The Association between Pain and Depression, Anxiety, and Cognitive Function among Advanced Cancer Patients in the Hospice Ward

Abstract

BackgroundPain is the most common but severe physical symptom among cancer patients. This study aimed to identify correlation between pain and psychological symptoms for terminal cancer patients.MethodsThe total sample consisted of 69 subjects who were recruited through two hospice wards, limited to patients who were mentally alert and had no psychiatric diseases. The subjects were divided into two groups according to the numerical rating scale: the pain-free group, 0 to 3 points; and the pain group, 4 to 10 points. We used the Beck depression inventory (BDI), Beck anxiety inventory (BAI), mini-mental status examination-Korea (MMSE-K), and short form 36 health survey (SF-36). Logistic regression analysis was performed to verify the correlation between pain and other psychosocial disorders.ResultsThe mean scores of BDI in the pain-free and pain groups were 25.7 and 31.5; mean BAI scores were 23.4 and 34.7; mean MMSE-K scores were 25.7 and 21.8, respectively. There were no significant differences between the two groups in SF-36 score except scores of body pain. The results of logistic regression analysis adjusted for age, sex, marital status, types of cancer, history of chemotherapy, or radiotherapy showed significant correlation between pain and depression (BDI ≥ 24; odds ratio [OR], 4.199; 95% confidence interval [CI], 1.171 to 15.060), and pain and cognitive impairment (MMSE < 24; OR, 5.495; 95% CI, 1.449 to 20.843); but not between pain and anxiety (BAI ≥ 22; OR, 3.011; 95% CI, 0.907 to 9.997).ConclusionPain significantly affects depression and cognitive impairment among advanced cancer patients in the hospice ward. Accordingly, more aggressive treatment of pain is required to reduce not only physical suffering but also physiological distress.

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“…This is not unexpected as depressive and anxiety disorders have been shown to be associated with worse pain severity over time [30], and pain has been shown to significantly correlate with depression in patients with advanced cancer [31]. We would hypothesize that at least some of the Anxiety/Depression benefits observed are linked to effective control of disease.…”

Anxiety, depression and pain-related coping behaviors with pain behaviors in cancer patients who are aware or unaware of their cancer

“…The subscale scores of the PCQ were not significantly different between the groups. However, a helplessness subscale score of 19 (17)(18)(19)(20)(21)(22) and a selfcoping subscale score of 23,50 (12,25) were the highest scores. The group comparisons for the HADS and the OAU are shown in Table 4.…”

“…[2,[23][24][25][26][27] It has been suggested that anxiety and depression independently contributed to the emergence of mental health and somatic symptoms, [27] pain-aggravated mood disorders. [25] Thus, a significant correlation between physical symptoms, such as pain, and depression and/or anxiety might be more common in depressed cancer patients. [26] However, in some studies, depression was found to be more prominent than anxiety; therefore, pain has been suggested to directly correlate with depression.…”

“…[26] However, in some studies, depression was found to be more prominent than anxiety; therefore, pain has been suggested to directly correlate with depression. [2,25] Pain coping scores Cancer pain may be observed as both chronic and acute pain. Acute pain develops as a result of tissue damage; hyperactivity of the sympathetic nervous system shows a strong correlation with the level of anxiety, whereas chronic pain is related to depression and vegetative symptoms.…”

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“…In the present study, 69 patients (29.3%) had a PHQ‐9 score of ≥10, which is slightly higher than that found in a previous study that used the same criteria and was probably caused by our inclusion of patients with metastatic and advanced disease. Ko et al reported that about 60% of cancer patients had depression in a hospice ward in Korea . However, comparisons are problematic because the prevalence of depression among cancer patients could be affected by physical condition, disease progression, metastasis, and other factors, and thus, prevalence rates should be compared in similar backgrounds …”