Prevalence of Cancer Pain, Health-Related Quality of Life, and Its Associated Factors among Patients with Cancer at the National Cancer Institute, Sri Lanka: A Cross-Sectional Study

Background: Cancer pain is prevalent, undertreated, and profoundly impairs health-related quality of life (HRQOL), particularly in low- and middle-income countries. Despite the global burden, population-level data from Sri Lanka remain scarce. This study estimated the prevalence and severity of cancer pain, described HRQOL, and identified independent predictors of HRQOL among adult patients with cancer attending Apeksha Hospital, Maharagama, Sri Lanka.
Methods: A cross-sectional study recruited 309 adult patients with cancer attending oncology outpatient clinics between December 2023 and April 2024. Data were collected using the Sinhala-validated Short-Form Brief Pain Inventory (BPI-SF) and the EORTC QLQ-C30 (version 3; scored 0–100 across five functional scales, nine symptom scales, and a global health status/HRQOL scale), supplemented by a structured sociodemographic and clinical questionnaire. Descriptive statistics, Mann–Whitney U tests, Chi-square tests, Spearman rank-order correlations, and multiple linear regression were performed.
Results: A total of 309 adult cancer patients participated (mean age 51.2 years, SD 10.2; 72.8% female). The prevalence of cancer pain was 58.6% (n = 181); among patients with pain, 77.3% reported mild, 13.3% moderate, and 9.4% severe pain. The mean global HRQOL score (EORTC QLQ-C30) was 53.99 (SD 23.91). Patients with pain reported significantly lower HRQOL than those without (mean 50.32 vs. 59.18; Mann–Whitney U = 8,914.50; Z = −3.451; p < 0.001). In the multivariable linear regression, pain presence (β = −0.165, p = 0.005) and low household income (β = −0.132, p = 0.022) were independent predictors of poorer HRQOL, explaining 3.1% of the variance of global HRQOL (adjusted R² = 0.031).
Conclusions: The prevalence of cancer pain was 58.6%, with the majority (77.3%) reporting mild pain. The mean global HRQOL score was 53.99, indicating moderate impairment. Cancer pain is independently associated with poorer HRQOL, along with financial hardship. Routine validated pain screening, guideline-concordant multimodal pain management, and targeted socioeconomic support are urgently needed within Sri Lankan oncology services.