Assessment of pain and nutritional status in patients undergoing palliative radiotherapy

Oliveira, Patricia Mineiro de; Oliveira, Victória Regina da Silva; Otoch, Jose Pinhata; Dale, Camila Squarzoni

doi:10.63231/2595-0118.20250008-pt

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ORIGINAL ARTICLE • Brazilian Journal of Pain 8 • 2025 • https://doi.org/10.63231/2595-0118.20250008-en linkcopy

Assessment of pain and nutritional status in patients undergoing palliative radiotherapy

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES Cancer pain has a high prevalence and significant psychosocial impact. Nutritional analysis and instrumental assessment of pain in cancer patients provide guidelines for better control, as nutritional status is a prognostic factor. The objective of this study was to investigate the characteristics of pain and its association with nutritional status in patients undergoing antalgic radiotherapy in a public hospital in the Brazilian Amazon.

METHODS This is a prospective, non-randomized, observational study that enrolled forty-eight patients for palliative antalgic treatment in the Radiotherapy Department of the Hospital Regional do Baixo Amazonas (HRBA - Lower Amazonas Regional Hospital), Brazil. Validated questionnaires were used to assess and exclude comorbidities and pain symptoms. Data collection included uni and multidimensional instruments for pain analysis before and after radiotherapy, and analysis of clinical, epidemiological, and nutritional data.

RESULTS Half of the patients were cachectic; the other half, who were not cachectic, were overweight patients with low appendicular lean mass. Patients responded well to antalgic radiotherapy both immediately and after 1 month of treatment. Cachectic patients had a higher score by the Visual Analogue Scale with significantly lower numerical reduction. Response rates were lower and deterioration after radiation occurred more frequently in this group. Cachectic patients had more neuropathic pain and longer pain duration. This group also presented a higher score for catastrophic thoughts about pain and a higher rate of anxiety and depression symptoms.

CONCLUSION Considering the results obtained, a negative influence of poor nutritional status is observed on the response to antalgic irradiation and pain symptoms. This fact that must be considered when planning the treatment of cancer patients.

Keywords:
Cachexia; Cancer pain; Radiotherapy

HIGHLIGHTS

Nutritional status interferes with pain response

Cachectic patients have higher pain scores

Cachectic patients present pain with neuropathic characteristics

Epidemiological and clinical history			n	Mean±SEM	%
Women			23	49.1 ± 2.6	48
Men			25	66 ± 1.9	52
Economic Classification (ABEP)
			n	Mean±SEM	%
B2			5	25.6 ± 0.7	10
C1			10	20.2 ± 0.4	21
C2			10	15.9 ± 0.3	21
D			22	11.9 ± 0.4	46
E			1	5 ± 0.0	2
Cognition and schooling (MEEM)
Low schooling/ cognition			24	13.7 ± 0.9	50
Satisfactory schooling/cognition			24	24 ± 0.6	50
Premorbid Cognitive Abilities Scale (PCAS)
≤15 points (low cognitive profile)			23	6.4 ± 0.98	47.9
≥ 16 points (high cognitive profile)			25	21.4 ± 0.8	52.1
Occupation
Manual work			34	n/a	71
Services			12	n/a	27
Intelectual			1	n/a	2
Risk of Alcohol abuse(AUDIT)
Low risk			45	0.11 ± 0.07	93.8
Risk consumption			2	8.0 ± 0.0	4.2
Likely dependency			1	23.0 ± 0.0	2.1
Primary site	Non-cachetics	Cachetics	Follow up outcome	Non-cachetics	Cachetics
Primary site	% (n)	% (n)	Follow up outcome	% (n)	% (n)
Prostate	37.5% (n=9)	29.2% (n=7)	Death	12.5% (n=3)	45.8% (n=11)
Breast	37.5% (n=9)	25% (n=6)	Death	12.5% (n=3)	45.8% (n=11)
Lung	8.3% (n=2)	12.5% (n=3)	Palliative care	0	8.3% (n=2)
Uterine cervix	4.17% (n=1)	4.15% (n=1)	Chemotherapy	12.5% (n=3)	12.5% (n=3)
Gastrointestinal	4.17% (n=1)	8.3% (n=2)	Hormone therapy	45.8% (n=11)	16.7% (n=4)
Multiple Myeloma	4.17% (n=1)	4.15% (n=1)	Oncologic follow up	20.8% (n=5)	0
Others	4.17% (n=1)	16.7% (n=4)	Unknown status	8.3% (n=2)	16.7% (n=4)

Nutritional status	Non-cachectic		Cachectic
Nutritional status	n	%	n	%
Body Mass Index (BMI)
Underweight (<18,5)	2	8	6	25
Healthy weight range (18,6-24,9)	9	38	15	62.5
Overweight (25-29,9)	10	42	3	12.5
Obesity (>30)	3	27	0	0
Appendicular Lean Mass Index (ALMI)
Low (<7,6 kg/m² men; < 5,5kg/m² women)	13	54	17	71
Normal (>7,6 kg/m² men; >5,5kg/m² women)	11	46	7	29
Fat Free Mass Index (FFMI)
Low (<16,7 kg/m² men; < 14,6 kg/m² women)	8	33	13	54.2
Normal (16,7 a 19,8 kg/m² men; 14,6 a 16,8 kg/m² women)	13	54	8	33.3
High (>19,8 kg/m² men; >16,8 kg/m² women)	3	13	3	12.5
CASCO	Non-cachectic		Cachectic
Domains	n	%	n	%
BWC (40 pts max)	0.1	n/a	21.3	n/a
IMD (20 pts max)	3		4.5
PHP (15 pts max)	9		10.3
ANO (15 pts max)	3.6		6.1
QoL (10 pts max)	4.4		5.2
Mean Score	20		47.4

