Pain Characterization: Presentation Patterns, and Multidimensional Assessment in Women with Advanced Gynecologic Cancer in a Palliative Care Service

Abstract Background Pain in advanced cancer is a complex and multidimensional phenomenon extending beyond intensity to include biological, psychological, and social components. In women with advanced gynecologic malignancies, pain is highly prevalent yet often undercharacterized, particularly in resource-limited settings where disparities in access and delayed integration of palliative care may influence its presentation and management. Objective To characterize multidimensional pain features and identify distinct descriptive pain patterns in women with advanced gynecologic cancer receiving palliative care. Design Observational study. Setting/Subjects Electronic medical records of women aged ≥18 years with advanced gynecologic cancer and documented pain, treated at a tertiary cancer center in Mexico between 2013 and 2023, were reviewed. Measurements Sociodemographic and clinical variables were collected. Pain assessment included location, intensity, time of onset, and characteristics (somatic, visceral, neuropathic, or mixed). Psychosocial factors, including anxiety and depression, were also evaluated. Descriptive statistics were used to explore multidimensional pain patterns. Results A total of 1,015 women were included (median age 56 years; most had≤12 years of education). Cervical and ovarian cancers predominated (43.4% and 32.3%). Pain was mainly pelvic or abdominal (81.0%) and commonly mixed visceral/neuropathic. Median intensity was moderate (4/10), with higher intensity in uterine sarcoma (median 7/10). Nearly half of patients presented anxiety or depression. Conclusions Pain in advanced gynecologic cancer is heterogeneous and multidimensional, with identifiable tumor-type-specific pain patterns that may inform individualized, patient-centered management strategies, particularly in resource-limited settings