Advertisement

Supportive Care in Cancer

, Volume 25, Issue 12, pp 3759–3767 | Cite as

Multicenter, cross-sectional observational study of the impact of neuropathic pain on quality of life in cancer patients

  • So Yeon Oh
  • Sang Won Shin
  • Su-Jin Koh
  • Sang Byung Bae
  • Hyun Chang
  • Jung Han Kim
  • Hyo Jung Kim
  • Young Seon Hong
  • Keon Uk Park
  • Jeanno Park
  • Kyung Hee Lee
  • Na Ri Lee
  • Jung Lim Lee
  • Joung Soon Jang
  • Dae Sik Hong
  • Seung-Sei Lee
  • Sun Kyung Baek
  • Dae Ro Choi
  • Jooseop Chung
  • Sang Cheul Oh
  • Hye Sook Han
  • Hwan Jung Yun
  • Sun Jin Sym
  • So Young Yoon
  • In Sil Choi
  • Byoung Yong Shim
  • Seok Yun Kang
  • Sung Rok Kim
  • Hyun Joo Kim
Open Access
Original Article

Abstract

Purpose

Neuropathic cancer pain (NCP) is a common and potentially debilitating symptom in cancer patients. We investigated the prevalence of NCP, as well as its management and association with QOL.

Methods

Cancer patients with pain ≥1 on the visual analogue scale (VAS) were surveyed with the Douleur Neuropathique (DN4) questionnaire, the Brief Pain Inventory-Short Form (BPI-SF), and the EuroQOL five dimensions (EQ-5D) questionnaire. The associations between NCP and pain severity or NCP and QOL, while controlling for variables relevant to QOL, were then analyzed.

Results

A total of 2003 patients were enrolled in this survey; the prevalence of NCP was 36.0% (n = 722, 95% CI, 32.5–39.5). We found that NCP in cancer patients was closely correlated to a higher pain severity (BPI-SF; 4.96 ± 1.94 versus 4.24 ± 2.02, p < 0.001), and in patients with NCP, pain more severely interfered with daily living, as compared to those without NCP (BPI-SF; 4.86 ± 2.71 versus 4.41 ± 2.87, p < 0.001). Patients with NCP also had worse QOL than those without NCP, as measured by EQ-5D index score (0.47 ± 0.30 vs. 0.51 ± 0.30, p = 0.005), and this was confirmed using multivariate analysis (p < 0.001), even after controlling for other variables such as age, sex, disease stage, cancer duration, radiotherapy, chemotherapy, and comorbidities. Importantly, adjuvant analgesics were used in less than half of patients with NCP (n = 358, 46.4%).

Conclusions

We found that NCP in cancer patients was significantly associated with a worsened QOL, and current management is inadequate. Therefore, future research aimed at developing improved strategies for management of NCP is required.

Keywords

Neuropathic pain Quality of life Neoplasm Pain management 

Introduction

Pain has been recognized as a key symptom in various types of cancer, and it is the most common symptom leading to a cancer diagnosis (in about 30% of patients) [1]. Although recent guidelines have emphasized the treatment of pain in cancer patients, it remains undertreated [2, 3]. It has also been found that cancer patients with pain have significantly lower levels of performance status and higher levels of anger, fatigue, depression, confusion, and lethargy, as compared to those cancer patients who did not experience pain, even after accounting for disease stage [4].

Neuropathic pain may adversely affect quality of life (QOL) in cancer patients and could also increase care difficulty [5, 6]. Previous studies have investigated the impact of NCP on QOL [6, 7, 8, 9]. But these mostly focused on chemotherapy-induced peripheral neuropathy (CIPN) alone in specific disease conditions. NCP is particularly important to diagnose because distinct treatment strategies are required that differ from those needed for nociceptive pain [10, 11, 12]. Critically, the features associated with NCP, including, but not limited to CIPN, especially among cancer patients, are poorly understood. To obtain a comprehensive insightful overview of NCP in cancer patients, it will be necessary to investigate the characteristics of a large group of general cancer patients with NCP, including those in all stages of disease, regardless of the treatments they have received.

This study was performed on behalf of Korean Cancer Study Group Neuropathic Cancer Pain Survey and was designed to assess the current status of NCP in cancer patients. We aimed to accomplish three main objectives: (i) determine the prevalence and associated characteristics of NCP in patients with cancer pain, (ii) identify the current patterns of management for NCP, and (iii) assess the association of NCP with QOL. We found that NCP was associated with a lower QOL in cancer patients, even after controlling for other potentially confounding variables, and it also remains undertreated, highlighting the need for improved pain management strategies.

