In Liver Cancer, Survival Linked to Low Pain Levels

Pain could be a predictor of survival in hepatocellular carcinoma (HCC), according to research reported in The Journal of Pain, published by the American Pain Society.

The new findings demonstrate that understanding the role of pain may be critical in treating patients with HCC. Previous studies have established that predictors of survival for primary and metastsatic liver cancer patients include an increase in upper abdominal pain. This study investigated whether pain in its own right might have prognostic significance. The authors examined a database of 3,417 patients with liver cancer who presented with and without pain. A Kaplan-Meier analysis was performed to determine the differences in survival for patients reporting pain and those who did not.

The authors noted that pain is associated with decreased health-related quality of life in cancer patients and also with increased disability and mood disorders. Pain, therefore, is a major component of quality of life evaluations. Diminished quality of life is associated with poorer survival in several tumor types, including HCC.

The data base analysis showed that pain was linked with poorer survival in liver cancer patients who presented with pain versus those who did not. The mean survival in those with pain was 325 days versus 498 days for patients who were pain-free. The authors also evaluated the impact of tumor characteristics to determine if they alone could account for the presence of pain and poorer survival rates. They reported that patients with pain had larger and more aggressive tumors and had alphafetaprotien blood levels (a proven poor prognostic factor in liver cancer) that were twice as high as in patients without pain.

The authors concluded that further investigation is needed to determine which quality of life factors are most predictive for survival in liver cancer patients. Whether the treatment of pain can increase quality of life and improve survival outcomes should be explored further in clinical trials.

Hepatocellular carcinoma is the most common primary malignant tumor of the liver, according to HCAdvocate.org. “Primary liver cancer accounts for less than 1% of all cancers in this country. It is the seventh most common cause of cancer related deaths in men and the ninth in women. However, the incidence in the United States has increased during the past two decades possibly due to a large pool of people with longstanding hepatitis C.”

The American Pain Society (APS) is a multidisciplinary community that brings together a diverse group of scientists, clinicians, and other professionals to increase the knowledge of pain and transform public policy and clinical practice to reduce pain-related suffering.

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