Palliative Care

PD 02 - Palliative 1 - Poster Discussion

1014 - Quantitative-Qualitative Analyses of Patient-Reported Pain Response After Palliative Radiation Therapy

Sunday, October 21
1:45 PM - 1:51 PM
Location: Room 217 C/D

Quantitative-Qualitative Analyses of Patient-Reported Pain Response After Palliative Radiation Therapy
D. D. Shi1,2, L. M. Hertan3, M. S. Krishnan1, S. Skamene1, R. Shiloh1, M. A. Huynh1, A. Spektor1, C. Zaslowe-Dude1, and T. A. Balboni1; 1Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, 2Harvard Medical School, Boston, MA, 3Beth Israel Deaconess Medical Center, Boston, MA

Purpose/Objective(s): Pain response is important in assessing efficacy of palliative radiation therapy (RT) for pain, though the degree to which a 0-10 scale is a reliable assessment is unclear. The purpose of this study is to correlate patient-reported perceptions of pain change to change based on the 10-point pain scale, as well as to qualitatively characterize themes of how patient-reported pain changes.

Materials/Methods: This prospective study enrolled patients age≥20 with metastatic solid malignancies undergoing RT for spinal metastasis at a single institution from December 2016 through June 2017. Patients rated their pain at the site of treatment from 0-10 at RT start, and at 1 and 4 weeks post RT completion. At 1 and 4 weeks post RT, patients also reported their perceived percent improvement in pain (0%-100%) since RT start. At 4 weeks post RT, 20 patients were randomly selected to qualitatively describe how their pain changed since the start of RT. The primary endpoint was the difference between calculated percent change in pain versus patient-reported percent change in pain. Patients’ answers prompted by an open-ended question about pain response were transcribed verbatim and qualitatively analyzed.

Results: Sixty-five patients were included in this analysis. Five patients received treatment at two sites and rated pain at each site separately. Prior to RT start, average 0-10 pain rating was 4.6. At 1 week post-RT completion, 54% (36/67) reported a percentage change in pain that was +/- 10% of their calculated percent change in pain compared to baseline, 33% (22/67) reported a perceived percent change >10% of calculated, and 13% (9/67) reported a percent change that was <10% of calculated. At four weeks post-RT, 48% (28/58) reported a percentage change in pain that was +/- 10% of calculated, 41% (24/58) reported a perceived percent change >10% of calculated, and 10% (6/58) reported a perceived percent change <10% of calculated. Four qualitative themes emerged regarding the character of pain response, including changes in: pain quality (n=19), activities (n=9), function (n=7) and medication use (n=2).

Conclusion: About 50% of patients described a perceived change in pain that was disparate from their calculated change based on the 0-10 pain scale, with most patient estimates of percent change being greater than the change calculated with the 0-10 scale. Qualitative pain improvement revealed multiple themes regarding pain changes.

Author Disclosure: D.D. Shi: None. L.M. Hertan: None. M.S. Krishnan: None. S. Skamene: None. R. Shiloh: None. A. Spektor: Employee; Boston University. Honoraria; Bayer Pharmaceuticals, Astellas Pharma, Inc. C. Zaslowe-Dude: None. T.A. Balboni: Employee; Dana-Farber Cancer Institute. Research Grant; Templeton Foundation. Steering Committee Member; ASCO Palliative Care Steering Committee Member.

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