Pain in ovarian cancer patients: prevalence, characteristics, and associated symptoms

Background. The prevalence characteristics, and impact of pain and other symptoms have not been studied systematically in women with ovarian cancer. Anecdotally, pain has been associated with the onset of the disease and is a common problem among those with advanced cancer; symptoms other than pain appear to be highly prevalent. Given the profound influence of pain and other symptoms on quality of life, the evaluation of these phenomena could provide data relevant to the cIinical management of these patients and advance quality. of life research in the area of symptom assessment. Methods. Questionnaires were completed by 111 inpatient; and 40 outpatients with ovarian cancer who were undergoing treatment at a cancer center. Measures include a a comprehensive pain questionnaire: the Rand Mental Health Inventory, Functional Living Index--Cancer; and the Memorial Symptom Assessment Scale. Results. The sample (N = 151) represented 74% of the eligible patients. The median age was 55 year's (range, 23-86), 82% had Stage Ill or IV disease at presentation, and 69% had active disease at the time of the survey. Pain, fatigue and psychologic distress were the most prevalent symptoms. Sixty-two percent (N = 94) described it pain syndrome that preceded the onset or recurrence of the disease. and 42% (N = 63) reported 'persistent or frequent pain' during the preceding 2 weeks. The latter pain had a median duration of 2 weeks (range, less than 1 to 75% weeks) and usually was in the abdominopelvic region (80%), frequent or almost constant (66%), and moderate to severe. Most patients reported moderate or greater pain-related interference with various aspects of function, particularly activity (68%), mood (62%), work (62%), and overall enjoyment of life (61%). Performance status, inpatient status. and unmarried status were significant predictors of pain presence or intensity, and both performance status and extent of tumor were significant predictors of pain interference with function. Conclusions. Among those with ovarian cancer, greater than 40% experienced pain that substantially undermined function in one half to two thirds of these patients. Impaired performance status is associated most strongly with pain. The onset or recurrence of disease often is heralded by a stereotype pain syndrome. Cancer 1994: 74:907-15, Key words: ovarian cancer, pain, cancer pain, palliative care, quality of life.