Comprehensive Pain Management, Quality of Life, and Mental Health in Advanced Cancer: A Propensity Score-Matched Retrospective Study.

چکیده اصلی

For advanced cancer patients, unrelieved moderate-to-severe pain adversely affects quality of life and psychological well-being. While pain control is fundamental to palliative care, the benefits associated with a multimodal approach warrant investigation. This PSM-based retrospective study (2022-2025) evaluated the associations between comprehensive pain management and quality-of-life and mental health outcomes in advanced cancer. Participants received either comprehensive management (standard analgesics plus ≥1 adjunct modality: interventional oncology, thermotherapy, psychological counseling, or palliative support) or pharmacotherapy alone. One-to-one nearest-neighbor matching balanced demographics, disease status, and baseline pain severity. Primary endpoints (Numerical Rating Scale [NRS], Pain Management Index, European Organization for Research and Treatment of Cancer Quality of Life Core Scale, Hospital Anxiety and Depression Scale) were assessed at baseline and two weeks. Propensity matching yielded 60 balanced pairs from 150 patients (standardized mean differences < 0.1). At 2 weeks, multimodal therapy was associated with superior analgesia (NRS: 2.8 ± 1.1 vs 4.2 ± 1.3), higher response rates (58.3% vs 35.0%), and fewer undertreated cases (16.7% vs 41.7%) (all P < 0.05). Comprehensive care was associated with better functional capacity (68.5 ± 12.4 vs 55.3 ± 13.6), lower symptom burden (25.6 ± 8.9 vs 38.4 ± 11.2) (P < 0.001), and lower anxiety/depression scores (6.2 ± 2.8 vs 9.5 ± 3.1; 5.8 ± 2.5 vs 8.9 ± 3.0, P < 0.001). Opioid escalation was attenuated in the multimodal arm (47.26% vs 65.27%, P < 0.001), while adverse events were similar (P > 0.05). Regression identified comprehensive care as an independent correlate of better outcomes, and sensitivity analyses confirmed its robustness. In conclusion, comprehensive pain management was associated with superior pain control, better quality of life, and improved psychological outcomes in advanced cancer compared to standard analgesia, alongside reduced opioid escalation-a finding that may have clinical relevance for reducing opioid-related adverse events.

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