Methods

Study design

This observational study is non-interventional, multicenter, and cross-sectional. The study was performed between February 2013 and March 2014 in the oncology clinic of 28 general hospitals, representing the general cancer patient population in the Republic of Korea. The first step of the study procedure was to interview and screen individual patients by medical personnel. Informed consent was then obtained from all eligible patients. Patients who signed the consent were next asked to complete a survey questionnaire about pain and QOL. Physicians evaluated the patients to determine the presence of neuropathic pain, and both demographic and clinical information was retrieved from the medical records. Lastly, the questionnaires and case report forms were collected, and the study data were analyzed. Central institutional review board (IRB) of Korean Cancer Study Group (KCSG) approved this study (study ID: KCSG PC13-02). After central approval, institutional approval was obtained again by every institution of the participating investigators.

Patients

A total of 2003 patients were enrolled in the survey. Inclusion criteria were patients who (1) were aged 20 years or older, (2) were diagnosed with cancer, (3) had pain with a visual analogue scale (VAS) measurement of one or higher, and (4) could understand and sign the informed consent. Patients were excluded if they had pain that is unrelated to cancer as per a physician’s discretion.

Data collection and measurement

Clinical information potentially related to pain or neuropathic pain, including past medical histories, were collected from patient medical records. Current pain control status was evaluated by reviewing all drugs administered during the preceding 6 weeks. The presence of neuropathic pain was determined using the DN4 questionnaire where a total score of 4 or higher was defined as NCP in this study. The questionnaire consists of 10 items, 7 items related to pain quality which are based on an interview with the patient, and 3 items which are based on the clinical examination. A score of 1 is given to each positive item and a score of 0 to each negative item. The total score is calculated as the sum of all 10 items, and the cutoff value for the diagnosis of neuropathic pain is a total score of 4 out of 10 [13]. Pain characteristics were further evaluated using the Brief Pain Inventory-Short Form (BPI-SF) [14], Korean version [15]. BPI-SF is a self-administered questionnaire used to evaluate pain on its severity and its impact on the patient’s daily functioning. Items in the pain severity evaluate the pain “at its worst,” “at its least,” and “on average” over the previous 24 h, as well as pain at the time of completing the questionnaire. On the other hand, the pain interference scale asks the patient to rate how their pain interferes with their enjoyment of life, general activity, walking ability, mood, sleep, normal work, and relationships with other people. Patients respond on a 0 to 10 numerical scale where higher scores indicate higher level of pain and interference [14, 15]. Health-related QOL was measured using the Korean version of the EuroQOL five dimensions (EQ-5D) and the EQ-5D visual analogue scale (VAS) [16, 17, 18]. The EQ-5D index score consisted of five metrics, including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, with three grades of severity for each item. The EQ-5D index score ranges from 0 to 1, with larger values indicating a better QOL. The EQ-5D VAS is simple thermometer-like bar scale, in which a patient can draw a line between 0 (worst) and 100 (best) indicating his or her overall condition, which is a gross self-assessment of general health status of the day that the survey is administered.

Statistical analyses

We estimated a target sample size based on the assumption that the prevalence of neuropathic pain is 30% [19]. With a significance level of 0.05 and an estimated error rate of 2%, the required number of patients to be enrolled was calculated to be about 2000:
$$ n= p\left(1- p\right){\left(\frac{za/2}{d}\right)}^2,\kern0.5em p=0.3,\kern0.5em Za/2=1.96\kern0.5em \mathrm{when}\kern0.5em a=0.05,\kern0.5em d=0.02. $$
For the data analysis, descriptive statistics were performed to determine the demographic and clinical characteristics of patients (Table 1). A Student’s t test was performed to compare the mean differences in pain level and QOL between the NCP and non-NCP groups (Tables 2 and 4). Univariate regression analyses were performed to explore the factors associated with QOL (EQ5D) (Table 3). Using the determinants that were significantly (p value < 0.05) associated with EQ5D in this univariate analysis, we performed multiple regression analysis. To determine if there were any interactions between two independent variables, we performed multiple regression analysis including sex (p value 0.338), other statistically significant (p value < 0.05) variables, and potential interaction terms. Among all multiple regression models, we selected the model with the smallest Akaike information criterion value. All statistical analyses were performed using IBM SPSS Statistics 20.0 (IBM Corporation, NY, USA).
Table 1

Characteristics of study participants

Patient data

Total n = 2003

n (%)

Gender

 Male

1089 (54.4)

 Female

914 (45.6)

Age, median (range)

61.0 (21–94)

Time from diagnosis of cancer (months), median (range)

13.0 (1–336)

Stage

 1

46 (2.3)

 2

103 (5.1)

 3

250 (12.5)

 4

1428 (71.3)

