Cancer patients quality of life after intrathecal drug delivery for advanced pain management: a patient-reported outcome analysis

Objectives: Cancer-related pain (CRP) is a common, most feared symptom experienced by cancer patients, adversely affecting quality of life and cancer outcomes. Patient-reported outcomes (PRO) measures are a patient's report of their health condition without interpretation of the response by a health care provider. This study assesses PRO measures after therapy using an intrathecal drug delivery system (IDDS) for cancer pain management. Design, setting, subjects, and methods: The retrospective study included adult patients undergoing IDDS implantation from January 2022 to January 2023 at the University of Minnesota Medical Center. Patients with moderate to severe CRP (VAS > 4) who had failed conventional medical therapy for pain control or had severe opioid-related side effects were considered for IDDS therapy. PRO measures were evaluated by the Patient Reported Outcomes Measurement Information System (PROMIS). The measurements were collected weekly during the first month after implantation and then during monthly follow-up. Linear mixed effects models with a random intercept for each participant are fit to the PROMIS outcomes to compare the change in scores. Results: During the study period, 23 patients received IDDS treatment for CRP, and 20 patients (age 57.2 ± 17.1 years, female sex 65%, Caucasian ethnicity 90%, stage IV cancer 90%) were included in the final analysis. The mean oral morphine equivalent consumption at implantation was 237 ± 309. The patients started with severely reduced physical function, mobility, self-efficacy, social activity, social role, and satisfaction with roles. They also presented with mild-moderate sleep disturbance, anxiety, and depression symptoms. Of all the domains, pain interference and sleep disturbance consistently improved throughout the study period. Conclusions: Pain interference and Sleep disturbance as measured by PRO measures improved with IDDS therapy among patients with refractory pain and advanced metastatic cancer.