Background: Pain is a condition that often occurs in patients with head and neck cancer. Pain in patients with malignancy occurs mostly due to metastatic processes.

Method: This research is a cross-sectional descriptive study to measure variables using the VAS, BPI, HADS, and LANSS questionnaires.

Result: 127 subjects met the inclusion and exclusion criteria. Most patients with were male (63.8%), with the most ages being in the 46–55 year group (33.9%). Most patients were in stage III (48%), with the most diagnosed being nasopharyngeal malignancy (42.5%). About 60.6% of patients have received pain management according to WHO Step 2 and most suffered from neuropathic pain (65.8%) with the most pain intensity being moderate pain (53.5%). Pain interfered most with activities (91.3%) and as many as 64.6% experienced depression.

Conclusion: A description of pain in head and neck patients is needed for good management of malignancy and pain management.

Pain, head and neck malignancy, VAS, BPI, HADS, LANSS

Head and neck malignancy is a prevalent form of cancer, ranking sixth worldwide (Aupérin 2020) It affects various areas such as the sinonasal region, oral cavity, larynx, and salivary glands. In 2019, there were around 890,000 new cases reported (Keam et al. 2021).

Pain is a common issue for these patients, with 50% to 90% experiencing it, predominantly caused by metastasis (Mercadante et al. 2021) Studies show that 45.15% of head and neck malignancy patients in the US reported pain, with 11.5% describing it as severe (Cramer et al. 2018). The International Association for The Study of Pain defines pain as an unpleasant sensory and emotional experience linked to tissue damage (Tribius et al. 2018). It can stem from the cancer itself or as a treatment side effect. Various factors contribute to pain, including tissue damage and nerve fiber infiltration. It can be acute or chronic, with patients often experiencing both.

The head and neck region is particularly sensitive to pain due to its dense innervation (Bianchini et al. 2019). Around 50.42% of patients feel pain due to tumor invasion. Accurate pain assessment is crucial for appropriate management as untreated pain can lead to psychological and emotional disturbances. More than half of patients still have unresolved pain issues.

This study aim to describe pain in head and neck cancer patient. Understanding the pain characteristics helps guide treatment decisions. Comprehensive approaches are necessary for effective pain management, including pharmacological and non-pharmacological therapies. Research on pain profiles can aid in the evaluation, diagnosis, and management of head and neck malignancy patients.

The research design employed for this study is cross-sectional and descriptive, enabling the simultaneous measurement of variables. The research utilizes a set of questionnaires, including the Visual Analog Scale (VAS), Brief Pain Inventory (BPI), Hospital Anxiety and Depression Scale (HADS), and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), all administered through interview sessions.

This study focuses on patients diagnosed with head and neck malignancies, identified through histopathological examinations, who went to the ORL-HNS Oncology Clinic and were admitted to the inpatient ward of Hasan Sadikin Hospital Bandung. The study was conducted from February to April 2023 and includes adult patients aged above 18 years. Exclusion criteria were established for patient selection, excluding individuals with impaired consciousness and those facing communication disorders from participating in the research.

Data collection techniques encompass two main approaches: an examination of patient medical records to extract relevant information and comprehensive interviews conducted with patients to supplement data not present in the medical records. The Statistical Package for the Social Sciences (SPSS) version 24.0 for Windows is utilized for data processing. Patient characteristics and status are methodically organized and presented in tabular formats. Descriptive statistical analysis, featuring counts (n) and percentages (%), is employed to effectively summarize the data. Patient-specific details from the questionnaires are consolidated into a table illustrating essential characteristics, such as age, gender, education, socio-economic background, working diagnosis, pain intensity scores, and cancer location. Subsequent analysis of subject characteristics and pain intensity employs Fisher’s Exact Test.

This study found that most head and neck cancer patients were male, which is consistent with previous research by Park et al. (2022) in Asia. In terms of education, contrary to Nathania’s research, the majority of patients in this study had a high school education (Nathania et al. 2020). The most common age group was 46–55 years old, with an average age of 48.24 years. Steffen et al. (2020) reported a global trend of younger patients developing head and neck cancer due to lifestyle factors like alcohol consumption and smoking. A large portion of patients in this study were diagnosed at stage III, indicating delayed healthcare-seeking behavior, which could be attributed to a lack of understanding of the signs and symptoms. As a tertiary healthcare provider, RSHS often receives patients with more advanced difficulties compared to other hospitals.

