Assessment and Treatment Outcomes of Pain in Cancer Patients Undergoing Chemotherapy – A Tertiary Care Centre Experience

INTRODUCTION

Pain remains a significant challenge in cancer treatment, affecting approximately two-thirds of patients undergoing chemotherapy. Despite advancements in pain management guidelines, their implementation in clinical practice remains suboptimal.^[1] The effective management of pain is crucial, as unaddressed pain not only diminishes the quality of life but also exacerbates psychological distress and reduces treatment adherence.^[2]

Cancer pain is complex and multifactorial, arising from direct tumour involvement, treatment-related side effects or a combination of nociceptive and neuropathic mechanisms. The subjective nature of pain and its variability among individuals make assessment and management particularly challenging.^[3] Gender-specific differences in pain perception, influenced by hormonal and psychological factors, add another layer of complexity to this issue.

This study aims to evaluate the prevalence and severity of pain in chemotherapy patients, focusing on its management and the associated factors influencing pain perception. The primary goal is to assess the efficacy of pharmacological interventions in alleviating pain and improving patient outcomes.^[4] By identifying patterns and gaps in current pain management practices, this study seeks to provide insights that could guide future clinical strategies and enhance patient care.^[5] Local and regional pain relief in India faces significant challenges due to restricted access to speciality care, underutilization of palliative care and drug regulatory barriers to access to opioids, and this emphasises the requirement for local context-specific, scalable solutions.

The hypothesis underpinning this study is that individualised pain management tailored to the severity and type of pain significantly improves patient comfort and reduces reliance on high-potency opioids.^[6] The study also addresses the deficiency in long-term follow-up data regarding pain management outcomes, aiming to fill this gap and provide a foundation for future research.

MATERIALS AND METHODS

Cancer type distribution

The study included 104 patients diagnosed with various types of cancer. The distribution of cancer types among the patients was as illustrated in Figure 1:

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Figure 1:

Cancer types distributions.

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• Breast cancer: 34 patients (32.69%)

• Lymphoma: 10 patients (9.62%)

• Ovarian cancer: 10 patients (9.62%)

• Colon cancer: 10 patients (9.62%)

• Cervical cancer: 6 patients (5.77%)

• Lung cancer: 5 patients (4.81%)

• Stomach cancer: 5 patients (4.81%)

• Endometrial cancer: 4 patients (3.85%)

• Multiple myeloma: 4 patients (3.85%)

• Prostate cancer: 3 patients (2.88%)

• Pancreatic cancer: 3 patients (2.88%)

• Renal cell carcinoma: 2 patients (1.92%)

• Others: 8 patients (7.68%).

These distributions reflect the common prevalence of different cancers, with breast cancer being the most frequently diagnosed among the study cohort.

RESULTS

Demographics

A total of 104 participants were included in the study, comprising 56 females (54%) and 48 males (46%). Participants’ ages ranged from 24 to 81 years, with the mean age being 53.2 ± 14.1 years as illustrated in Figure 2. Females predominated in the age group of 45–55 years, whereas males were evenly distributed across all age ranges.

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Figure 2:

Male and female patients undergoing chemotherapy. The numbers 56 and 48 denote the number of males and females.

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Pain scores

Pain intensity was categorised using the NRS:

• No pain: 21 participants (20%)

• Mild pain (1–3): 45 participants (43%)

• Moderate pain (4–6): 28 participants (27%)

• Severe pain (7–9): 10 participants (10%).

Females reported a higher prevalence of moderate-to-severe pain (38%) compared to males (26%) as illustrated in Figure 3. Statistical analysis revealed a significant association between gender and pain intensity (P = 0.031). Pain intensity scores using NRS is illustrated in Figure 4.

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Figure 3:

Females reported higher pain scores than males.

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Figure 4:

Pain scores using NRS.

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DISCUSSION

This study highlights the significant burden of pain among patients undergoing chemotherapy, emphasising its intensity, gender-based variations and the effectiveness of management strategies. The findings demonstrate that individualised pain management approaches were highly effective, with 91% of participants achieving symptom relief. Gender differences in pain perception were evident, with females reporting higher pain scores than males, which may be attributed to biological, hormonal and psychological factors influencing pain sensitivity. In addition, the data reveal that patients^[18] aged 45–64 years experienced the most severe pain, supporting the notion that pain perception and tolerance vary across different age groups. Elderly patients (>65 years) report lower pain during chemotherapy due to altered pain perception and psychosocial adaptation. Ageing is associated with changes in the nervous system that can reduce pain sensitivity or alter pain signalling, leading to underreporting or diminished perception of pain. Older adults often have better emotional coping mechanisms, acceptance of illness or different pain expectations based on life experience, which may influence how they perceive and report pain. These insights reinforce the need for targeted pain management strategies that consider demographic factors.

The study provides crucial insights into the importance of a holistic approach to pain management, integrating both pharmacological and non-pharmacological interventions to optimise patient outcomes.^[19] The effectiveness of combined strategies suggests that a multimodal approach, incorporating medications along with psychological and supportive care, can significantly improve pain relief and overall well-being. This underscores the role of emotional, which includes breakthrough pain^[20] and psychological support in enhancing treatment efficacy, as unmanaged pain can lead to increased distress, anxiety and reduced quality of life. The findings also highlight the necessity for healthcare providers to develop gender- and age-specific pain management^[21] protocols to ensure personalised care that meets the unique needs of each patient. In the Indian context, non-pharmacologic pain management strategies such as yoga, mindfulness-based practices, music therapy and Ayurvedic therapies (e.g. Abhyanga and herbal remedies) are culturally acceptable and widely accessible. In addition, group therapy and community-based support programmes can provide psychosocial relief and improve coping in chronic pain patients. Oncology outpatient and inpatient services in India should incorporate routine pain assessments into chemotherapy treatment workflows, ensuring timely identification and management of pain. Integrating multidisciplinary approaches, including pharmacologic, psychosocial and culturally relevant non-pharmacologic interventions, can enhance patient comfort and treatment adherence.

CONCLUSION

Future research should focus on larger sample sizes and exploring innovative non-pharmacological therapies such as cognitive-behavioural interventions, mindfulness techniques and integrative medicine approaches. By addressing these aspects, future studies can further refine pain management strategies, contributing to improved clinical outcomes and more effective healthcare policies aimed at enhancing the quality of life for chemotherapy patients.