Recent data from the National Cancer Institute suggest that more than 60% of people diagnosed with cancer will be alive within 5 years of their diagnosis, and about one in three individuals will experience cancer at some point in their life. Clinical studies have shown that many patients with cancer also experience significant pain, either from the cancer itself or from the treatments that are required to eliminate the disease. Most cancer survivors who have pain report that it is relieved only some of the time. The consequences of poorly treated pain are profound, ranging from poor sleep and mood to reduced function and even an increased risk of death. As Americans continue to age at an increasing pace, the incidence of pain accompanying cancer is expected to rise. The healthcare system is likely to be burdened substantially because of these important quality-of-life (QOL) issues.
Trending Pain in Cancer Survivors
In the May 1, 2011 issue of Cancer, my colleagues and I from the University of Michigan Health System published a study that examined cancer-related chronic pain and its impact on QOL in African-American and Caucasian cancer survivors. The study, which was sponsored by the Lance Armstrong Foundation, focused on current and past pain, health, and QOL in survivors of breast, colorectal, lung, and prostate cancer, as well as multiple myeloma. About one in five cancer survivors (19.5%) experienced current pain, and two in five (42.6%) reported pain within the past 2 years since being diagnosed with their cancer. The pain was worse for African Americans and women than for Caucasians and men.
“When necessary and appropriate, both pharmacologic and non-pharmacologic therapies should be utilized to optimize pain care and improve QOL.”
Our research also revealed that the most significant source of pain was cancer surgery (53.8%) for Caucasians and cancer treatment (46.2%) for African Americans. Women reported having increased pain, more pain flares, more disability due to pain, and were more depressed than men with cancer because of their pain. African Americans with pain reported higher pain severity and expressed more concern about harmful pain resulting as a treatment side effect. They also had greater pain-related disability. Overall, cancer survivors in the study who experienced pain were more likely to report:
Greater depressive symptoms.
More pain symptoms.
Increased financial difficulties.
A Population Deserving of More Attention
Our study addresses a significant knowledge gap and survivorship issue, and highlights significant clinical and health policy issues. Pain associated with cancer may cause increased morbidity and diminished QOL for many survivors. Clinicians need to be proactive when addressing pain and make efforts to address depression, physical functioning, and financial considerations in these individuals. Fortunately, there are opportunities to improve the quality of clinical care for cancer survivors, especially with regards to pain. When necessary and appropriate, both pharmacologic (eg, opioids and nerve blocks) and non-pharmacologic therapies (eg, counseling) should be utilized to optimize pain care and improve QOL.
Clinicians also need to think about how they communicate with their cancer survivors about pain. Differences in communication styles may compromise the willingness of patients to disclose concerns and the willingness of providers to address these concerns. In future analyses, it would behoove clinicians to explore interventions that aim to optimize physician-patient communication, address attitudes regarding pain management, and decrease physician variability in pain management decision making to improve the quality of pain care and reduce disparities in care.
Readings & Resources (click to view)
Green CR, Hart-Johnson T, Loeffler DR. Cancer-related chronic pain: examining quality of life in diverse cancer survivors. Cancer. 2010 Nov 18. Available at:http://www.canceronlinejournal.com/view/OTc2ODcxL0pBLzU5MDgxMy9udWxs/journalArticleHtml.html.
Green CR, Montague L, Hart-Johnson T. Consistent and breakthrough pain in diverse advanced cancer patients: a longitudinal examination. J Pain Symptom Manage. 2009;37:831-847.
Deimling GT, Sterns S, Bowman KF, Kahana B. The health of older-adult, long-term cancer survivors. Cancer Nurs. 2005;28:415-424.
Jensen MP, Chang HY, Lai YH, Syrjala KL, Fann JR, Gralow JR. Pain in long-term breast cancer survivors: frequency, severity, and impact. Pain Med. 2010;11:1099-1106.