 Unknown

176 (8.8)

Comorbidities and historya, b

 Diabetes

309 (15.4)

 Liver cirrhosis

44 (2.2)

 Traumatic injury

43 (2.1)

 Herpes zoster

41 (2.0)

Management of paina

 Opioid analgesics

1313 (65.6)

 Non-opioid analgesics

748 (37.3)

 Anticonvulsants

464 (23.2)

 Antidepressants

134 (6.7)

 Corticosteroids

91 (4.5)

 Benzodiazepines

68 (3.4)

 Others

48 (2.4)

 None as analgesic

257 (12.8)

Experienced treatmenta

 Chemotherapy

1753 (87.5)

 Surgery

799 (39.9)

 Radiation

602 (30.1)

 None

220 (11.0)

Chemotherapeutic agentsa, c

 Alkylating agents

1209 (60.4)

 Taxanes

485 (24.2)

 Vinca alkaloids

150 (7.5)

 Others

1500 (74.9)

Primary and metastatic sites of cancera

 Gastrointestinal tract

982 (49.0)

 Respiratory system

490 (24.5)

 Skins, bones, connective tissue

288 (14.4)

 Lymphatic-hematopoietic system

272 (13.6)

 Genitourinary system

269 (13.4)

 Breast

221 (11.0)

 Head and neck region

188 (9.4)

 Others/multiple primary

70 (3.5)

 Unknown

6 (0.3)

aPermitted overlap

bComorbidities with incidence of less than 2% were not presented in this table

c N = 1751 (missing N = 2, those who did not select type of chemotherapeutic agents were excluded). Others include antimetabolites, topoisomerase inhibitors, cytotoxic antibiotics, etc.

Table 2

Pain and QOL scores in patients with and without NCP

Mean ± SD

Total (n = 2003)

NCP (n = 722)

Non-NCP (n = 1281)

p a

Pain VAS at screening

4.37 ± 2.27

4.90 ± 2.27

4.08 ± 2.01

<0.001

Pain Severity from BPI-SF

4.50 ± 2.02

4.96 ± 1.94

4.24 ± 2.02

<0.001

Pain Interference score from BPI-SF

4.57 ± 2.82

4.86 ± 2.71

4.41 ± 2.87

<0.001

EQ-5D index score

0.49 ± 0.30

0.47 ± 0.30

0.51 ± 0.30

0.005

EQ-5D VAS

57.42 ± 30.48

56.53 ± 21.42

57.92 ± 34.55

0.327

SD standard deviation, NCP neuropathic cancer pain, VAS visual analogue scale

a p value by Student’s t test

Table 3

Univariate and multivariate analyses of factors associated with QOL (EQ-5D index score)

 

Univariate analysis

Multivariate analysis

B a

p a

B b

p b

Sex, male (female)c

0.013

0.338

0.026

0.067

Age, ≥60 (<60)

−0.065

<0.001

−0.055

0.000

Duration of cancer, ≥13 months (<13 months)

−0.033

0.015

−0.024

0.102

Stage, IV (stages I–III)

−0.110

<0.001

−0.102

0.000

Chemotherapy, done (never done)

0.116

<0.001

0.069

0.000

Radiotherapy, done (never done)

−0.048

0.001

−0.050

0.001

Surgery, done (never done)

0.020

0.137

  

Comorbidities, present (none)

−0.085

<0.001

−0.072

0.000

Diagnosis of NCP, DN4 ≥ 4 (DN4 < 4)

−0.039

0.005

−0.053

0.000

NCP-targeted therapy, present (none)

−0.012

0.421

  

aBy regression analysis

bBy multiple regression analysis, R 2 = 0.065

cReference variables are in parenthesis

Results

Patient characteristics

Demographic and clinical characteristics of all patients are presented in Table 1. The majority of patients had advanced-stage cancer (71.3%) and had or were receiving chemotherapy (87.5%). Among comorbidities, the prevalence of diabetes (15.4%) appeared to be the highest among our study population. Other comorbidities relevant to neuropathic pain were rare. For management of pain, opioid analgesics were most commonly used among all patients (65.6%), followed by non-opioid analgesics (37.3%) and anticonvulsants (23.2%).

