Supportive Care in Cancer

, Volume 27, Issue 5, pp 1663–1672 | Cite as

Patients with head and neck cancer may need more intensive pain management to maintain daily functioning: a multi-center study

  • Shih-Feng Cho
  • Kun-Ming Rau
  • Yu-Yun Shao
  • Chia-Jui Yen
  • Ming-Fang Wu
  • Jen-Shi Chen
  • Cheng-Shyong Chang
  • Su-Peng Yeh
  • Tzeon-Jye Chiou
  • Ruey-Kuen Hsieh
  • Ming-Yang Lee
  • Yung-Chuan Sung
  • Kuan-Der Lee
  • Pang-Yu Lai
  • Ming-Sun Yu
  • Wen-Li Hwang
  • Ta-Chih LiuEmail author
Original Article



The purpose of this study is to investigate the prevalence of pain, pain management, and impact of recent pain on daily functioning in patients with head and neck cancer (HNC) and patients with other cancers.


This multi-center survey was conducted by using Brief Pain Inventory questionnaire to evaluate pain status and its impact on daily functioning.


A total of 3289 patients were analyzed including 708 HNC patients and 2581 patients with other cancers. The overall pain prevalence was 69.17%. A higher percentage of HNC patients had recent pain (60.59 vs. 44.01%, P < 0.001), required pain management (86.29 vs. 72.03%, P < 0.001), and used any analgesics (53.81 vs. 34.52%, P < 0.001). HNC patients with pain management had a higher prevalence of recent pain (85.83 vs. 81.14%, P = 0.044) and a slightly lower satisfaction rate (74.00 vs. 79.70%, P = 0.070). Regarding the impact of pain on daily functioning, HNC patients had a lower mean interference score for general activity such as walking, normal work, sleep, and life enjoyment.


The HNC patients may need more intensive pain management to achieve optimal pain control and maintain daily functioning.


Head and neck cancer Prevalence of pain Pain management Daily functioning Multi-center study 



This work was supported by the Taiwan Cancer Palliative Care Society and by Janssen Pharmaceuticals, Taiwan. Editorial support in the form of copyediting and manuscript formatting was provided by Cactus Communications and funded by Janssen Taiwan. This study was also supported by a grant from Kaohsiung Medical University Hospital (KMUH103-3M11).

Author contributions

S.F.C. and T.C.L. designed the study.

K.M.R., Y.Y.S., C.J.Y., M.F.W., J.S.C., C.S.C., Y.M.L., T.J.C., R.K.H., M.Y.L., Y.C.S., K.D.L., P.Y.L., M.S.Y., W.L.H., and T.C.L. collected clinical data.

S.F.C. and T.C.L. conducted the database interpretation and statistical analysis.

S.F.C. wrote the manuscript.

T.C.L. approved of the last version of the manuscript.

All the authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest statement

We have read and understood the policy of Supportive Care in Cancer on disclosing conflicts of interest. The authors of this manuscript do not have any financial relationship with the organization that sponsored the research. The authors have full control of all primary data and agree to allow the journal to review study-related data if requested.

Supplementary material

520_2018_4404_MOESM1_ESM.doc (60 kb)
ESM 1 (DOC 60 kb)


