Pain prevalence and intensity in advanced pancreatic cancer: a nationwide cohort study

Pain is a major concern in patients with advanced pancreatic cancer, significantly affecting quality of life, treatment tolerance, and end-of-life experience. However, data on its prevalence, course, and determinants remain limited, particularly regarding the dynamics of pain as a primary outcome in real-world patient populations. This nationwide cohort study, conducted within the PACAP-PROM registry (2016-2023), included patients with locally advanced (LAPC) or metastatic pancreatic cancer (mPC). Pain was assessed using 5 items from the EORTC QLQ-C30, PAN26, and EQ-5D-5L questionnaires, with the primary outcome being pain prevalence at baseline and comparisons between LAPC and mPC. Secondary outcomes included pain trajectories over 3 to 18 months and the association between chemotherapy and pain, evaluated using mixed-effects logistic regression. Overall, 794 patients were included, of whom 648 (82%) received cancer therapy, and 146 (18%) received best supportive care (BSC). At baseline, 54% to 78% of patients reported pain, with no differences between LAPC and mPC. Although pain prevalence decreased at 3 months, variable patterns developed thereafter. Patients receiving BSC reported more pain (57% vs 38%, P = 0.029) and greater pain-related interference with daily activities (53% vs 38%, P = 0.024). Chemotherapy was independently associated with lower odds of higher pain severity categories for current pain (OR 0.51; 95% CI 0.37-0.70) and pain interference (OR 0.44; 95% CI 0.31-0.63). In conclusion, pain prevalence exceeds 50% in patients with advanced pancreatic cancer and remains a key concern that can be positively influenced by chemotherapy. These findings emphasize the need for routine pain assessment and individualized symptom management from diagnosis onward.