Friday, January 28, 2011

Cancer Survivors Suffer Burden of Chronic Pain

Cancer PainIn a study published online ahead of print in the journal Cancer, researchers at the University of Michigan, Ann Arbor, reported that 43% of cancer survivors had experienced pain since their diagnosis and 20% had current chronic pain related to their conditions [Green et al. 2010]. Furthermore, the pain was worse for black cancer survivors and also for women, who experienced significantly more pain, more pain flare-ups, higher disability related to pain, and more depression.

Study participants consisted of 199 cancer survivors — breast, colorectal, lung, prostate cancer, or multiple myeloma — who were recruited through the Michigan State Cancer Registry. They ranged in age from 57 to 79 years, 31% were black, and 49% were female. At the time of the study, almost all of them were cancer free or in remission (95% of women, 96% of men).

Women experienced significantly more pain (p<0.001) and greater pain severity (p=0.04) than men. Women also reported poorer cognitive functioning and more depressive symptoms. Black patients experienced greater pain severity than the others (p<0.05). They also had more pain-related interference and disability, expressed more fatalism, and had more concerns about harmful pain treatment effects. Overall, black patients also had significantly poorer general health and physical and social functioning.

As might be expected, patients with current pain reported significantly poorer general health (p=0.001), and worse physical and social functioning (p<0.001). Those with longer-standing pain reported significantly greater financial problems (p=0.003).

COMMENTARY: We have previously noted [here] that that 70% of persons with cancer experience significant pain and, despite the fact that such distress can be effectively controlled in up to 90% of those patients by following currently available opioid-prescribing guidelines, fewer than half receive adequate pain relief. This is not particular to the United States; for example, other research [discussed here] has shown that patients with cancer in much of Europe are being denied access to pain relief because of over-zealous regulations restricting the availability and accessibility of opioid-based medications.

It can be questionable to generalize the results of this present study to all cancer survivors, based on a sampling of fewer than 200 patients, and this should be kept in mind. Still, this study, which was funded by the Lance Armstrong Foundation, appears to confirm that it is misleading to assume that cancer pain is being better managed than other types of acute or chronic pain. Lead author Carmen R. Green, MD, commented, “All in all, the high prevalence of cancer and pain — and now chronic cancer pain — among these survivors, especially blacks and women, shows that there's more work to be done in improving the quality of care and research” [in Nelson 2011].

REFERENCES:
> Green CR, Hart-Johnson T, Loeffler DR. Cancer-related chronic pain: examining quality of life in diverse cancer survivors. Cancer. 2010(Nov); epub ahead of print [
abstract].
> Nelson R. Chronic Pain Common in Cancer Survivors Needs to Be Addressed. Medscape Medical News. 2011(Jan 24) [
available here].