Prevalence and management of neuropathic pain

NCP was present in 722 out of the 2003 patients surveyed, and thus the prevalence of NCP was found to be 36.0% (95% CI, 32.5–39.5). Among the patients diagnosed with NCP (N = 722), in most cases, it was associated with chemotherapy; 668 patients (92.5%) had received or were receiving chemotherapy, while 54 patients (7.5%) had never received chemotherapy. The prevalence of NCP was significantly higher among patients who had received or were receiving chemotherapy (n = 1753) compared to its prevalence of those who have never received chemotherapy (n = 250) (38.1 versus 21.6%, p < 0.001, Supplementary Appendix Table 1). Patients with moderate to severe pain (VAS ≥ 4, n = 497) had a higher prevalence of NCP than those with mild pain (n = 225) (42.4 vs. 27.1%) (Fig. 1). However, fewer than half of the patients with both moderate to severe pain and NCP were being treated with adjuvant analgesics targeting the NCP (n = 358, 49.6%) (Fig. 1), although these were more frequently prescribed in this group than to those without NCP (23.0%) (p < 0.001 by χ 2 test, details in Supplementary Appendix Fig. 1).
Fig. 1

Prevalence of NCP according to pain intensity. NCP was more prevalent in patients with moderate to severe pain than in those with mild cancer pain (comparison between double-lined boxes; p < 0.001 by χ 2 test). Among patients having pain with a severity of VAS ≥4, less than half were treated with adjuvant analgesics targeting NCP (lower boxes). Treatment with adjuvant analgesics targeting NCP was defined as the administration of antidepressants, anticonvulsants, corticosteroids, benzodiazepines, and with or without opioid or non-opioid analgesics

Prevalence and management of cancer pain

More than half of the patients (n = 1173, 58.6%) had moderate to severe pain (VAS ≥ 4), implying that cancer pain was not being adequately managed. Contrary to NCP, the portion of severe pain was significantly higher among patients who have never received chemotherapy (n = 250) compared to those had received or were receiving chemotherapy (n = 1753) (p = 0.010, Supplementary Appendix Table 1). Pharmacologic management for the pain was presented at Table 1. Even though all patients participating in this study were those who reported some degree of cancer pain, still 12.8% (n = 257) of the total patients were not prescribed any analgesic. When comparing pain treatment patterns in patients with or without NCP, we found that anticonvulsants, antidepressants, and benzodiazepines were more commonly used in patients with NCP then patients without NCP, whereas opioids, non-opioids, and corticosteroids were more commonly used in patients without NCP.

NCP association with pain severity and QOL

The pain severity score from the BPI-SF was measured in all patients; however, the pain interference score could not be measured in two patients. All patients answered the EQ-5D VAS, but six did not complete the EQ-5D index score questionnaire. Table 2 shows the differences in the mean pain and QOL scores in those with or without NCP. Patients with NCP had higher pain severity scores (p < 0.001) and higher pain interference scores (p < 0.001) in their daily living, than those without NCP. The QOL, as measured by the EQ-5D index score, was significantly worse in patients with NCP, than in those without NCP (p = 0.005). When analyzed by subscales of the EQ-5D, patients with NCP had a greater number of extreme problems than those without NCP in both the pain/discomfort and the anxiety/depression domain (p < 0.001 and p = 0.007, respectively). Proportion distributions by each level of mobility, self-care, and usual activities domains were not significantly different between patients with and without NCP (Supplementary Appendix Table 2).

Factors associated with QOL

We analyzed demographic and clinical factors potentially affecting the EQ-5D index score and found that younger age (p < 0.001), shorter duration of cancer (p = 0.015), absence of comorbidities (p < 0.001), and absence of neuropathic pain (p = 0.005) were associated with better QOL scores in our univariate analysis. Conversely, patients with stage IV cancers (p < 0.001), those who never received chemotherapy (p < 0.001), or those who underwent radiotherapy (p < 0.001) had worse QOL status (Table 3). Even after a multivariate analysis, a diagnosis of NCP was among the factors that significantly affected QOL (p < 0.001); EQ-5D index score was 0.442 in patients with NCP and 0.497 in patients without NCP (p < 0.001), after adjusting for other variables.

The effect of adjuvant analgesics targeting NCP on pain and QOL

We investigated the mean pain and QOL score differences in patients receiving adjuvant analgesics targeting NCP and in those who did not. We found that patients with NCP who were managed with adjuvant analgesics had less interference with their daily living (p = 0.041) and had a better QOL (by EQ-5D VAS score) (p = 0.043) (Table 4). If we again examine the details of the EQ-5D index score, a smaller proportion of patients having extreme problems were observed in the group receiving adjuvant analgesics, as compared to the group that were not receiving adjuvant analgesics in the mobility, self-care, and usual activities domains (p = 0.028, 0.031, and 0.005, respectively, linear-by-linear association). Proportion distributions in the pain/discomfort and anxiety/depression domains were not significantly different between the two groups (Supplementary Appendix Table 3).
Table 4

Comparison of pain and QOL scales in patients diagnosed with NCP, with and without adjuvant analgesics targeting NCP

Mean ± SD

Total (n = 772)

p a

With adjuvant analgesics targeting NCP (n = 358)

