San Francisco, CA—If you know someone who has cancer, reaching out could be the medicine he or she needs. According to data presented at the 2019 ASCO Supportive Care in Oncology Symposium, increased social support may function as an analgesic that helps to mitigate one of the most common symptoms experienced by patients with cancer—pain.
The findings from this retrospective analysis of nearly 12,000 patients with cancer showed that anxiety and depression are contributing factors to pain intensity; however, the effect of depression and anxiety on pain differed by the level of social support. In other words, said lead investigator of the study, Sarah K. Galloway, PhD, Psychologist, Department of Supportive Oncology, Levine Cancer Institute of Atrium Health, Charlotte, NC, social support may buffer the negative impact of anxiety and depression on pain.
“Clinicians who treat cancer pain should be attuned to modifiable psychological factors, which can greatly influence a patient’s pain experience,” said Dr Galloway. “Evaluating patients’ emotional health after a cancer diagnosis can help alleviate pain from their cancer and its treatment.”
Symptoms of pain can significantly impair quality of life and functioning, said Dr Galloway, but pain is only one of many ailments that a patient with cancer may have. Anxiety and depression are prevalent in this population and are correlated with pain. Furthermore, said Dr Galloway, although patients often use social support to cope with cancer and its treatment, the evidence linking cancer pain intensity and social support is lacking.
This study included 11,815 patients with stage I to stage IV cancer who completed a routine psychosocial distress screening at a large academic hybrid, multisite, community-based cancer institute between January 2017 and January 2019. The researchers then matched 7333 participants to their hospital cancer registry and included clinical and demographic factors into lasso regression models. The models identified pain predictors from the patients’ self-reported anxiety, depression, and social support, and analyzed the effect of anxiety and depression on pain by levels of social support.
The mean pain score reported by patients was 3 (scale 0-10), but 17% of the study patients had severe pain (a score of ≥7); this percentage was even higher among certain subpopulations. Patients with thoracic, musculoskeletal, gastrointestinal, or gynecologic cancers were more likely than those with other types of cancer to report severe pain, as were patients with advanced-stage disease and lower income. Race may play a role as well. A higher percentage of African-American, Native-American, and Latino patients had severe pain compared with white patients.
The data also showed that anxiety, depression, and social support significantly affected pain intensity, and these associations remained even after accounting for patient characteristics. For patients completing distress screening 1 year from diagnosis, the effect of anxiety and depression on pain varied by the level of perceived social support.
“To my knowledge, this is the largest study to date across all of the different variables in cancer pain,” said Dr Galloway. “It emphasizes the need to evaluate psychological symptoms early when addressing cancer pain, which is something that is not assessed regularly and should be. It also underscores the importance of family, interpersonal relationships, and community on pain and illness.”
According to Dr Galloway, although there is no way to determine whether the pain results from the cancer, its treatment, or something else, the study findings demonstrate the need for interdisciplinary and multimodal—pharmaceutical and nonpharmaceutical—interventions for pain control.
Tools such as cognitive behavioral therapy, mindfulness, and acceptance and commitment therapy can help alleviate psychological distress and pain and improve quality of life, said Dr Galloway. He encouraged patients to discuss feelings of depression and anxiety, as well as issues of social support with their physicians.
The researchers aim to analyze these data in a longitudinal format to examine how the impact of social support differentially affects mood, anxiety, and pain across the course of cancer therapy from diagnosis to acute treatment and survivorship. Dr Galloway and her colleagues are also planning prospective interventional studies that target some of these modifiable psychosocial factors to influence pain intensity.
Richard T. Lee, MD, Director, Supportive and Integrative Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH, who discussed the study, emphasized that simply identifying symptoms is not enough. Rather, he said, clinicians must determine the optimal intervention to help reduce symptom burden.
“Whatever the symptom burden may be, we have to keep in mind that these patients are also undergoing active cancer treatment,” Dr Lee said. “The interventions that we decide to pursue could have short- and long-term impacts on our patients, which is why I’m looking forward to more research in this area,” he added.
