Pain is one of the most common symptoms associated with cancer and its treatment, and feelings of anxiety and depression can intensify the level of pain patients experience, according to the results from a study by Galloway et al that will be presented at the 2019 Supportive Care in Oncology Symposium (Abstract 76). However, authors also reported that having greater social support can help mitigate the negative impact of anxiety and depression on the level of pain patients experience. The study’s findings emphasize the need for interdisciplinary, multimodal approaches to cancer pain management.

Study Methodology

The researchers analyzed information from nearly 12,000 patients with stage I–IV cancer who completed a routine tablet-based psychosocial distress screening at Levine Cancer Institute from 2017 to 2019. The participants were matched to 7,333 patients in a cancer registry. Median age of the study participants was 59 years old; 61% were female and 77% were white. Clinicodemographic factors were incorporated into lasso regression models. The models identified pain predictors from self-reported anxiety, depression, and social support.

The researchers then analyzed whether the effect of anxiety and depression on pain level differed by levels of social support.

Results
The researchers found that tumor site, advanced stage of disease, black race, and lower income were independently associated with severe pain. In addition, anxiety, depression, and social support were significant factors impacting pain intensity, and these associations remained after accounting for patient characteristics.

Anxiety (β = 0.48, P < .001) and depression (β = 0.69, P < .001) were related to pain intensity after accounting for clinicodemographic factors. The effect of depression on pain differed by level of social support (P = .009). The effect of anxiety on pain differed in patients reporting transportation issues (P = .035).

“Our data suggests that patient characteristics of race, income, tumor site, and disease staging independently predict pain intensity. Anxiety and depression are significant factors of pain intensity; these associations remain after accounting for patient characteristics. Social support buffers the negative impact of anxiety/depression on pain. Clinicians who treat cancer pain should be attuned to modifiable psychological factors, which can greatly influence a patient’s pain experience. [Our] findings emphasize the need for interdisciplinary multimodal approaches for cancer pain,” concluded the study authors.

Clinical Relevance

In a statement commenting on this study’s findings, Monica S. Krishnan, MD, 2019 Supportive Care in Oncology Symposium News Planning Team member, said “Clinicians are trained and eager to alleviate patients’ pain, but what we often overlook is an assessment of their psychological health. This study finds that emotional health has a direct relationship to physical health and symptoms, emphasizing the importance of examining the totality of the patient’s health.”

Future analyses of the data the researchers collected will examine how the impact of social support impacts mood, anxiety, and pain from diagnosis and treatment and throughout survivorship. “Anxiety, depression, and social support are modifiable factors that can greatly impact a patient’s cancer pain experience,” said lead study author Sarah Kathryn Galloway, PhD, a psychologist at Levine Cancer Center. “[Our] study results demonstrate the need for interdisciplinary, multimodal—pharmaceutical and nonpharmaceutical—interventions for cancer-related pain.”

Disclosure: For full disclosures of the study authors, visit coi.asco.org.