Musculoskeletal pain and its impact on rates of hospitalisation and mortality in cancer: a linked electronic health record cohort study (MSKCOM)

Conference:

SAPC ASM 2022 - UCLan

Talk Code:

4B.7

Presenter:

Kayleigh Mason

Twitter:

@KayleighJMason

Co-authors:

Kayleigh J Mason, James Bailey, Neil Heron, Michelle Marshall, Felix Achana, Ying Chen, John J Edwards, Martin Frisher, Alyson L Huntely, Christian D Mallen, Mamas A Mamas, May Ee Png, Stephen Tatton, Simon White, Kelvin P Jordan

Author institutions:

Keele University, Queen's University Belfast, Oxford University, Xi'an Jiaotong - Liverpool University, Bristol University

Problem

Patients with painful musculoskeletal conditions have an increased risk of developing cancer, but less is known about whether this impacts on the longer-term cancer prognosis. This study aims to determine whether patients with painful musculoskeletal conditions have a greater incidence of hospitalisation and mortality following diagnosis of incident primary cancer.

Approach

Data were obtained from a national primary care records database (Clinical Practice Research Datalink; CPRD Aurum) with linkage to hospitalisation and mortality records. Patients aged >45 years with incident primary breast, colorectal, lung or prostate cancer recorded in primary care were included. Patients were stratified by consultations in primary care for painful musculoskeletal conditions (defined as regional pain, osteoarthritis and inflammatory arthritis) in the 24 months prior to cancer, and also stratified by severity. Severe musculoskeletal pain was defined as prescription of strong/very strong opioids or secondary care referral in the 6 months before cancer.Time-to-event outcomes included hospital admission and all-cause mortality. Incidence rates per 1,000 person-years (IR/1000py) were calculated and multivariable flexible parametric models estimated the adjusted hazard ratio (aHR). Covariates included socio-demographics and comorbidities.

Findings

There were 428,866 patients with an incident primary cancer diagnosis (140,335 [33%] breast; 85,580 [20%] colorectal; 84,802 [20%] lung; 118,414 [27%] prostate) with median age 70 years and 50% females in the total cancer cohort. 28% of patients consulted for musculoskeletal pain in the 2 years prior to cancer diagnosis with 17% recorded with regional pain, 7% osteoarthritis and 4% inflammatory arthritis when stratified by condition, and 6% categorised as severe when stratified by severity. Patients with inflammatory arthritis and severe pain were prescribed strong/very strong opioids in the 2 years prior to cancer more commonly than those without pain (46% and 43% vs 19%, respectively). Patients with severe musculoskeletal pain had the highest risk for hospitalisation (IR/1000py 640 vs no pain 419; aHR 1.04, 95% CI 1.02-1.06) and all-cause mortality (IR/1000py 216 vs no pain 145; aHR 1.19, 1.15-1.22). Patients with musculoskeletal conditions had an increased incidence of hospitalisation (IR/1000py regional 477, osteoarthritis 543 and inflammatory 512 vs no pain 419) and mortality (IR/1000py regional 160, osteoarthritis 164 and inflammatory 186 vs no pain 145) compared to those without pain, but after adjustment for socio-demographics and comorbidity there were no increased risks observed by type of musculoskeletal condition.

Consequences

Patients with severe musculoskeletal pain were at greater risk of poorer long-term outcomes following diagnosis of incident primary cancer. Higher proportions of patients with severe musculoskeletal pain were prescribed strong/very strong opioids. This may have masked cancer pain and impacted the diagnosis of the underlying (and yet to be diagnosed) cancer.

Submitted by:

Kayleigh Mason

Funding acknowledgement:

This project was funded by the Nuffield Foundation (OBF/43974), but the views expressed are those of the authors and not necessarily the Foundation. Visit www.nuffieldfoundation.org. KJM, KPJ and CDM are also supported by matched funding awarded to the NIHR National Institute for Health Research (NIHR) Applied Research Collaboration (West Midlands). CDM is also funded by the National Institute for Health Research (NIHR) School for Primary Care Research. The study was approved by the CPRD Independent Scientific Advisory Committee (ref 20_000147). CPRD: This study is based in part on data from the Clinical Practice Research Datalink obtained under licence from the UK Medicines and Healthcare products Regulatory Agency. The data is provided by patients and collected by the NHS as part of their care and support. The interpretation and conclusions contained in this study are those of the authors alone. ONS Data: The interpretation and conclusions contained in this study are those of the authors alone. HES Data/ONS Data: Copyright © 2020, re-used with the permission of The Health & Social Care Information Centre. All rights reserved.