  1. 1.
    Blank FS, Mader TJ, Wolfe J, Keyes M, Kirschner R, Provost D (2001) Adequacy of pain assessment and pain relief and correlation of patient satisfaction in 68 ED fast-track patients. J Emerg Nurs 27:327–334CrossRefGoogle Scholar
  2. 2.
    Bozimowski G (2012) Patient perceptions of pain management therapy: a comparison of real-time assessment of patient education and satisfaction and registered nurse perceptions pain. Manag Nurs 13:186–193Google Scholar
  3. 3.
    Bradley PJ (2012) Multidisciplinary clinical approach to the management of head and neck cancer. Eur Arch Otorhinolaryngol 269:2451–2454CrossRefGoogle Scholar
  4. 4.
    Brana I, Siu LL (2012) Locally advanced head and neck squamous cell cancer: treatment choice based on risk factors and optimizing drug prescription. Ann Oncol 23(Suppl 10):x178–x185CrossRefGoogle Scholar
  5. 5.
    Breivik H, Cherny N, Collett B, de Conno F, Filbet M, Foubert AJ, Cohen R, Dow L (2009) Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol 20:1420–1433CrossRefGoogle Scholar
  6. 6.
    Burton AW, Fanciullo GJ, Beasley RD, Fisch MJ (2007) Chronic pain in the cancer survivor: a new frontier. Pain Med 8:189–198CrossRefGoogle Scholar
  7. 7.
    Chaplin JM, Morton RP (1999) A prospective, longitudinal study of pain in head and neck cancer patients. Head Neck 21:531–537CrossRefGoogle Scholar
  8. 8.
    Chen YJ, Chang JT, Liao CT, Wang HM, Yen TC, Chiu CC, Lu YC, Li HF, Cheng AJ (2008) Head and neck cancer in the betel quid chewing area: recent advances in molecular carcinogenesis. Cancer Sci 99:1507–1514CrossRefGoogle Scholar
  9. 9.
    Chiang CY, Chang HY (2016) A population study on the time trend of cigarette smoking, cessation, and exposure to secondhand smoking from 2001 to 2013 in Taiwan. Popul Health Metrics 14:38CrossRefGoogle Scholar
  10. 10.
    Chua KS, Reddy SK, Lee MC, Patt RB (1999) Pain and loss of function in head and neck cancer survivors. J Pain Symptom Manag 18:193–202CrossRefGoogle Scholar
  11. 11.
    Daut RL, Cleeland CS, Flanery RC (1983) Development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases. Pain 17:197–210CrossRefGoogle Scholar
  12. 12.
    De Sanctis V, Bossi P, Sanguineti G, Trippa F, Ferrari D, Bacigalupo A, Ripamonti CI, Buglione M, Pergolizzi S, Langendjik JA, Murphy B, Raber-Durlacher J, Russi EG, Lalla RV (2016) Mucositis in head and neck cancer patients treated with radiotherapy and systemic therapies: literature review and consensus statements. Crit Rev Oncol Hematol 100:147–166CrossRefGoogle Scholar
  13. 13.
    Deandrea S, Montanari M, Moja L, Apolone G (2008) Prevalence of undertreatment in cancer pain. A review of published literature. Ann Oncol 19:1985–1991CrossRefGoogle Scholar
  14. 14.
    van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J (2007) Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol 18:1437–1449CrossRefGoogle Scholar
  15. 15.
    van der Peet EH, van den Beuken-van Everdingen MH, Patijn J, Schouten HC, van Kleef M, Courtens AM (2009) Randomized clinical trial of an intensive nursing-based pain education program for cancer outpatients suffering from pain. Support Care Cancer 17:1089–1099CrossRefGoogle Scholar
  16. 16.
    Epstein JB, Wilkie DJ, Fischer DJ, Kim YO, Villines D (2009) Neuropathic and nociceptive pain in head and neck cancer patients receiving radiation therapy. Head Neck Oncol 1:26CrossRefGoogle Scholar
  17. 17.
    Ferlito A, Shaha AR, Silver CE, Rinaldo A, Mondin V (2001) Incidence and sites of distant metastases from head and neck cancer. ORL J Otorhinolaryngol Relat Spec 63:202–207CrossRefGoogle Scholar
  18. 18.
    Greco MT, Roberto A, Corli O, Deandrea S, Bandieri E, Cavuto S, Apolone G (2014) Quality of cancer pain management: an update of a systematic review of undertreatment of patients with cancer. J Clin Oncol 32:4149–4154CrossRefGoogle Scholar
  19. 19.