	Non-cachectic				Cachectic
	Pre-RT	Post-RT		1 month Post-RT	Pre-RT	Post-RT	1 month Post-RT
Neuropathic pain (DN≥4)	41.7% (n=10)	41.7% (n=10)		30% (n=3)	83.3% (n=20)	54.2% (n=13)	36.4% (n=4)	n/a
Nociceptive pain (DN4<4)	50% (n=12)	25% (n=6)		30% (n=3)	12,5% (n=3)	33.3% (n=8)	36.4% (n=4)	n/a
Painless (DN4=0)	8.3% (n=2)	33.3% (n=8)		40% (n=4)	4,2% (n=1)	27.3% (n=3)	27.3% (n=3)	n/a
Mcgill Dimensions	Non-cachectic				Cachectic			p-value
	Pre-RT		Post-RT	1 month Post-RT	Pre-RT	Post-RT	1 month Post-RT
	mean±sem		mean±sem	mean±sem	mean±sem	mean±sem	mean±sem
Intensity (0-10)	6.5±0.6		5.3±0.7	4.3±1.3	8.7±0.3	6.2±0.8	4.8±2.1	0.0271*
Sensory (max. 8 pts)	4.4±0.5		3.5±0.6	1.2±0.6	6.4±0.4	4.4±0.7	3±1.7	0.0008*
Affective (max. 5 pts)	3.1±0.4		2.4±0.3	2.0±0.7	3.8±0.3	3.7±0.4	2.4±1.0	0.0982
Evaluative (max. 2 pts)	1.4±0.1		1.0±0.1	0.8±0.3	1.6±0.1	1.4±0.2	0.8±0.4	0.0377*
Total (max. 15 pts)	9.0±0.9		6.9±1.0	4.7±1.8	11.6±0.6	9.3±1.1	6.2±3.0	0.0186*
Mechanical Pain Thresholds	Non-cachetic				Cachetic			p-value
	Pre-RT		Post-RT	1 month post-RT	Pre-RT	Post-RT	1 month post-RT
	mean±sem		meana±sem	mean±sem	mean±sem	mean±sem	mean±sem
MPeT(g)	0.32±0.09		0.20±0.06	0.09±0.01	0.36±0.09	0.39±0.16	0.15±0.02	>0.9999
MPT (g)	1.24±0.48		0.82±0.34	0.23±0.03	1.54±0.34	1.41±0.48	1.82±0.96	>0.9999
SMPT (VAS)	3.04±0.53		2.79±0.49	2.00±0.42	3.54±0.41	3.70±0.50	2.72±0.76	>0.9999
ALOD (VAS)	5.20±0.84		3.33±0.82	3.30±1.23	4.50±0.77	4.75±0.77	5.63±1.26	>0.9999
WUR	0.73±0.08		0.75±0.07	0.81±0.06	0.70±0.05	0.72±0.05	0.75±0.09	>0.9999

Anxiety	Non-cachectic			Cachectic			p-value
Anxiety	Pre-RT	Post-RT	1 month Post-RT	Pre-RT	Post-RT	1 month Post-RT	p-value
Likely	12.5% (n=3)	12.5% (n=3)	0%	29.2% (n=7)	29.2% (n=7)	15.4% (n=2)	0.5404
Possible	25% (n=6)	20.8% (n=5)	14.3% (n=2)	25% (n=6)	33.3% (n=8)	38.5% (n=5)
Unlikely	62.5% (n=15)	66.7% (n=16)	85.7% (n=12)	45.8% (n=11)	37.5% (n=9)	46.2% (n=6)
Depression	Pre-RT	Post-RT	1 month Post-RT	Pre-RT	Post-RT	1 month Post-RT	p-value
Likely	16.7% (n=4)	16.7% (n=4)	14.3% (n=2)	33.3% (n=8)	50% (n=12)	53.8% (n=7)	0.3915
Possible	29.2% (n=7)	33.3% (n = 8)	50% (n=7)	29.2% (n=7)	16.7% (n=4)	15.4% (n=2)
Unlikely	54.2% (n=13)	50% (n=2)	35.7% (n=5)	37.5% (n=9)	33.3% (n=8)	30.8% (n=4)
PCS score	Pre-RT	Post-RT	1 month Post-RT	Pre-RT	Post-RT	1 month Post-RT	p-value
	mean±sem	mean±sem	mean±sem	mean±sem	mean±sem	mean±sem	>0.9999
	15.75±2.50	11.21±1.48	9.20±3.07	23.79±2.98	20.38±2.77	14.82±4.10	>0.9999

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