Pain and survival in patients with squamous cell cancer of the head and neck (HNSCC): analysis of 2,622 newly diagnosed HNSCC patients

Pain is often one of the first signs of head and neck cancer. In the present study, we assessed the importance of self-reported pain in predicting survival outcomes of patients newly diagnosed with squamous cell cancer of the head and neck (HNSCC). Pain was assessed using the 0-10 numeric rating scale (0=no pain; 10= worst pain possible) at initial presentation to the Cancer Center, prior to any cancer treatment. Kaplan–Meier survival curves and log-rank tests were used to evaluate the effect of severe pain (score of > 7) on the time to death. The effect of severe pain on survival was assessed using multivariate Cox proportional hazards regression analysis, adjusting for age, race, sex, alcohol and smoking, comorbidities, clinical stage, cancer site, and treatment. The sample included 2,662 HNSCC patients (oral=1349; pharynx=800; larynx=513) presenting to the Cancer Center from January, 2000-December, 2009. Severe pain (score of > 7) was reported by as many as 17% of the whole sample (oral= 20.4%; pharynx=18.8%; larynx=16.1%; p=0.135). Severe pain significantly varied by smoking status, alcohol intake, race, comorbid conditions, and TNM staging. Overall survival time was 398.5 weeks (mean) and 458 weeks (median). Mean and median survival time among those with non-severe pain was 417 (mean) and 507 (median) weeks versus 309.7 (mean) and 304 weeks (median) among those with severe pain (log rank= 0.0001). Univariate Cox regression analysis showed that severe pain was significantly associated with survival, which persisted in the multivariate analysis (HR= 1.27; 95% CI, 1.04-1.56, P=0.02). Race, smoking, alcohol intake, cancer site, cancer stage, comorbidities (heart disease, lung disease) and cancer treatment were also independently associated with poorer survival, whereas sex was not associated with survival. Our findings provide important insights on the importance of pain treatment and control in the care of patients with HNSCC. Supported by NIDCR RO1DE022891.