    Grond S, Zech D, Diefenbach C, Radbruch L, Lehmann KA (1996) Assessment of cancer pain: a prospective evaluation in 2266 cancer patients referred to a pain service. Pain 64:107–114CrossRefGoogle Scholar
  20. 20.
    Huang CH, Chu ST, Ger LP, Hou YY, Sun CP (2007) Clinicopathologic evaluation of prognostic factors for squamous cell carcinoma of the buccal mucosa. J Chin Med Assoc 70:164–170CrossRefGoogle Scholar
  21. 21.
    Jadad AR, Browman GP (1995) The WHO analgesic ladder for cancer pain management. Stepping up the quality of its evaluation. Jama 274:1870–1873CrossRefGoogle Scholar
  22. 22.
    Keefe FJ, Manuel G, Brantley A, Crisson J (1986) Pain in the head and neck cancer patient: changes over treatment. Head Neck Surg 8:169–176CrossRefGoogle Scholar
  23. 23.
    Liao CM, Lin CM (2015) Geographical inequalities in alcohol-related mortality rates in Taiwan due to socio-demographic differences. Alcohol Alcohol 50:558–564CrossRefGoogle Scholar
  24. 24.
    Licitra L, Keilholz U, Tahara M, Lin JC, Chomette P, Ceruse P, Harrington K, Mesia R (2016) Evaluation of the benefit and use of multidisciplinary teams in the treatment of head and neck cancer. Oral Oncol 59:73–79CrossRefGoogle Scholar
  25. 25.
    Lo WL, Kao SY, Chi LY, Wong YK, Chang RC (2003) Outcomes of oral squamous cell carcinoma in Taiwan after surgical therapy: factors affecting survival. J Oral Maxillofac Surg 61:751–758CrossRefGoogle Scholar
  26. 26.
    Macfarlane TV, Wirth T, Ranasinghe S, Ah-See KW, Renny N, Hurman D (2012) Head and neck cancer pain: systematic review of prevalence and associated factors. J Oral Maxillofac Res 3:e1CrossRefGoogle Scholar
  27. 27.
    Mantyh PW (2006) Cancer pain and its impact on diagnosis, survival and quality of life. Nat Rev Neurosci 7:797–809CrossRefGoogle Scholar
  28. 28.
    Marquie L, Raufaste E, Lauque D, Marine C, Ecoiffier M, Sorum P (2003) Pain rating by patients and physicians: evidence of systematic pain miscalibration. Pain 102:289–296CrossRefGoogle Scholar
  29. 29.
    McCaul LK (2012) Oral and dental management for head and neck cancer patients treated by chemotherapy and radiotherapy. Dental Update 39:135–138 140CrossRefGoogle Scholar
  30. 30.
    Merino OR, Lindberg RD, Fletcher GH (1977) An analysis of distant metastases from squamous cell carcinoma of the upper respiratory and digestive tracts. Cancer 40:145–151CrossRefGoogle Scholar
  31. 31.
    Ohrn KE, Sjoden PO, Wahlin YB, Elf M (2001) Oral health and quality of life among patients with head and neck cancer or haematological malignancies. Support Care Cancer 9:528–538CrossRefGoogle Scholar
  32. 32.
    Rose-Ped AM, Bellm LA, Epstein JB, Trotti A, Gwede C, Fuchs HJ (2002) Complications of radiation therapy for head and neck cancers. The patient’s perspective. Cancer Nurs 25:461–467 quiz 468-469CrossRefGoogle Scholar
  33. 33.
    Saxena A, Gnanasekaran N, Andley M (1995) An epidemiological study of prevalence of pain in head & neck cancers. Indian J Med Res 102:28–33Google Scholar
  34. 34.
    Sroussi HY, Epstein JB, Bensadoun RJ, Saunders DP, Lalla RV, Migliorati CA, Heaivilin N, Zumsteg ZS (2017) Common oral complications of head and neck cancer radiation therapy: mucositis, infections, saliva change, fibrosis, sensory dysfunctions, dental caries, periodontal disease, and osteoradionecrosis. Cancer Med 6:2918–2931CrossRefGoogle Scholar
  35. 35.
    Sutherland JE, Wesley RM, Cole PM, Nesvacil LJ, Daly ML, Gepner GJ (1988) Differences and similarities between patient and physician perceptions of patient pain. Fam Med 20:343–346Google Scholar
  36. 36.
    Vokes EE, Weichselbaum RR, Lippman SM, Hong WK (1993) Head and neck cancer. N Engl J Med 328:184–194CrossRefGoogle Scholar
  37. 37.
    Wagner CL, Baggerly C, McDonnell S, Baggerly KA, French CB, Baggerly L, Hamilton SA, Hollis BW (2016) Post-hoc analysis of vitamin D status and reduced risk of preterm birth in two vitamin D pregnancy cohorts compared with South Carolina March of Dimes 2009–2011 rates. J Steroid Biochem Mol Biol 155:245–251CrossRefGoogle Scholar