Without adjuvant analgesics targeting NCP (n = 364)

Pain VAS at screening

4.82 ± 2.25

4.98 ± 2.29

0.372

Pain Severity from BPI-SF

4.88 ± 1.95

5.04 ± 1.93

0.262

Pain Interference score from BPI-SF

4.66 ± 2.63

5.07 ± 2.78

0.041

EQ-5D index score

0.49 ± 0.28

0.45 ± 0.31

0.090

EQ-5D VAS

58.15 ± 19.77

54.93 ± 22.84

0.043

SD standard deviation, NCP neuropathic cancer pain

a p value by Student’s t test

Discussion

In this study, we clearly found that patients with NCP have a worse QOL than those without NCP. This difference is statistically significant, even after controlling for other variables affecting QOL. In addition to NCP, older age, advanced cancer stage, never having received chemotherapy, have received radiotherapy, and presence of comorbidities were associated with low QOL scores. This is particularly meaningful, as we included patients who never received chemotherapy in our survey.

To the best of our knowledge, this is the first study that clearly demonstrates the relationship between NCP and QOL in a population of cancer patients encompassing a broad array of conditions. Apart from studies on CIPN, those that directly assessed QOL differences in various cancer patients with or without NCP are rare. As we expected, we observed that regardless of receiving chemotherapy or not, diagnosis of NCP was a significant factor that lowered patients QOL. Our study population consisted mainly of incurable advanced-stage cancer patients, as well as patients undergoing treatment and cancer survivors. By doing this, we tried to obtain a global perspective of the general features of neuropathic pain in cancer patients and clarify its association with QOL.

One recently published study showed that neuropathic symptoms, such as numbness and tingling, are associated with poor QOL [6]. However, this study focused on CIPN in patients receiving chemotherapy. There are many additional studies that have examined the relationship between CIPN and QOL, and the negative association between the two is well-established. According to a recent systematic review [20], out of 11 studies that assessed the relationship between CIPN and QOL, eight showed a correlation between CIPN and worsened QOL [8, 21, 22, 23, 24, 25, 26]. The remaining three studies did not find an association between CIPN and QOL. Among those eight studies that reported an association between CIPN and a lower QOL, one recent large-scale study showed that out of 1643 colorectal cancer survivors, those who reported to have a greater number of neuropathy symptoms (upper 10%) had a statistically significantly worse QOL, as compared to those with fewer neuropathy symptoms (lower 90%) [8]. Other studies demonstrated the association of CIPN and worse QOL in patients with colorectal cancer [7], lung cancer [21], lymphoma [24], ovarian cancer [26], and various solid tumors [23].

In this study, neuropathic cancer pain was diagnosed in 722 patients, out of 2003 patients surveyed, and the estimated prevalence was 36%. This was similar to result from recent systematic review reporting that the prevalence of pain with neuropathic component was 39.1% (95% CI, 28.9%–49.5%) [27]. More recently, a European survey estimated an occurrence rate of 32.6% (95% CI, 29.62–35.58) for cancer-related neuropathic pain among cancer patients having chronic pain [28].

The etiology of NCP has not been fully defined. Although according to a systematic review [27], only 20.3% of cases were attributed to cancer treatment, a recently published study suggests that a larger portion of neuropathic pain originates from anticancer treatment (68.9% tumor-related, 42.9% treatment-related) [29]. In our present study, most patients with NCP had received, or had been receiving chemotherapy (87.5%), implying that a larger portion of NCP may be caused by anticancer treatments than previously known.

Although it is recommended that anticonvulsants or antidepressants are used in combination with opioid analgesics for management of NCP [30, 31, 32], we found that adjuvant analgesics, such as anticonvulsants, antidepressants, corticosteroids, benzodiazepines, or phenothiazines, were rarely used for the purpose of pain control in our study population. Less than half of patients with NCP were prescribed adjuvant analgesics, along with opioids or non-opioid analgesics. This proportion is not increased, even in patients experiencing moderate-to-severe pain and NCP, and this suggests that physicians should pay increased attention to pain in their cancer patients.

