Gabbard Jennifer, Isom Scott, Statler Tiffany, Asselin Joanna, Callahan Kathryn E, Pajewski Nicholas M, Wagner Lynne I, Parala-Metz Armida, Tooze Janet A, Klepin Heidi D
Department of Internal Medicine, Section of Gerontology and Geriatrics, School of Medicine, Wake Forest University, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Support Care Cancer. 2025 Jul 26;33(8):722. doi: 10.1007/s00520-025-09779-x.
Pain is a prevalent and often undertreated symptom among older adults with cancer. This study examined whether self-reported pain levels are associated with overall survival (OS) in older adults newly diagnosed with cancer receiving chemotherapy.
This retrospective cohort study included patients aged ≥ 65 years with newly diagnosed lung, colorectal, or breast cancer between 2017 and 2020, identified via a cancer registry at an academic medical center. Self-reported pain using the numeric rating scale (0-10), documented within 30 days of chemotherapy initiation, was categorized as none (0), mild (1-4), moderate (5-7), or severe (8-10). Baseline demographics, opioid use, and frailty (measured using a deficit accumulation approach) were collected. Kaplan-Meier was used to compare OS between groups. Cox proportional hazards models evaluated the association between pain levels and OS, adjusting for demographics, cancer stage and type, opioid use, and frailty.
Among 509 patients (median age 72.2 years; 55% female; 83.5% white; 13.4% Black), pain was highly prevalent: 16.5% reported mild, 19.6% moderate, and 17.3% severe pain. Median OS was significantly lower for patients with severe pain (9.1 months, 95% CI 6.5-12.7) compared to those with no pain (29.1 months, p < 0.0001). Severe pain (HR 1.60, 95% CI 1.14-2.24) and moderate pain (HR 1.52, 95% CI 1.10-2.10) were independently associated with higher mortality.
Self-reported pain was significantly associated with reduced OS in older adults with cancer. These findings suggest that self-reported pain may serve as a clinical indicator of poor prognosis and support the role of routine pain assessment in identifying high-risk patients to support patient-centered care.
疼痛是老年癌症患者中普遍存在且常常未得到充分治疗的症状。本研究调查了新诊断为癌症并接受化疗的老年人自我报告的疼痛程度是否与总生存期（OS）相关。
这项回顾性队列研究纳入了2017年至2020年间年龄≥65岁、新诊断为肺癌、结直肠癌或乳腺癌的患者，这些患者通过一所学术医疗中心的癌症登记处确定。在化疗开始后30天内使用数字评分量表（0-10）自我报告的疼痛被分类为无（0）、轻度（1-4）、中度（5-7）或重度（8-10）。收集了基线人口统计学数据、阿片类药物使用情况和虚弱程度（使用缺陷累积法测量）。采用Kaplan-Meier法比较各组的总生存期。Cox比例风险模型评估疼痛程度与总生存期之间的关联，并对人口统计学、癌症分期和类型、阿片类药物使用情况和虚弱程度进行了调整。
在509例患者中（中位年龄72.2岁；55%为女性；83.5%为白人；13.4%为黑人），疼痛非常普遍：16.5%报告有轻度疼痛，19.6%报告有中度疼痛，17.3%报告有重度疼痛。与无疼痛患者（29.1个月，p<0.0001）相比，重度疼痛患者的中位总生存期显著更低（9.1个月，95%置信区间6.5-12.7）。重度疼痛（风险比1.60，95%置信区间1.14-2.24）和中度疼痛（风险比1.52，95%置信区间1.10-2.10）与更高的死亡率独立相关。
自我报告的疼痛与老年癌症患者总生存期的降低显著相关。这些发现表明，自我报告的疼痛可能是预后不良的临床指标，并支持常规疼痛评估在识别高危患者以支持以患者为中心护理方面的作用。
