title: Factors associated with pain among ambulatory patients with cancer with advanced disease at a comprehensive cancer center.
abstract: OBJECTIVE
  The prevalence and severity of pain have not been well described among oncology patients in ambulatory care. To better understand the burden of pain among patients with advanced cancer, we examined the prevalence of pain reported during office and treatment visits.
  
  
  METHODS
  A retrospective study of 4,014 patients with advanced disease (stage 4 at diagnosis or metastatic progression) who completed an ambulatory visit between 2004 and 2006 was conducted at a comprehensive cancer center in Boston, Massachusetts.
  
  
  RESULTS
  At their first visit during the study period, 74% of patients reported no pain (0 score); 12%, low pain (1 to 3 score); 9%, moderate pain (4 to 6 score); and 5%, severe pain (7 to 10 score). The prevalence of pain was highest among patients who were younger than 60 years of age, were nonwhite, did not speak English as their primary language, or were covered by Medicaid, received free care, or paid their own health care costs. Patients with thoracic, breast, and head and neck cancers had higher pain scores than those with other diseases. Pain was reported more frequently among patients whose diagnosis or metastatic progression occurred less than 3 months before the reported pain score. In multivariable regression analysis, age, race, cancer type, and time since diagnosis/progression were identified as important factors associated with severe pain.
  
  
  CONCLUSIONS
  Younger age, minority race, and recent onset of advanced disease are associated with severe pain among patients with cancer. Recognizing these high-risk groups could inform targeted interventions to address pain care in ambulatory patients with advanced cancer.
authors.affiliation: Dana-Farber Cancer Institute, Boston, MA 02215, USA. sherri_stuver@dfci.harvard.edu
authors.forename: Sherri O
authors.initials: SO
authors.lastname: Stuver
authors.forename: Thomas
authors.initials: T
authors.lastname: Isaac
authors.forename: Jane C
authors.initials: JC
authors.lastname: Weeks
authors.forename: Susan
authors.initials: S
authors.lastname: Block
authors.forename: Donna L
authors.initials: DL
authors.lastname: Berry
authors.forename: Roger B
authors.initials: RB
authors.lastname: Davis
authors.forename: Saul N
authors.initials: SN
authors.lastname: Weingart
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D002173:Cancer Care Facilities; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010146:Pain / Q000175:diagnosis* / Q000453:epidemiology*; D010147:Pain Measurement; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States; D055815:Young Adult