Our study has several limitations. First, in spite of the clear association between NCP and worsened QOL, we could not confirm a causal relationship between NCP and QOL, due to our cross-sectional study design. Additionally, although there was a statistical significance between NCP and non-NCP patients, the QOL difference was relatively small. Second, the population included in this study was heterogeneous; we enrolled patients who were receiving anticancer treatments, those who were under palliative care after finishing chemotherapy, and those who never underwent chemotherapy. This is what distinguishes our study from the other studies, which mostly focuses on CIPN in patients receiving a specific chemotherapy regimen. Such heterogeneity may attenuate or potentiate the association between NCP and QOL. By virtue of this heterogeneity however, this study can provide a general overview of the neuropathic pain in the cancer patients until more evidence on NCP etiology is available. Third, due to our cross-sectional study design, patients having a DN4 score <4 included both of patients who had never had NCP and those who may have experienced NCP but its symptoms were improved after management. From our study results, it is impossible to distinguish the two. Fourth, cutoff for poorly controlled pain was NRS score of 4, which was arbitrarily decided by the investigators instead of reflecting patients’ personalized pain goal. And because we included patients who were not receiving any analgesics, the population without analgesics may have affected the overall outcome, such as the relationship between NCP and QOL.

In summary, this study provides a clinically meaningful overview of neuropathic pain in patients with cancer pain. We found that there was a clear association between NCP and both increased pain severity and worsened QOL. These results suggest the need for prospective study aimed at clarifying the causality between neuropathic pain and worsened QOL. Furthermore, in general, pain was not adequately managed in our study population, and NCP-targeting drugs are not widely used. Therefore, new management strategies with improved efficacy are required, as current pharmacological management is not sufficient to alleviate neuropathic pain, and efforts to elucidate the detrimental effect of neuropathic pain will be meaningless, in the absence of effective methods to improve it.

Notes

Acknowledgments

We appreciate SookJung Hyun, statistician at Primecore Consulting, for her statistical support.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.

Funding

This research was sponsored by Pfizer.

Supplementary material

520_2017_3806_MOESM1_ESM.docx (18 kb)
Supplementary Appendix Table 1 (DOCX 18 kb)
520_2017_3806_MOESM2_ESM.docx (16 kb)
Supplementary Appendix Table 2 (DOCX 15 kb)
520_2017_3806_MOESM3_ESM.docx (162 kb)
Supplementary Appendix Table 3 (DOCX 162 kb)
520_2017_3806_MOESM4_ESM.docx (162 kb)
Supplementary Appendix Fig. 1 (DOCX 162 kb)

