Cancer-related pain in head and neck cancer survivors: longitudinal findings from the Head and Neck 5000 clinical cohort

Reports suggest pain is common in head and neck cancer (HNC).However, past studies are limited by small sample sizes and design andmeasurement heterogeneity. Using data from the Head and Neck 5000 longitudinalcohort, we investigated pain over a year post-diagnosis. We assessed: temporaltrends; compared pain across HNC treatments, stages, sites and by HPV status;and identified subgroups of patients at increased risk of pain.

Sociodemographic and clinical data and patient-reported pain(measured by EORTC QLQ-C30 and QLQ-H&N35) were collected at baseline(pre-treatment), 4- and 12- months. Using mixed effects multivariableregression, we investigated time trends and identified associations between (i)clinically-important general pain and (ii) HN-specific pain and clinical,socio-economic, and demographic variables.

2,870 patients were included. At baseline, 40.9% hadclinically-important general pain, rising to 47.6% at 4-months anddeclining to 35.5% at 12-months. HN-specific pain followed a similarpattern (mean score (sd): baseline 26.4 (25.10); 4-months. 28.9 (26.55);12-months, 17.2 (19.83)). Across time, general and HN-specific pain levels wereincreased in: younger patients, smokers, and those with depression andcomorbidities at baseline, and more advanced, oral cavity and HPV negativecancers.

There is high prevalence of general pain in people living with HNC.We identified subgroups more often reporting general and HN-specific paintowards whom interventions could be targeted.

Greater emphasis should be placed on identifying and treating painin HNC. Systematic pain screening could help identify those who could benefitfrom an early pain management plan.