title: Survival patterns in squamous cell carcinoma of the head and neck: pain as an independent prognostic factor for survival.
abstract: Survival outcomes in patients with squamous cell carcinoma of the head and neck (HNSCC) vary by extent of disease, behavioral factors, and socioeconomic factors. We assessed the extent to which pretreatment pain influences survival in 2,340 newly diagnosed patients with HNSCC, adjusting for disease stage, symptoms, pain medications, comorbidities, smoking, alcohol consumption, age, sex, and race/ethnicity. Patients rated their pain at presentation to the cancer center (0 = "no pain" and 10 = "pain as bad as you can imagine"). Survival time was calculated from the date of diagnosis to the date of death of any cause or last follow-up. Five-year overall survival was calculated for all the variables assessed in the study. Severe pain (≥7) was most prevalent among those with oral cancer (20.4%; pharynx = 18.8%; larynx = 16.1%) and significantly varied by tumor stage, fatigue severity, smoking status, comorbid lung disease, and race (all P < .05) across cancer diagnoses. Overall 5-year survival varied by pain for oral (severe pain = 31% vs nonsevere pain = 52%; P < .001) and pharyngeal cancer (severe pain = 33% vs nonsevere pain = 53%; P < .001). Multivariable analyses showed that pain persisted as an independent prognostic factor for survival. Pain reported prior to treatment should be considered in understanding survival outcomes in HNSCC patients.
  
  
  CONCLUSIONS
  Pretreatment pain was an independent predictor of survival in a large sample of HNSCC patients even after accounting for tumor node metastasis stage, fatigue, age, race/ethnicity, smoking, and alcohol intake. Therefore, symptoms at presentation and before cancer treatment are important factors to be considered in understanding survival outcomes in HNSCC patients.
authors.affiliation: Department of Emergency Medicine, University of Texas M.D. Anderson Cancer Center, Houston, Texas. Electronic address: creyes@mdanderson.org.
authors.forename: Cielito C
authors.initials: CC
authors.lastname: Reyes-Gibby
authors.affiliation: Department of Symptom Research, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Karen O
authors.initials: KO
authors.lastname: Anderson
authors.affiliation: Department of Emergency Medicine, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Kelly W
authors.initials: KW
authors.lastname: Merriman
authors.affiliation: Department of Emergency Medicine, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Knox H
authors.initials: KH
authors.lastname: Todd
authors.affiliation: Department of Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Sanjay S
authors.initials: SS
authors.lastname: Shete
authors.affiliation: Department of Head and Neck, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Ehab Y
authors.initials: EY
authors.lastname: Hanna
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology* / Q000628:therapy; D015897:Comorbidity; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D007822:Laryngeal Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D015999:Multivariate Analysis; D010146:Pain / Q000453:epidemiology / Q000503:physiopathology*; D010147:Pain Measurement; D010610:Pharyngeal Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D011379:Prognosis; D000077195:Squamous Cell Carcinoma of Head and Neck
keywords: Pain; depression; fatigue; head and neck; survival; symptoms