Temporal characterization of acute pain and toxicity kinetics during radiation therapy for head and neck cancer. A retrospective study

Vivian Salama; Sara Youssef; Tianlin Xu; Kareem A. Wahid; Jaime Chen; Jillian Rigert; Anna Lee; Katherine A. Hutcheson; Brandon Gunn; Jack Phan; Adam S. Garden; Steven J. Frank; William Morrison; Jay P. Reddy; Michael T. Spiotto; Mohamed A. Naser; Cem Dede; Renjie He; Abdallah S.R. Mohamed; Lisanne V. van Dijk; Ruitao Lin; Carlos J. Roldan; David I. Rosenthal; Clifton D. Fuller; Amy C. Moreno

Oral Oncology Reports (Sep 2023)

Temporal characterization of acute pain and toxicity kinetics during radiation therapy for head and neck cancer. A retrospective study

Vivian Salama,
Sara Youssef,
Tianlin Xu,
Kareem A. Wahid,
Jaime Chen,
Jillian Rigert,
Anna Lee,
Katherine A. Hutcheson,
Brandon Gunn,
Jack Phan,
Adam S. Garden,
Steven J. Frank,
William Morrison,
Jay P. Reddy,
Michael T. Spiotto,
Mohamed A. Naser,
Cem Dede,
Renjie He,
Abdallah S.R. Mohamed,
Lisanne V. van Dijk,
Ruitao Lin,
Carlos J. Roldan,
David I. Rosenthal,
Clifton D. Fuller,
Amy C. Moreno

Affiliations

Vivian Salama: Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA; Corresponding author. Head and Neck Division, Department of Radiation Oncology, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
Sara Youssef: Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
Tianlin Xu: Department of Biostatistics, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
Kareem A. Wahid: Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
Jaime Chen: Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
Jillian Rigert: Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
Anna Lee: Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
Katherine A. Hutcheson: Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
Brandon Gunn: Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
Jack Phan: Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
Adam S. Garden: Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
Steven J. Frank: Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
William Morrison: Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
Jay P. Reddy: Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
Michael T. Spiotto: Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
Mohamed A. Naser: Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
Cem Dede: Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
Renjie He: Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
Abdallah S.R. Mohamed: Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
Lisanne V. van Dijk: Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA; Department of Radiation Oncology, Medical Center Groningen, University of Groningen, Groningen, NL, USA
Ruitao Lin: Department of Biostatistics, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
Carlos J. Roldan: Department of Pain Medicine, Division of Anesthesiology, Critical Care Medicine, and Pain Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
David I. Rosenthal: Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
Clifton D. Fuller: Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
Amy C. Moreno: Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA; Corresponding author. Head and Neck Division, Department of Radiation Oncology, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. Phone: 713-745-5490

Journal volume & issue: Vol. 7
p. 100092

Abstract

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Objectives: Pain during Radiation Therapy (RT) for oral cavity/oropharyngeal cancer (OC/OPC) is a clinical challenge due to its multifactorial etiology and variable management. The objective of this study was to define complex pain profiles through temporal characterization of pain descriptors, physiologic state, and RT-induced toxicities for pain trajectories understanding. Materials and methods: Using an electronic health record registry, 351 OC/OPC patients treated with RT from 2013 to 2021 were included. Weekly numeric scale pain scores, pain descriptors, vital signs, physician-reported toxicities, and analgesics were analyzed using linear mixed effect models and Spearman's correlation. Area under the pain curve (AUCpain) was calculated to measure pain burden over time. Results: Median pain scores increased from 0 during the weekly visit (WSV)-1 to 5 during WSV-7. By WSV-7, 60% and 74% of patients reported mouth and throat pain, respectively, with a median pain score of 5. Soreness and burning pain peaked during WSV-6/7 (51%). Median AUCpain was 16% (IQR (9.3–23)), and AUCpain significantly varied based on gender, tumor site, surgery, drug use history, and pre-RT pain. A temporal increase in mucositis and dermatitis, declining mean bodyweight (−7.1%; P < 0.001) and mean arterial pressure (MAP) 6.8 mmHg; P < 0.001 were detected. Pulse rate was positively associated while weight and MAP were negatively associated with pain over time (P < 0.001). Conclusion: This study provides insight on in-depth characterization and associations between dynamic pain, physiologic, and toxicity kinetics. Our findings support further needs of optimized pain control through temporal data-driven clinical decision support systems for acute pain management.

Published in Oral Oncology Reports

ISSN: 2772-9060 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.sciencedirect.com/journal/oral-oncology-reports

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