Pain Is More Prevalent and Severe in Men with Metastatic Disease and Use of Docetaxel  

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Men who have metastatic castration-resistant prostate cancer and have used docetaxel reported a higher prevalence and greater severity of pain than docetaxel-naive patients, according to results of an anonymous survey conducted at five comprehensive cancer centers in the Prostate Cancer Clinical Trials Consortium.

Overall, 461 patients with prostate cancer completed the survey, which included the Brief Pain Inventory (BPI), as well as questions about diagnosis, treatment, and analgesic use. Patients were asked to rate their worst pain in the last 24 hours and the last 7 days, on a scale of 0 to 10, with 0 being no pain and 10 being “pain as bad as you can imagine.”

The “prevalence and severity of cancer-related pain and analgesic use were tabulated according to castration-resistant status and exposure to docetaxel chemotherapy,” the researchers wrote in Journal of Oncology Practice. Among the 147 patients with metastatic castration-resistant prostate cancer involving bone, 89 or 61% had been exposed to docetaxel and 58 or 39% had not.

“Pain of any level was more common among docetaxel-exposed vs docetaxel-naive patients with [metastatic castration-resistant prostate cancer] (70% [62 of 89] vs 38% [22 of 58], respectively; P < .001). BPI score ≥ 4 was reported by 38% (34 of 89) of docetaxel-pretreated and 24% (14 of 58) of docetaxel-naive patients with [metastatic castration-resistant prostate cancer],” the researchers reported.

“A striking finding of this study is the apparent underuse of analgesics, including narcotic analgesics, among the men with pain, consistent with other recent reports,” the investigators noted. Among patients with a worst BPI pain score ≥ 4 in the past 7 days, 40% reported no narcotic analgesic use. Among those with BPI scores ≥ 7, only 27% (6 of 22) reported use of a long-acting narcotic and 18% (4 of 22) reported no analgesic use.

The five participating institutions were Memorial Sloan-Kettering Cancer Center, New York; Duke University Cancer Institute, Durham, North Carolina; Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore; The University of Texas MD Anderson Cancer Center, Houston; and Oregon Health & Science University Knight Cancer Institute, Portland. ■

Autio KA, et al: J Oncol Pract. June 25, 2013 (early release online).




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