Chemotherapy exposure is independently associated with reduced pain severity in advanced pancreatic cancer

1. Chemotherapy appears to be independently associated with reduced pain severity in advanced pancreatic cancer, reinforcing the importance of routine, longitudinal pain assessment and proactive, individualized symptom management from diagnosis through palliative care.

Evidence Rating Level: 2 (Good) 

Pain is a highly prevalent and debilitating symptom in advanced pancreatic cancer, yet longitudinal, population-based data on its course and modifiable determinants remain limited. This nationwide Dutch cohort study analyzed prospectively collected patient-reported outcomes from 794 patients with locally advanced (LAPC, 40%) or metastatic pancreatic cancer (mPC, 60%) enrolled in the PACAP-PROM registry (2016-2023). Pain was assessed at baseline and through 18 months using five items from validated EORTC and EQ-5D-5L questionnaires, with associations between chemotherapy exposure and pain severity evaluated via multivariable ordinal mixed-effects models. At baseline, 54% to 78% of patients reported pain across the five domains, with no significant differences between LAPC and mPC. Pain prevalence decreased at 3 months but followed variable patterns thereafter. Patients receiving best supportive care reported significantly more pain and greater functional interference than those receiving anticancer treatment. Chemotherapy exposure was independently associated with lower odds of higher pain severity for both current pain (OR 0.51) and pain interference (OR 0.44).

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