Cancer-Related Chronic Pain Among Survivors

TON - February 2011 Vol 4, No 1 — February 16, 2011

Cancer-related pain does not stop after the initial treatment period for almost 20% of survivors. In a first-of-its-kind study, researchers also found racial, in this study blacks, and sex, in this study women, disparities in cancer-related chronic pain.

Defining survivorship as beginning at diagnosis, Carmen R. Green, MD, and colleagues at the University of Michigan, Ann Arbor, surveyed diverse cancer survivors with breast, colorectal, lung, and prostate cancer as well as multiple myeloma to evaluate the impact of cancer- related chronic pain on quality of life (QOL). To ensure consistency, the researchers analyzed data using diagnosis plus 2 years.

Of 199 patients, 31% were black, 49% were women, 20% experienced current pain, and 43% reported pain since diagnosis. Although the rate of pain among blacks did not significantly differ from that of whites, blacks reported greater pain severity (P = .001), as well as interference and disability (P <.05). Com pared with men, women experienced more pain (P <.001) and greater severity (P = .04).

When the researchers looked at the impact of this pain, they found that patients with current pain reported poorer general health (P = .001) and physical (P <.001), role (P <.001), and social (P <.001) functioning. In addition, pa tients with past pain re ported greater financial difficulty (P = .003). In an effort to identify those at risk for pain, the researchers looked at age, race, sex, and cancer type and treatment. They found no significant predictors for current pain; however, female sex predicted having had pain since diagnosis (b= –.43; P = .02), as did black race (b = .45; P <.001).

“This is where nurses really can have a tremendous role in improving pain care, because they are really good at methods to improve a pa tient’s quality of life,” said Green in an interview with the Academy of Oncology Nurse Navigators, noting that asking patients about pain and informing them of the potential for pain and working with them to improve their QOL is important. She suggested that nurses can “get the patient to talk about the fact that they may have pain, and acknowledge that the pain is not necessarily a sign that the cancer has gotten worse or that the cancer has come back. They can let patients know that there are a number of different things that healthcare providers can do to assess and treat pain, from acupuncture to psychological counseling to medications to nerve blocks.”

Awareness and continued research are equally important. “This is a significant survivorship issue and health policy issue,” said Green. “If you think about one in three people having cancer and, if our numbers hold up in other studies, that 20% of people have cancer-related chronic pain, we are talking about millions of people who are impacted in their quality of life and health and well-being when we can do something to improve all these.”

As the first study to identify these disparities, Green suggested that much re search remains to be done. For example, we do not currently know if there are additional barriers that we need to address, such as financial, emotional, or social barriers, or if there are cultural norms that make these populations more at risk.

The complete study is published online in Cancer (November 18, 2010).

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