Zhang Yeying, Guo Yuna
Department of Anesthesiology, The Affiliated Hospital of Hangzhou Normal University, No.126 Wenzhou Road, Gongshu District, Hangzhou, Zhejiang, 310015, China.
Department of Oncology, Zhuji People's Hospital of Zhejiang Province, No. 9 Jianmin Road, Zhuji, Zhejiang, 311800, China.
BMC Public Health. 2025 Jan 25;25(1):325. doi: 10.1186/s12889-025-21406-2.
Evidence is lacking on whether chronic pain is related to the risk of cancer mortality. This study seeks to unveil the association between chronic pain and all-cause, cancer, as well as non-cancer death in cancer patients based on the National Health and Nutrition Examination Survey (NHANES) database.
Cancer survivors aged at least 20 (n = 1369) from 3 NHANES (1999-2004) cycles were encompassed. Chronic pain and cancer were determined through self-report. We employed records from the National Death Index for the determination of death status and reason. All-cause, cancer, and non-cancer deaths were primary outcomes. We used time-dependent ROC curve assessment to evaluate the predictive value of chronic pain for death in cancer patients.
Over a median 141-month follow-up (interquartile range: 61-201 months), 884 (64.57%) of 1,369 cancer sufferers died, of which 259 (18.91%) died from cancer, and 625 (45.65%) from other causes. Compared with non-chronic pain survivors, chronic pain correlated with elevated all-cause mortality (Hazard Ratio (HR), 1.40; 95% CI, 1.14-1.72, p = 0.001) and cancer death (HR, 1.75; 95% CI, 1.16-2.64, p = 0.008), primarily in patients with pain lasting 3 months or more. Chronic pain was related to higher non-cancer mortality (HR, 1.38; 95% CI, 1.04-1.82, p = 0.025), and no significant results were found in pain duration. Time-dependent ROC curves showed the area under the curve (AUC) for all-cause mortality at 1, 3, 5, 10, and 20-year survival for chronic pain of 0.71, 0.78, 0.84, 0.89, and 0.96, respectively. The AUCs for cancer mortality at 1, 3, 5, 10, and 20-year for chronic pain were 0.83, 0.87, 0.91, 0.94, and 0.95, respectively, and those for non-cancer mortality at 1, 3, 5, 10, and 20-year for chronic pain were 0.82, 0.86, 0.90, 0.91, and 0.97, respectively.
Chronic pain is associated with heightened all-cause and cancer mortality in the cancer population. Clinical staff should focus on chronic pain in this patient population.
慢性疼痛是否与癌症死亡率风险相关尚缺乏证据。本研究旨在基于美国国家健康与营养检查调查（NHANES）数据库揭示癌症患者中慢性疼痛与全因死亡、癌症死亡以及非癌症死亡之间的关联。
纳入了来自3个NHANES（1999 - 2004年）周期中年龄至少20岁的癌症幸存者（n = 1369）。慢性疼痛和癌症通过自我报告确定。我们利用国家死亡指数记录来确定死亡状态和原因。全因死亡、癌症死亡和非癌症死亡是主要结局。我们使用时间依赖性ROC曲线评估来评估慢性疼痛对癌症患者死亡的预测价值。
在中位141个月的随访期（四分位间距：61 - 201个月）内，1369名癌症患者中有884名（64.57%）死亡，其中259名（18.91%）死于癌症，625名（45.65%）死于其他原因。与非慢性疼痛幸存者相比，慢性疼痛与全因死亡率升高相关（风险比（HR），1.40；95%置信区间，1.14 - 1.72，p = 0.001）以及癌症死亡相关（HR，1.75；95%置信区间，1.16 - 2.64，p = 0.008），主要发生在疼痛持续3个月或更长时间的患者中。慢性疼痛与较高的非癌症死亡率相关（HR，1.38；95%置信区间，1.04 - 1.82，p = 0.025），且在疼痛持续时间方面未发现显著结果。时间依赖性ROC曲线显示，慢性疼痛在1、3、5、10和20年生存时全因死亡率的曲线下面积（AUC）分别为0.71、0.78、0.84、0.89和0.96。慢性疼痛在1、3、5、10和20年癌症死亡率的AUC分别为0.83、0.87、0.91、0.94和0.95，慢性疼痛在1、3、5、10和20年非癌症死亡率的AUC分别为0.82、0.86、0.90、0.91和0.97。
慢性疼痛与癌症人群中全因死亡率和癌症死亡率升高相关。临床工作人员应关注这一患者群体中的慢性疼痛。
