Colon Cancer 741 Epidemiology

In a survey of 117 colon cancer survivors, 30% frequently experienced pain. In another community-based survey, 173 colorectal cancer survivors completed a quality of life instrument, the FACT-C,133 and the Health Utilities Index-Mark III.134 These researchers found that pain did not improve over time. Lower income status was associated with the pain dimension on the HUI and the physical dimension of the FACT-C. More detailed information regarding pain was not available.135 In a survey of 259 long-term (mean follow-up 9 years) female colorectal cancer survivors who completed the SF-36, bodily pain scores varied with the number of comorbid conditions with a correlation coefficient r = -0.42, p < 0.001. The comorbid conditions included arthritis (57%), hypertension (46%), anxiety (19%), and osteoporosis (18%).136

Phantom pain has been regularly reported. In one group of 40 survivors, 26 (65%) experienced phantom rectal sensations, with onset in the postoperative period, to starting 8 years later. In six patients, the sensations had spontaneously stopped.137 In a series of 22 survivors who had undergone abdominoperineal resection, 68% experienced a phantom rectum, and a smaller subset of 18% reported phantom pain with sensations of phantom pain like hemorrhoids, pricking and shooting, or like hard feces that would rupture the rectum. This started within 1-2 months after surgery, and the severity decreased over time.138

A perineal pain syndrome was described in a group of 286 patients with rectal cancer who underwent perineal resection, where 11% developed a chronic perineal pain syndrome. Patients with early onset pain had a 26% tumor recurrence rate and those who presented several months later had an 80% recurrence rate.139 Patients with locally recurrent rectal cancer have a 40% chance of experiencing significant posttreatment pelvic pain.140 In another follow-up study in 121 rectal cancer survivors with a median follow-up of 2 years, 20 patients (15%) reported persistent pain, and this significantly affected their quality of life.141

7.5. Hematologic Malignancies 7.5.1. Epidemiology

In the Childhood Cancer Survivors Study, 8.6% of patients with leukemia reported pain related to cancer or its treatment. In one study of 161 Acute Lymphocytic Leukemia survivors at a single institution, 30% reported pain. The presence of pain was a predictor for fatigue (OR = 5.56, 95% CI: 2.13-14.5) and for depression (OR = 5.04, 95% CI: 2.15-11.9).142

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