The role of pain in head and neck cancer recurrence and survivorship.

OBJECTIVE To examine pain, a common symptom in patients with head and neck cancer, and its relationship to recurrence and survivorship. DESIGN Prospective, observational study. SETTING Tertiary care institution. PATIENTS A total of 339 patients with head and neck carcinomas who participated in the Department of Otolaryngology's Outcomes Assessment Project between February 28, 1998, and November 30, 2001. Of 355 patients enrolled during this period, 7 were omitted from the study because they presented with persistent disease and 9 were omitted owing to a lack of valid pain data. Data on health-related quality of life were collected from the remaining patients at diagnosis and then at 3, 6, 9, and 12 months after diagnosis. INTERVENTION Administration of surveys and questionnaires. MAIN OUTCOME MEASURES The relationship of self-reported pain level with health-related quality of life during the first year, recurrence status, and 5-year disease-specific survivorship was determined through univariate and multivariate analyses. RESULTS Pain was associated with age, general physical and mental health conditions, depressive symptoms, survival rate, and recurrence within the first year. The 5-year survival rate was 81.8% for patients with low posttreatment pain and 65.1% for those with high pain. Posttreatment pain and tumor site were independent predictors of recurrence. Pain level, age, and treatment modality were independent predictors of 5-year survival. CONCLUSION Because of its association with recurrence and survival, pain within the first year of treatment for head and neck cancer is an important symptom that should be appropriately monitored and managed during routine follow-up.