Epidemiology Of Pain In Cancer Survivors

While surveys have not been done specifically for pain, some information can be gleaned from quality of life surveys of cancer survivors. Information on the prevalence of pain in cancer survivors is sometimes contradictory. In some studies the prevalence of pain may actually be lower than in a control group, and may differ between studies. There are a number of possible explanations. Recruitment strategies may be different, leading to different populations studied. As many pain syndromes can result from specific cancer treatments, the prevalence of pain syndromes may be affected by the era in which the patient was treated. The response rates vary between surveys. It should also be noted that surveys rely on self-report with additional professional pain assessments only done rarely. How patients interpret the survey questions can affect the response. Consequently, the prevalence of cancer-related pain in survivors, and how that relates to other common pain complaints, is difficult to discern at this point.

In this section, we will present data from larger surveys of survivors. Surveys limited to survivors by disease site will be summarized elsewhere in this chapter.

One of the first surveys was of 687 members of the National Coalition for Cancer Survivorship, where 81% of the respondents were women, breast cancer was the most frequent diagnosis (43%), and the median time from diagnosis was 80 months, the scores for physical well-being were lowest of the different quality of life domains, and both fatigue and aches/pains were rated by respondents as affecting their physical well-being. Interestingly, living with a spouse, being more than 5 years after diagnosis, and a higher income level were ameliorating factors.16

In a survey of 9535 survivors of childhood cancer, the prevalence of pain attributed to cancer or its treatment was 10.2%. Patients at increased risk were those with age greater than 24 years at interview, income of less than $20,000/year (OR = 1.8; 95% CI: 1.5-2.1), education of high school or less (OR = 1.4; 95% CI: 1.2-1.6), and diagnoses of sarcoma (OR = 1.9, 95% CI: 1.5-2.3) or bone cancer (OR = 3.1; 95% CI: 2.5-3.8) were at increased risk for pain. Patients with a diagnosis of Hodgkin's disease were at decreased risk (OR = 0.7; 95% CI: 0.6-0.9). Patients who had received radiation therapy had an increased odds ratio varying from 1.5 to 3.4 depending on the region radiated. This was not found for surgery or chemotherapy. The authors noted the difficulty in evaluating somatic complaints as a significant percentage of survivors of sarcomas and bone tumors experience cancer-related anxiety and fears, and therefore the need for a multifaceted approach to evaluation in order to determine those factors that affect pain in individual survivors.17

For older adults, a survey of 321 survivors (mean age 72 years, average period of time from diagnosis 10 years) randomly selected from a tumor registry of a cancer center found that out of 22 possible symptoms, the average number was 3.5 (SD = 2), and one symptom was attributed to cancer or its treatment. The most common symptom was pain, present in 31% and attributed to cancer by 21% of the patients with pain. By primary site, pain was reported by 42% of patients with breast cancer, 27% ofpatients with colorectal cancer, and 20% ofpatients with prostate cancer. Pain was attributed to cancer by 29% of the patients with breast cancer, 11% of the patients with colorectal cancer, and 11% of patients with prostate cancer. The number of years since diagnosis was inversely correlated to the association of a symptom with cancer, and the number of symptoms was correlated both with the number of types of treatments, and with having received chemotherapy.18 In another survey of 964 older cancer survivors compared to 14,333 control patients, cancer survivors were more likely to experience arthritis (69% vs. 59%, p < 0.001) and to report frequent pain (36.4% vs. 29%, p < 0.005).19 Other quality of life surveys show that in certain types of cancer, such as testicular and cervical cancers, survivors report less pain than control groups.20,21

From these studies, we can conclude that a significant fraction of cancer survivors experience pain which they attribute to their cancer or its treatment. There are data to indicate that a high-risk group of survivors for cancer-related pain are within 5 years of treatment, have a lower socioeconomic status, and are more likely to have undergone intensive treatments.

Much remains to be learned regarding the epidemiology of pain in cancer survivors. While healthy controls report a similar prevalence of pain, the type, quality, and the impact of pain may differ in cancer survivors

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