Pain is prevalent and persisting in cancer survivors: Differential factors across age groups

Abstract

Objective-The Institute of Medicine documents a significant gap in care for long term side effects of cancer treatment, including pain. This paper characterizes age differences in the prevalence and predictive characteristics of pain to guide clinicians in identification and treatment.Materials and Methods-A sample of 170 adults with head and neck, esophageal, gastric, or colorectal cancers were recruited from two regional Veterans Administration Medical Centers. Face to face interviews were conducted 6, 12, and 18 months after diagnosis with the PROMIS scale to assess pain and PHQ-9 scale to assess depression. Descriptive statistics characterized incidence and prevalence of pain impact and intensity ratings. Multivariate linear hierarchical regression identified clinical characteristics associated with pain in older versus younger age groups.Results-Clinically significant pain was endorsed in one third (32%) of the sample, with younger adults reporting higher levels of the impact of pain on daily activities and work, and also higher pain intensity ratings than older adults. In younger adults, pain ratings were most associated with lower social support and higher depression, as well as advanced cancer stage. In older adults,

The cost of survival: an exploration of colorectal cancer survivors’ experiences of pain

“…CRC survivors who reported pain on the day of the survey or the week preceding participation in the survey indicated significantly poorer SRH, lower overall QoL scores, worse physical, social, emotional and functional wellbeing and a greater degree of CRC-specific QoL concerns compared to CRC survivors who did not report pain. The prevalence of pain in this sample of CRC survivors mirror the findings of previous research of cancer survivors which include multiple tumor groups [5,[7][8][9][10][11], albeit slightly higher than the prevalence reported in CRC survivor samples of other studies [5,9]. However, the finding that gender and time since diagnosis are not associated with CRC survivors' experience of pain refutes the findings of several studies [10,11,13,14,16,18].…”

“…The positive reframing of QoL in the presence of chronic symptoms is a widely discussed and accepted concept within the chronic illness literature [3,6]. However, it is estimated one third of cancer survivors experience pain following curative cancer treatment [5,[7][8][9][10][11], compared to almost two thirds of those receiving anti-cancer treatment, or living with advanced, metastatic or terminal cancer [7]. Pain is ranked as one of the most common symptoms experienced by cancer survivors [4,9,10], and has been associated with poorer physical [12] functional [11][12][13][14], psychological [14,15] and overall [16] QoL, and may contribute to social isolation in survivorship [17].…”

“…Furthermore, pain has been shown to occur in clusters with fatigue, insomnia [19], depression [8,11] and anxiety [11]. The influence of age on pain is the subject of debate.…”

“…The influence of age on pain is the subject of debate. Although almost one third of cancer survivors report pain [5,[7][8][9][10][11], approximately one tenth of older CRC survivors attribute pain to cancer-related factors [9], compared to almost two fifths of general CRC survivor samples [11]. Studies have revealed older cancer survivors are reluctant to attribute symptoms of pain, fatigue or cognitive dysfunction to cancer [17], whereas age-related factors have greater predictive ability than cancer-related factors for symptoms of pain, low energy levels and weakness [13].…”

“…Many studies of cancer survivors' pain focus on samples which include multiple tumor groups and varying inclusion criteria [8,9,[13][14][15], resulting in small samples of each tumor group or a lack of analysis of data pertaining to particular tumor groups. Meanwhile, studies which evaluate the pain of CRC survivors' have limited generalizability and scope due to small samples sizes [11,16], lack of clear definition of cancer survivorship [15], or sampling of older [12,19], early stage (<2 years) [18,19] or long-term cancer survivors (>5 years) [12].…”