References

  1. 1.
    Breivik H, Cherny N, Collett B, et al. (2009) Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol : mdp001Google Scholar
  2. 2.
    Deandrea S, Montanari M, Moja L, Apolone G (2008) Prevalence of undertreatment in cancer pain. A review of published literature. Ann Oncol 19:1985–1991CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Hong SH, Roh SY, Kim SY et al (2011) Change in cancer pain management in Korea between 2001 and 2006: results of two nationwide surveys. J Pain Symptom Manag 41:93–103CrossRefGoogle Scholar
  4. 4.
    Lin C-C, Lai Y-L, Ward SE (2003) Effect of cancer pain on performance status, mood states, and level of hope among Taiwanese cancer patients. J Pain Symptom Manag 25:29–37CrossRefGoogle Scholar
  5. 5.
    Hershman D, Weimer L, Wang A et al (2011) Association between patient reported outcomes and quantitative sensory tests for measuring long-term neurotoxicity in breast cancer survivors treated with adjuvant paclitaxel chemotherapy. Breast Cancer Res Treat 125:767–774CrossRefPubMedGoogle Scholar
  6. 6.
    Jones D, Zhao F, Brell J et al (2014) Neuropathic symptoms, quality of life, and clinician perception of patient care in medical oncology outpatients with colorectal, breast, lung, and prostate cancer. J Cancer Surviv:1–10Google Scholar
  7. 7.
    Padman S, Lee J, Kumar R et al (2015) Late effects of oxaliplatin-induced peripheral neuropathy (LEON)—cross-sectional cohort study of patients with colorectal cancer surviving at least 2 years. Support Care Cancer 23:861–869CrossRefPubMedGoogle Scholar
  8. 8.
    Mols F, Beijers T, Lemmens V, van den Hurk CJ, Vreugdenhil G, van de Poll-Franse LV (2013) Chemotherapy-induced neuropathy and its association with quality of life among 2- to 11-year colorectal cancer survivors: results from the population-based PROFILES registry. J Clin Oncol 31:2699–2707CrossRefPubMedGoogle Scholar
  9. 9.
    Ezendam NPM, Pijlman B, Bhugwandass C, et al. Chemotherapy-induced peripheral neuropathy and its impact on health-related quality of life among ovarian cancer survivors: results from the population-based PROFILES registry. Gynecol Oncol. 135: 510–517Google Scholar
  10. 10.
    Hershman DL, Lacchetti C, Dworkin RH, et al. (2014) Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol: JCO. 2013.2054. 0914Google Scholar
  11. 11.
    Pachman DR, Watson JC, Lustberg MB et al (2014) Management options for established chemotherapy-induced peripheral neuropathy. Support Care Cancer:1–15Google Scholar
  12. 12.
    Müller-Schwefe G, Ahlbeck K, Aldington D et al (2014) Pain in the cancer patient: different pain characteristics CHANGE pharmacological treatment requirements. Curr Med Res Opin 30:1895–1908CrossRefPubMedGoogle Scholar
  13. 13.
    Bouhassira D, Attal N, Alchaar H et al (2005) Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain 114:29–36CrossRefPubMedGoogle Scholar
  14. 14.
    Cleeland C, Ryan K (1994) Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singap 23:129–138PubMedGoogle Scholar
  15. 15.
    Young Ho Y, Mendoza TR, Dae Seog H et al (2004) Development of a cancer pain assessment tool in Korea: a validation study of a Korean version of the Brief Pain Inventory. Oncology 66:439–444CrossRefGoogle Scholar
  16. 16.
    Park S, Park M, Won J et al (2006) EuroQol and survival prediction in terminal cancer patients: a multicenter prospective study in hospice-palliative care units. Support Care Cancer 14:329–333CrossRefPubMedGoogle Scholar
  17. 17.
    Kim SH, Kim HJ, Lee S-i, Jo M-W (2012) Comparing the psychometric properties of the EQ-5D-3L and EQ-5D-5L in cancer patients in Korea. Qual Life Res 21:1065–1073CrossRefPubMedGoogle Scholar
  18. 18.
    Rabin R, Charro Fd EQ-SD: a measure of health status from the EuroQol Group. Ann Med 2001;33: 337–343Google Scholar
  19. 19.
    Vadalouca A, Raptis E, Moka E, Zis P, Sykioti P, Siafaka I (2012) Pharmacological treatment of neuropathic cancer pain: a comprehensive review of the current literature. Pain Pract 12:219–251CrossRefPubMedGoogle Scholar
  20. 20.
    Mols F, Beijers T, Vreugdenhil G, van de Poll-Franse L (2014) Chemotherapy-induced peripheral neuropathy and its association with quality of life: a systematic review. Support Care Cancer:1–9Google Scholar
  21. 21.
    Cella D, Peterman A, Hudgens S, Webster K, Socinski MA (2003) Measuring the side effects of taxane therapy in oncology. Cancer 98:822–831CrossRefPubMedGoogle Scholar
  22. 22.
    Driessen CML, de Kleine-Bolt KME, Vingerhoets AJJM, Mols F, Vreugdenhil G (2012) Assessing the impact of chemotherapy-induced peripheral neurotoxicity on the quality of life of cancer patients. Support Care Cancer 20:877–881CrossRefPubMedGoogle Scholar
  23. 23.
    Griffith K, Couture D, Zhu S et al (2014) Evaluation of chemotherapy-induced peripheral neuropathy using current perception threshold and clinical evaluations. Support Care Cancer 22:1161–1169CrossRefPubMedGoogle Scholar
  24. 24.
    Kim B-J, Park H-R, Roh H et al (2010) Chemotherapy-related polyneuropathy may deteriorate quality of life in patients with B-cell lymphoma. Qual Life Res 19:1097–1103CrossRefPubMedGoogle Scholar
  25. 25.
    Ostchega Y, Donohue M, Fox N (1988) High-dose cisplatin-related peripheral neuropathy. Cancer Nurs 11:23–32CrossRefPubMedGoogle Scholar
  26. 26.
    Sorbe B, Graflund M, Nygren L et al (2012) A phase II study of docetaxel weekly in combination with carboplatin every three weeks as first line chemotherapy in stage IIB-IV epithelial ovarian cancer: neurological toxicity and quality-of-life evaluation. Int J Oncol 40:773–781PubMedGoogle Scholar
  27. 27.
    Bennett MI, Rayment C, Hjermstad M, Aass N, Caraceni A, Kaasa S (2012) Prevalence and aetiology of neuropathic pain in cancer patients: a systematic review. Pain 153:359–365CrossRefPubMedGoogle Scholar
  28. 28.
    Garzon-Rodriguez C, Lyras L, Gayoso LO et al (2013) Cancer-related neuropathic pain in out-patient oncology clinics: a European survey. BMC Palliat Care 12:41CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    García de Paredes ML, del Moral González F, Martínez del Prado P et al (2011) First evidence of oncologic neuropathic pain prevalence after screening 8615 cancer patients. Results of the On study. Ann Oncol 22:924–930CrossRefPubMedGoogle Scholar
  30. 30.
    Hershman DL, Lacchetti C, Dworkin RH et al (2014) Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 32:1941–1967CrossRefPubMedGoogle Scholar
  31. 31.
    Network NCC ( 2014) NCCN clinical practice guidelines in oncology (NCCN Guidelines®): adult cancer pain. V 2.2014Google Scholar
  32. 32.
    Ripamonti CI, Santini D, Maranzano E, Berti M, Roila F, Group obotEGW (2012) Management of cancer pain: ESMO Clinical Practice Guidelines. Ann Oncol 23:vii139–vii154CrossRefPubMedGoogle Scholar

