In one study of 222 survivors who had undergone axillary lymph node dissection as part ofbreast cancer surgery, 72% reported shoulder arm pain. Present pain intensity was a significant predictor of quality of life measured by the EORTC QLQ-C308 with (P = 0.29; p < 0.001). Pain discomfort affect (P = 0.42; p < 0.001), sensation of pain (P = 0.289; p < 0.001), and pain disability for self care (P = 0.261; p < 0.001) were important predictors ofpsychological distress as measured by the Mental Health Inventory.9,10 In another study, 55 survivors were surveyed with a health-related quality of life instrument, the RAND-36,11 at a mean follow-up of 2.7 years from surgery, 60% reported pain and reduction of grip strength. Shoulder pain was a significant factor for the domains of social functioning (p = -2.9; 95% CI: -5.0, -0.8), mental health (P = -2.3; 95% CI: -4.1, -0.5), vitality (P = -3.8; 95% CI: -5.8, -1.8), pain (P = -0.55; 95% CI: -7.1, -3.9), health perception (P = -4.5; 95% CI: -6.3, -2.7), and health change (P = -3.8; 95% CI: -6.3, -1.3).12
In related investigations, researchers studied utility values for 692 survivors of breast, colon, melanoma or lung cancer who participated in the 1998 National Health Information Survey. Utility scores were generally lower in the acute period within 1 year of diagnosis, and were highest in the period greater than 5 years from diagnosis. Pain was a significant negative predictor of utility in long-term survivors of breast cancer (P = -0.06; 95% CI: -0.11, -0.012), colon cancer (P = -0.13; 95% CI: -0.23, -0.03), and lung cancer (P = -0.21; 95% CI: -0.37, -0.05). The other negative predictors were comorbid medical conditions.13
How pain affects quality of life in cancer survivors is an area for further study. The significance of pain to cancer survivors was explored in Gil et al.14 In the current paradigm ofthe symptom experience, perception ofthe symptom leads to a cognitive response (symptom recognition), which in turn may generate an emotional response (distress).15 Distress in turn then affects quality of life. Further understanding of the associations between pain and quality of life in cancer survivors will enable the development of interventions for both the pain itself and quality of life.
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