Background & Aims
Cancer-related pain is common and undertreated. Exercise is known to have a pain-relieving effect in non-cancer and cancer-related pain.1 However, much of the evidence related to cancer-related pain comes from trials involving people with good prognostic cancers like breast and prostate cancer. In contrast, underrepresented in exercise oncology trials are people with rarer or later stage cancers, which are associated with lower survival prospects and higher morbidity, such as women with recurrent ovarian cancer. The aim of this analysis was to (1) describe the prevalence of pain in women undergoing chemotherapy for recurrent ovarian cancer, (2) assess the relationship between pain and other health-related outcomes in this cohort, and to (3) explore the effect of participating in a telephone-delivered exercise intervention during chemotherapy for recurrent ovarian cancer on pain outcomes.
Methods
This was a single-arm, phase II, pre- post- exercise intervention trial2, involving 50 women undergoing chemotherapy for recurrent ovarian cancer. The intervention was delivered via exercise professionals during 12 telephone sessions scheduled over a 6-month period plus five optional in-person sessions. While the target weekly exercise prescription was 150 minutes of moderate-intensity, multimodal exercise, exercise prescriptions were individualised according to patient-specific circumstances. Patient-reported outcomes including self-reported pain, neurotoxicity (FACT-GOG-NTX), quality of life (EQ-5D, FACT-G, FACT-O), and anxiety and depression (HADS), were assessed pre- and post-intervention. Results were described using N (%) and means (standard deviation (SD)). Correlations, (un)paired t-tests and chi-squared analyses were used to assess cross-sectional relationships and to explore changes in outcomes and the relationship between pain and health-related outcomes.
Results
Women were on average 61 (SD 10) years, and 67% and 37% reported mild to severe pain and moderate to severe pain, respectively, with a reported average pain of 3.1 (SD 2.7)/10. Women with higher levels of pain reported lower health-related quality of life (FACT-G: r=-0.51; FACT-O: r=-0.56; both p<.001), higher neurotoxicity (r=-0.62, p<0.001), higher depression (r=0.56, p<0.01) and trends of higher anxiety (r=0.28, p=0.06). Compared to pre-intervention, fewer women reported mild to severe and moderate to severe pain (50% and 19%, respectively; p<0.09) post-exercise intervention. Improvements between pre- and post-intervention were seen in all health-related quality of life sub/total scales, neurotoxicity, anxiety and depression with clinically relevant but non-significant changes. Clinically relevant trends for greater improvements in quality of life, anxiety and depression were seen in women with moderate to severe pain at baseline compared with women reporting no or mild pain.
Conclusions
These preliminary findings showed that pain in women with ovarian cancer is prevalent, with one in three women experiencing moderate to severe levels of pain. Higher levels of cancer-related pain were associated with lower health-related outcomes. Participating in a 6-month moderate-intensity, multimodal exercise intervention was associated with reduced cancer-related pain (with only 1 in 5 experiencing moderate to severe levels of pain post-intervention) and improved health-related outcomes, especially in those with higher levels of pain pre-intervention. If accepted, the full analysis will be presented at the 2024 IASP conference 2024.
References
1.Plinsinga ML, Singh B, Rose GL, Clifford B, Bailey TG, Spence RR, Turner J, Coppieters MW, McCarthy AL, Hayes SC. The Effect of Exercise on Pain in People with Cancer: A Systematic Review with Meta-analysis. Sports Med. 2023 Sep;53(9):1737-1752. doi: 10.1007/s40279-023-01862-9.
2.Hayes SC, Spence RR, Janda M, et al Pre-post feasibility trial of a telephone-delivered exercise intervention for patients during chemotherapy for recurrent ovarian cancer: the ECHO-R trial protocol BMJ Open 2024;14:e077158. doi: 10.1136/bmjopen-2023-077158
Presenting Author
Melanie Plinsinga
Poster Authors
Topics
- Specific Pain Conditions/Pain in Specific Populations: Cancer Pain & Palliative Care