  38. 38.
    Williams JE, Peacock J, Gubbay AN, Kuo PY, Ellard R, Gupta R, Riley J, Sauzet O, Raftery J, Yao G, Ross J (2015) Routine screening for pain combined with a pain treatment protocol in head and neck cancer: a randomised controlled trial. Br J Anaesth 115:621–628CrossRefGoogle Scholar
  39. 39.
    de Wit R, van Dam F, Loonstra S, Zandbelt L, van Buuren A, van der Heijden K, Leenhouts G, Duivenvoorden H, Huijer Abu-Saad H (2001) Improving the quality of pain treatment by a tailored pain education programme for cancer patients in chronic pain. Eur J Pain 5:241–256CrossRefGoogle Scholar
  40. 40.
    Wong ES, Wang BC, Garrison LP, Alfonso-Cristancho R, Flum DR, Arterburn DE, Sullivan SD (2011) Examining the BMI–mortality relationship using fractional polynomials. BMC Med Res Methodol 11:175CrossRefGoogle Scholar
  41. 41.
    Zelman DC, Dukes E, Brandenburg N, Bostrom A, Gore M (2005) Identification of cut-points for mild, moderate and severe pain due to diabetic peripheral neuropathy. Pain 115:29–36CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Shih-Feng Cho
    • 1
    • 2
  • Kun-Ming Rau
    • 3
    • 4
  • Yu-Yun Shao
    • 5
  • Chia-Jui Yen
    • 6
  • Ming-Fang Wu
    • 7
    • 8
  • Jen-Shi Chen
    • 9
    • 4
  • Cheng-Shyong Chang
    • 10
  • Su-Peng Yeh
    • 11
  • Tzeon-Jye Chiou
    • 12
    • 13
  • Ruey-Kuen Hsieh
    • 14
  • Ming-Yang Lee
    • 15
  • Yung-Chuan Sung
    • 16
    • 17
  • Kuan-Der Lee
    • 18
  • Pang-Yu Lai
    • 19
  • Ming-Sun Yu
    • 20
  • Wen-Li Hwang
    • 21
  • Ta-Chih Liu
    • 1
    Email author
  1. 1.Division of Hematology and Oncology, Department of Internal MedicineKaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiungTaiwan
  2. 2.Faculty of Medicine, College of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
  3. 3.Division of Oncology, Department of Internal MedicineKaohsiung Chang Gung Memorial HospitalKaohsiungTaiwan
  4. 4.College of Medicine, Chang Gung UniversityTaoyuanTaiwan
  5. 5.Department of OncologyNational Taiwan University HospitalTaipeiTaiwan
  6. 6.Division of Hematology and Oncology, Department of Internal MedicineNational Cheng Kung University HospitalTainanTaiwan
  7. 7.School of MedicineChung Shan Medical UniversityTaichungTaiwan
  8. 8.Division of Medical OncologyChung Shan Medical University HospitalTaichungTaiwan
  9. 9.Division of Medical Oncology in the Hematology and Oncology, Department of Internal Medicine,Linkou Chang Gung Memorial HospitalTaoyuanTaiwan
  10. 10.Department of Internal MedicineChanghua Christian HospitalChanghuaTaiwan
  11. 11.Division of Hematology and Oncology, Department of Internal MedicineChina Medical University HospitalTaichungTaiwan
  12. 12.Division of Transfusion Medicine, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan
  13. 13.School of Medicine, National Yang-Ming UniversityTaipeiTaiwan
  14. 14.Division of Hematology and Oncology, Department of Internal MedicineMackay Memorial HospitalTaipeiTaiwan
  15. 15.School of Medicine, College of Medicine, Fu-Jen Catholic UniversityNew Taipei CityTaiwan
  16. 16.Department of OncologyDitmanson Medical Foundation Chia-Yi Christian HospitalChiayiTaiwan
  17. 17.Division of Hematology-Oncology, Department of Internal MedicineCathay General HospitalTaipeiTaiwan
  18. 18.Division of Hematology and Oncology, Department of Internal MedicineChang Gung Memorial HospitalChia-yiTaiwan
  19. 19.Division of Hematology and OncologyE-DA HospitalKaohsiungTaiwan
  20. 20.Division of Hematology and Oncology, Department of Internal MedicineKaohsiung Veterans General HospitalKaohsiungTaiwan
  21. 21.Division of Hematology/Medical Oncology, Department of MedicineTaichung Veterans General HospitalTaichungTaiwan

Personalised recommendations