Nasopharyngeal cancer accounted for 42.5% of head and neck cancers in this study. Pain management followed WHO guidelines, with 60.2% receiving Step 2 pain medications. 64.8% experienced neuropathic pain, possibly due to nerve compression or inflammation. The rich innervation in the head and neck area contributes to this high prevalence. (Purwata et al. 2015; Lemos et al. 2019; Ghodrati et al. 2021; Mercadante et al. 2021).

50.8% of respondents experienced moderate pain. Head and neck cancer patients reported pain intensity scores above 5. 89% of respondents had pain that interfered with their activities. Males (86.3%) reported more interference than females (100%). Pain side effects increased with age, with 88.9% of the 18–25 age group and 100% of 66 and above reporting activity disturbances.

The type of diagnosis also influenced activity disturbances, with oropharyngeal, laryngeal, thyroid, and salivary gland cancers (100%) causing the most activity disturbances. Ye et al. suggested that cancers in the orofacial region can significantly disrupt daily activities because of their unique pain characteristics, rich blood vessels, and innervation. (Ye et al. 2020). Orofacial regions involve organs like the mouth, tongue, lips, teeth, and jaw, which play essential roles in eating, speaking, and drinking. Pain in these areas can lead to social dysfunction and nutritional problems (Viganó et al. 1998).

The proportion of neuropathic pain was higher in males than females, which contradicts previous research. However, another study found that neuropathic pain prevalence in Indonesia was higher in males. The higher proportion of neuropathic pain in males in this study may be due to the higher incidence of head and neck cancer in males. The 40–60 age group had the highest prevalence of neuropathic pain, consistent with other findings. Nasopharyngeal cancer was associated with the highest prevalence of neuropathic pain, which is activated by a specific gene. (Wettstein et al. 2019). Depressive symptoms were more common in males, contrary to pain side effects. Age did not significantly impact pain intensity in this study, which differs from previous research. (Majedi et al. 2019). Gender, however, was significantly associated with pain intensity, with women generally having higher sensitivity and lower pain thresholds. This may be attributed to various hormonal factors and differences in nerve density.

Education level was not significantly associated with pain intensity in head and neck cancer patients, consistent with previous research. However, socioeconomic status was found to be significantly associated with pain intensity (p=0.02), likely due to environmental stressors faced by patients with low socioeconomic status. Among stage III patients, 88.1% experienced moderate pain, while all stage IV patients experienced severe pain, indicating a correlation between clinical stage and pain intensity (p<0.001). Psychological distress was also significantly related to pain intensity (p<0.001), with 64.1% of patients experiencing depression. Depression in these patients may be influenced by physical symptoms and poor treatment responses.

Wu et al. (2023) found a correlation between pain and depression, with higher pain levels being associated with increased depression. Conversely, depression is highly correlated with pain, as depressed patients are more sensitive to pain discomfort, leading to depressive symptoms.

In this study, there was no significant difference in pain intensity between patients with neuropathic and non-neuropathic pain. This finding contradicts Wong et al. (2018) research, which suggested that neuropathic pain has higher pain intensity and duration than other types of pain. In head and neck cancer, patients may experience multiple types of pain alternately depending on their pain management, resulting in overall high pain intensity regardless of the type of pain (Wu et al. 2023).

In this study, some patients still experienced severe pain, indicating that pain management was not entirely successful. This suggests the need for comprehensive pain management to improve the quality of life of head and neck cancer patients, in line with WHO’s goal of freedom from cancer pain. This could be due to various factors investigated in this study. Comprehensive pain management is required to enhance the quality of life for head and neck cancer patients fully.

In this study, it was found that patients with head and neck malignancies experienced severe pain, with the most common type of pain being neuropathic pain, which significantly interfered with their activities. The majority of patients with head and neck malignancies also experienced psychological distress in the form of depression. About 88.1% of stage III head and neck malignancy patients experienced moderate pain, while 100% of stage IV head and neck malignancy patients had severe pain intensity. Head and neck malignancies in the laryngeal region were most commonly associated with severe pain intensity. Neuropathic pain was most frequently experienced in head and neck malignancies in the nasopharyngeal region. There was a significant relationship between gender, socioeconomic status, clinical stage, psychological distress, and the intensity of pain.