title: Early screening in patients with head and neck cancer identified high levels of pain and distress.
abstract: OBJECTIVE
  Pain and distress are recognized as the fifth and sixth vital signs in cancer care, respectively, as debilitating symptoms that are frequently under-recognized. The aim of this study was to document, using touch-screen technology, levels of pain and distress in patients with head and neck cancer before their assessment at a head and neck multidisciplinary referral clinic.
  
  
  METHODS
  A cross-sectional study over a 4-year period (2008 through 2011) was conducted for patients attending a head and neck oncology multidisciplinary team clinic in the Hunter New England referral district of Australia. Predictor variables were cancer stage and site. Cancer sites divided into 8 different regions, with distinction made for cutaneous versus noncutaneous sites. Outcome variables consisted of pain and distress levels. Pain was assessed using a Numerical Rating Scale of 0 to 10, and distress was assessed using the Distress Thermometer and PSYCH-6 scales. In the context of a screening study and for statistically comparing pain with other variables, pain was regarded as any score higher than 0. Clinically significant distress represented a Distress Thermometer score higher than 3 and a PSYCH-6 score of at least 3. Data analysis consisted of descriptive statistics, variance contrasts, and 2-tailed Pearson correlations.
  
  
  RESULTS
  Four hundred thirty-six patients were included in the study, with an equal number of cutaneous and noncutaneous cancer sites. Thirty-four percent of patients reported having pain, and 13% had clinically significant distress. Tumor stage did not significantly affect pain or distress scores.
  
  
  CONCLUSIONS
  There is a high level of pain and distress reported by patients with head and neck cancer before their assessment and management is discussed.
authors.affiliation: Department of Oral and Maxillofacial Surgery, John Hunter Hospital, Newcastle, Australia. deutscheng@hotmail.com
authors.forename: Nigel Gordon
authors.initials: NG
authors.lastname: Maher
authors.forename: Benjamin
authors.initials: B
authors.lastname: Britton
authors.forename: Gary Russell
authors.initials: GR
authors.lastname: Hoffman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010146:Pain / Q000209:etiology*; D010147:Pain Measurement / Q000379:methods