Pain in patients with newly diagnosed or relapsed acute leukemia

Abstract

Background: Acute leukemia (AL) is associated with substantial morbidity and mortality. We assessed the prevalence and correlates of pain in patients with newly-diagnosed or relapsed AL. Methods: Patients with newly-diagnosed or relapsed AL admitted to a comprehensive cancer center completed the Memorial Symptom Assessment Scale (MSAS), which assesses prevalence, severity and distress associated with pain and other symptoms. Factors associated with severe pain were assessed using logistic regression. Two raters completed chart reviews in duplicate for patients with severe pain (MSAS severity ≥3/4) to determine the site of pain. Results: In total, 318 patients completed questionnaires; 245 (77.0%) had acute myeloid or acute promyelocytic leukemia (AML/APL) and 73 (23.0%) had acute lymphoblastic leukemia (ALL); 289 (90.91%) were newly-diagnosed and 29 (9.1%) had relapsed disease. Pain was reported in 156/318 (49.2%), and 55/318 (17.3%) reported severe pain (≥3/4). Pain was associated with all psychological symptoms (all p<0.005) and some physical symptoms. Severe pain was associated with younger age (p=0.02), worse performance status (p=0.04), ALL diagnosis (p=0.04) and time from onset of chemotherapy (p=0.03), with pain peaking at 4 weeks after chemotherapy initiation. The most common sites of severe pain were oropharynx (22; 40%), head (12; 21.8%) and abdomen (11; 20%). Only 3 patients (0.9%) were referred to the symptom control/palliative care team during the month prior to or following assessment. Conclusions: Pain is frequent, distressing and predictable in patients undergoing induction chemotherapy for AL. Further research is needed to assess the efficacy of early supportive care in this population.