 408–410.

    Article  PubMed  CAS  Google Scholar 

  22. Becker N, Bondegaard TA, Olsen AK, Sjogren P, Bech P, Eriksen J. Pain epidemiology and health-related quality of life in chronic non-malignant pain patients referred to a Danish multidisciplinary pain center. Pain 1997; 73: 393–400.

    Article  PubMed  CAS  Google Scholar 

  23. Spiegel D, Sands S, Koopman C. Pain and depression in patients with cancer. Cancer 1994; 74: 2570–2578.

    Article  PubMed  CAS  Google Scholar 

  24. Kelsen DP, Portenoy RK, Thaler HT, et al. Pain and depression in patients with newly diagnosed pancreas cancer. J Clin Oncol 1995; 13: 748–755.

    PubMed  CAS  Google Scholar 

  25. Chapman GB, Elstein AS, Kuzel TM, Nadler RB, Sharifi R, Bennett CL. A Multi-attribute model of prostate cancer patients' preferences for health states. Qual Life Res 1999; 8: 171–180.

    Article  PubMed  CAS  Google Scholar 

  26. Skevington SM. Investigating the relationship between pain and discomfort and quality of life, using the WHOQOL. Pain 1998; 76: 395–406.

    Article  PubMed  CAS  Google Scholar 

  27. Rummans TA, Frost M, Suman VJ, et al. Quality of life and pain in patients with recurrent breast and gynecologic cancer. Psychosomatics 1998; 39: 437–445.

    PubMed  CAS  Google Scholar 

  28. Trowbridge R, Dugan W, Jay SJ, et al. Determining the effectiveness of a clinical-practice intervention in improving the control of pain in outpatients with cancer. Acad Med 1997; 72: 798–800.

    Article  PubMed  CAS  Google Scholar 

  29. da Silva FC, Fossa SD, Aaronson NK, et al. The quality of life of patients with newly diagnosed M1 prostate cancer: experience with EORTC clinical trial 30853. Eur J Cancer 1996; 32A: 72–77.

    Article  PubMed  CAS  Google Scholar 

  30. Osoba D, Rodrigues G, Myles ZB, Pater J. Interpreting the significance of changes in health-related quality of life scores. J Clin Oncol 1997; 16: 139–144.

    Google Scholar 

  31. Allison PJ, Locker D, Wood-Dauphinee S, Black M, Feine JS. Correlates of health-related quality of life in upper aerodigestive tract cancer patients. Qual Life Res 1998; 7: 713–722.

    Article  PubMed  CAS  Google Scholar 

  32. Cleeland CS, Syrjala KL. How to assess cancer pain. In: Turk DC, Melzack R (eds), Handbook of Pain Assessment, New York: Guilford Press, 1992: 362–387.

    Google Scholar 

  33. Vallerand AH. Measurement issues in the comprehensive assessment of cancer pain. Semin Oncol Nurs 1997; 13: 16–24.

    Article  PubMed  CAS  Google Scholar 

  34. SAS Institute, Inc. SAS Language Guide, Release 6.03 edition. Cary, NC: SAS Institute, 1988.

    Google Scholar 

  35. World Health Organization. Cancer Pain Relief. Geneva: World Health Organization, 1986.

    Google Scholar 

  36. American Pain Society Quality of Care Committee. Quality improvement in the guidelines for the treatment of acute pain and cancer pain. JAMA 1995; 274: 1874–1880.

    Article  Google Scholar 

  37. McLachlan S, Devins GM, Goodwin PJ. Factor analysis of the psychosocial items of the EORTC QLQ-C30 in metastatic breast cancer patients participating in a psychosocial intervention study. Qual Life Res 1999; 8: 311–317.

    Article  PubMed  CAS  Google Scholar 

  38. Ringdal K, Ringdal GI, Kaasa S, et al. Assessing the consistency of psychometric properties of HRQoL scales within the EORTC QLQ-C30 across populations by means of the Mokken Scaling Model. Qual Life Res 1999; 8: 25–43.

    Article  PubMed  CAS  Google Scholar 

  39. Chawla S, Mohanti BK, Rakshak M, Saxena S, Rath GK, Bahadur S. Temporal assessment of quality of life of head and neck cancer patients receiving radical radiotherapy. Qual Life Res 1999; 8: 73–78.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Owen, J.E., Klapow, J.C. & Casebeer, L. Evaluating the relationship between pain presentation and health-related quality of life in outpatients with metastatic or recurrent neoplastic disease. Qual Life Res 9, 855–863 (2000). https://doi.org/10.1023/A:1008944211294

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1008944211294

Navigation