Pain may be one of the most common symptoms experienced by patients with cancer, but researchers are still unpacking its mysteries, with some surprising results. According to data presented at the 2019 Supportive Care in Oncology Symposium,¹ greater social support may help mitigate pain in patients with cancer.

Results of the retrospective analysis of nearly 12,000 patients showed that higher levels of anxiety and depression were associated with increased pain intensity within 3 months of a cancer diagnosis and more than 1 year after diagnosis. What’s more, the effect of depression and anxiety on pain differed by the level of social support. These findings suggest that anxiety, depression, and social support may be modifiable factors that can greatly impact a patient’s pain experience, authors of the study noted.

Sarah Kathryn Galloway, PhD

“This is the largest study to date examining cancer pain intensity, psychological factors of anxiety and depression, and social support,” said Sarah Kathryn Galloway, PhD, a psychologist and clinical specialist at Levine Cancer Institute, Charlotte, North Carolina. “Based on these data, it looks like social support buffers the negative impact of anxiety and depression on pain. Clinicians who treat cancer pain should be attuned to modifiable psychological factors that can greatly influence a patient’s pain experience.”

As Dr. Galloway explained, symptoms of pain can cause significant impairment to patients’ quality of life and functioning. Anxiety and depression are also prevalent in the cancer population, she added, and both are highly comorbid with pain. Social support is an important resource used by patients to cope with cancer; however, Dr. Galloway noted that the evidence regarding the relation between cancer pain intensity and social support is relatively mixed.

Study Details and Key Findings

For this retrospective analysis, Dr. Galloway and colleagues included patients with stage I to IV cancer (n = 11,815) who completed a routine, tablet-based psychosocial distress screening at a large academic hybrid, multisite, community-based cancer institute between January 2017 and January 2019. The researchers matched participants to the Cancer Registry (n = 7,333) and incorporated clinical and demographic factors into lasso regression models. These models identified pain predictors from self-reported anxiety, depression, and social support; analyses examined whether the effect of anxiety and depression on pain differed by levels of social support.

As Dr. Galloway reported, approximately 17% of patients in the study experienced severe pain, but these percentages were higher among certain populations. Data showed that tumor site (thoracic, musculoskeletal, gastrointestinal, and gynecologic), advanced stage of disease, and lower income independently predicted pain intensity. When compared with white patients, a higher percentage of African American, Native American, and Latino patients also experienced severe pain.

In addition, Dr. Galloway reported, anxiety (β = 0.48, P < .001) and depression (β = 0.69, P < .001) were significant factors impacting pain intensity, and these associations remained after accounting for patient characteristics. What’s more, the relationship between depression and pain varied by the level of social support (P = .009) for patients screened within 3 months of diagnosis and 1 year removed from diagnosis. The effect of anxiety on pain also differed by the level of social support, said Dr. Galloway, but just for patients 1 year removed from diagnosis.

What’s Next?

“These findings demonstrate the need for interdisciplinary and multimodal—both pharmaceutical and nonpharmaceutical—interventions for pain,” Dr. Galloway concluded. “Based on these data, psychiatric and social factors can also differentially impact patients across their journey with cancer.”

Dr. Galloway and colleagues plan to analyze these data in a longitudinal format to study the differential impact of social support on mood, anxiety, and pain across the cancer trajectory. The researchers are also designing a prospective interventional trial to target some of these modifiable psychosocial factors to influence pain intensity. 

DISCLOSURE: Dr. Galloway reported no conflicts of interest.

REFERENCE

1. Galloway SK, Meadors P, Boselli D, et al: Anxiety, depression, pain, and social support in a large representative cancer population. 2019 Supportive Care in Oncology Symposium. Abstract 76. Presented October 26, 2019.