Copyright information

© The Author(s) 2017

Open Access This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Authors and Affiliations

  • So Yeon Oh
    • 1
  • Sang Won Shin
    • 2
  • Su-Jin Koh
    • 3
  • Sang Byung Bae
    • 4
  • Hyun Chang
    • 5
  • Jung Han Kim
    • 6
  • Hyo Jung Kim
    • 7
  • Young Seon Hong
    • 8
  • Keon Uk Park
    • 9
  • Jeanno Park
    • 10
  • Kyung Hee Lee
    • 11
  • Na Ri Lee
    • 12
  • Jung Lim Lee
    • 13
  • Joung Soon Jang
    • 14
  • Dae Sik Hong
    • 15
  • Seung-Sei Lee
    • 16
  • Sun Kyung Baek
    • 17
  • Dae Ro Choi
    • 18
  • Jooseop Chung
    • 19
  • Sang Cheul Oh
    • 20
  • Hye Sook Han
    • 21
  • Hwan Jung Yun
    • 22
  • Sun Jin Sym
    • 23
  • So Young Yoon
    • 24
  • In Sil Choi
    • 25
  • Byoung Yong Shim
    • 26
  • Seok Yun Kang
    • 27
  • Sung Rok Kim
    • 28
  • Hyun Joo Kim
    • 29
  1. 1.Internal MedicinePusan National University Yangsan HospitalYangsanSouth Korea
  2. 2.Medical Oncology, Department of Internal Medicine, Korea University Anam HospitalKorea University College of MedicineSeoulRepublic of Korea
  3. 3.Internal MedicineUlsan University College of MedicineUlsanSouth Korea
  4. 4.Internal MedicineSoonchunhyang University College of MedicineCheonanSouth Korea
  5. 5.Internal MedicineSeoul National University Bundang HospitalSoengnam-SiSouth Korea
  6. 6.Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University Medical CenterHallym University College of MedicineSeoulSouth Korea
  7. 7.Internal MedicineHallym University Sacred Heart HospitalAnyangSouth Korea
  8. 8.Internal Medicine, Seoul St. Mary’s HospitalThe Catholic University of KoreaSeoulSouth Korea
  9. 9.Internal Medicine, Dongsan Medical CenterKeimyung UniversityDaeguSouth Korea
  10. 10.Internal MedicineBobath Memorial HospitalSoengnam-SiSouth Korea
  11. 11.Internal MedicineYeungnam University College of MedicineDaeguSouth Korea
  12. 12.Internal MedicineChonbuk National University College of MedicineChonbukSouth Korea
  13. 13.Internal MedicineDaegu Fatima HospitalDaeguSouth Korea
  14. 14.Internal MedicineChung-Ang University College of MedicineSeoulSouth Korea
  15. 15.Internal MedicineSoonchunhyang University Bucheon HospitalBucheonSouth Korea
  16. 16.Internal MedicineSungkyunkwan University College of Medicine Kangbuk Samsung HospitalSeoulSouth Korea
  17. 17.Internal MedicineKyung Hee University Medical CenterSeoulSouth Korea
  18. 18.Internal MedicineHallym University Chuncheon Medical CenterChuncheonSouth Korea
  19. 19.Internal MedicinePusan National University HospitalPusanSouth Korea
  20. 20.Internal MedicineKorea University Guro HospitalSeoulSouth Korea
  21. 21.Internal MedicineChungbuk National University College of MedicineChungbukSouth Korea
  22. 22.Internal MedicineChungnam National University College of MedicineChungnamSouth Korea
  23. 23.Internal MedicineGachon University Gil Medical CenterIncheonSouth Korea
  24. 24.Internal MedicineKonkuk University Medical CenterSeoulSouth Korea
  25. 25.Internal MedicineSMG-SNU Boramae Medical CenterSeoulSouth Korea
  26. 26.Internal Medicine, St. Vincent’s HospitalThe Catholic University of KoreaSuwonSouth Korea
  27. 27.Department of Hematology-OncologyAjou University School of MedicineSuwonSouth Korea
  28. 28.Internal MedicineInje University Sanggye Paik HospitalSeoulSouth Korea
  29. 29.Corporate Affairs & Health and ValuePfizer Pharmaceutical Korea Ltd.SeoulSouth Korea

Personalised recommendations