title: Determinants of pain severity changes in ambulatory patients with cancer: an analysis from Eastern Cooperative Oncology Group trial E2Z02.
abstract: OBJECTIVE
  To understand changes in pain severity over time and to explore the factors associated with pain changes in ambulatory patients with solid tumors.
  
  
  METHODS
  We enrolled 3,106 patients with invasive cancer of the breast, prostate, colon/rectum, or lung from multiple sites. At baseline and 4 to 5 weeks later, patients rated their pain level on a 0 to 10 numerical rating scale. A 2-point change in pain score was defined as a clinically significant change in pain. Multivariable logistic models were fitted to examine the effects of pain management and demographic and clinical factors on change in pain severity.
  
  
  RESULTS
  We analyzed 2,761 patients for changes in pain severity. At initial assessment, 53.0% had no pain, 23.5% had mild pain, 10.3% had moderate pain, and 13.2% had severe pain. Overall, one third of patients with initial pain had pain reduction within 1 month of follow-up, and one fifth had an increase, and the improvement and worsening of pain varied by baseline pain score. Of the patients without pain at initial assessment, 28.4% had pain (8.9% moderate to severe) at the follow-up assessment. Logistic regression analysis showed that inadequate pain management was significantly associated with pain deterioration, as were lower baseline pain level, younger age, and poor health status.
  
  
  CONCLUSIONS
  One third of patients have pain improvement and one fifth experience pain deterioration within 1 month after initial assessment. Inadequate pain management, baseline pain severity, and certain patient demographic and disease characteristics are associated with pain deterioration.
authors.affiliation: Fengmin Zhao, Dana-Farber Cancer Institute, Boston, MA; Victor T. Chang, Veterans' Affairs New Jersey Health Care System/Rutgers-New Jersey Medical School, East Orange, NJ; Charles Cleeland and Michael J. Fisch, The University of Texas MD Anderson Cancer Center, Houston, TX; James F. Cleary, University of Wisconsin, Madison, WI; Edith P. Mitchell, Thomas Jefferson University, Philadelphia, PA; and Lynne I. Wagner, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Fengmin
authors.initials: F
authors.lastname: Zhao
authors.forename: Victor T
authors.initials: VT
authors.lastname: Chang
authors.forename: Charles
authors.initials: C
authors.lastname: Cleeland
authors.forename: James F
authors.initials: JF
authors.lastname: Cleary
authors.forename: Edith P
authors.initials: EP
authors.lastname: Mitchell
authors.forename: Lynne I
authors.initials: LI
authors.lastname: Wagner
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fisch
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000592:standards*; D001943:Breast Neoplasms / Q000150:complications; D015179:Colorectal Neoplasms / Q000150:complications; D005260:Female; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000175:diagnosis* / Q000209:etiology*; D059408:Pain Management / Q000379:methods / Q000592:standards; D010147:Pain Measurement; D011471:Prostatic Neoplasms / Q000150:complications; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors