Pain at the end of life in patients with cancer: a population-based study on prevalence, relief, and the role of pain assessment

BACKGROUND: Pain is common in advanced cancer, and its assessment is recognized as crucial for effective management. However, real-world evidence on pain prevalence, relief, and the impact of structured pain assessment across cancer types at the end of life remains limited. METHODS: We analyzed data from 215,317 patients who died from cancer reported to the Swedish Register of Palliative Care (2011-2023). Data are based on validated end-of-life questionnaires completed by healthcare providers after the patient's death. Patient characteristics and provider-reported pain outcomes (prevalence of pain, severe pain, structured pain assessment usage, pain relief) were evaluated. Pain prevalence and relief across cancer types were examined through multivariable logistic regression analyses. RESULTS: Overall, 82% of patients experienced pain and 35% severe pain during their final week of life. Highest pain prevalence occurred in pancreatic, prostate, and bone/soft tissue cancer and lowest in brain/CNS cancers. Complete pain relief was reported in 77% of patients, with lowest odds in patients with prostate and bone/soft tissue cancer and highest odds in patients with brain/CNS cancer. Pain assessment using validated tools was reported in 57% of patients, ranging from 49% in hematological malignancies to 64% in pancreatic cancer. Structured pain assessment was significantly associated with higher odds of complete pain relief both overall (adjusted OR 1.27, 95% CI 1.24-1.30) and across most cancer types. CONCLUSION: Pain remains highly prevalent in patients with cancer at the end of life, with variation in both occurrence and relief across cancer types. Structured pain assessment was consistently associated with higher odds of complete pain relief. These findings underscore the importance of routine, systematic pain assessment and tailored pain management strategies in end-of-life cancer care.