Patient-reported pain and emergency department utilization in patients with newly diagnosed ovarian cancer: A retrospective cohort study.

Abstract

11110 Background: Pain is one of the most common reasons for emergency department (ED) visits among patients with cancer. While patient-reported pain is increasingly captured in routine clinical care, its role in predicting ED utilization remains unclear. This study aimed to evaluate whether baseline patient-reported pain after ovarian cancer diagnosis is associated with subsequent ED visits. Methods: We conducted a retrospective cohort study of patients aged 18 years or older treated for ovarian cancer at an urban academic institution between 2019 and 2024. Inclusion criteria required (1) completion of a pain survey within 6 months of diagnosis, (2) all or part of first line treatment at our institution, and (3) at least six months of follow-up after pain survey submission. Patients rated their average pain over the past week on a 0–10 scale as part of routine intake, with mild defined as a score of 1 to 3 and moderate to severe as 4 or higher. The outcome was the occurrence of at least one ED visit within 6 months of the pain survey submission. Multivariable logistic regression was used to assess the relationship between patient-reported pain and ED utilization, adjusting for sociodemographic and clinical variables. Results: Among 894 patients who met inclusion criteria, the mean age at diagnosis was 59.7 years, 74.4% (n=665) were white, 7.3% (n=65) Hispanic or Latino, 69.0% (n=617) had advanced stage (III or IV) disease, 83.9% (n=750) received chemotherapy and 66.7% (n=596) had surgery within 6 months of diagnosis. Among the cohort, 331 (37.0%) reported mild pain, 345 (38.6%) reported moderate to severe pain, and 239 (26.7%) experienced at least one ED visit in the 6 months following the survey. A higher proportion of patients with moderate to severe pain had an ED visit compared to 26.0% of those with mild pain and 15.1% of those with no pain (34.8% vs. 26.0% vs. 15.1%, p<0.001). After adjusting for covariates, both mild (aOR 1.77, 95% CI 1.09-2.93, p=0.02) and moderate to severe (aOR 2.28, 95% CI 1.42 - 3.73, p=0.001) pain at baseline were associated with higher odds of an ED visit compared to patients without pain. In addition, younger age, non-white race, receipt of chemotherapy or surgery, and advanced stage disease were all significantly (p<0.05) associated with higher adjusted odds of an ED visit. Conclusions: Three out of four people with newly diagnosed ovarian cancer experience pain, with higher pain levels associated with increased odds of an ED visit. Our findings suggest that routinely collected pain scores could potentially be leveraged to identify at risk population, improve pain management and reduce ED visits for people diagnosed with ovarian cancer.