Cancer Pain and Coping

  • Sara E. AppleyardEmail author
  • Chris Clarke


Receiving a diagnosis of cancer can be devastating. Cancer continues to be one of the most feared diagnoses, and experiencing pain is a major fear for people diagnosed with cancer. Cancer pain is complex in aetiology and can be acute or chronic and can be caused by various compression, ischaemic, neuropathic or inflammatory processes. Many people with cancer will experience excruciating pain, which is often underreported and undertreated. The reasons for this are complex and include various factors including fears and beliefs held by patients. Cognitive factors are important modulators of pain and the appraisals, meanings and beliefs that people have in relation to illness, cancer, and pain, have implications in regard to help-seeking behaviours and the coping strategies people adopt. Cancer pain can impact a range of psycho-social factors across its course. Cancer pain relates to higher rates of psychological distress, anxiety and low mood, and the perception of pain intensity is, in turn, influenced by psychological factors. Cancer pain can negatively affect psychological health, and psycho-social factors can affect the pain experience. It has been suggested that people with a life-limiting illness experience ‘total pain’, and this can encompass psychological, social, practical, spiritual domains. Research demonstrates that cancer is predominantly an illness affecting older people, yet there is a higher risk of under-treated pain in this age group and there is a paucity of research into the subjective experiences of older people managing their cancer pain. Many older people are required to self-manage cancer pain at home as outpatients, due to drivers to keep people out of inpatient care, such as the high healthcare costs of inpatient treatment, and patients wanting to manage their illness, and die, at home. Our own research into this area found that the self-management of cancer pain involves a sequential and temporal process, which centres on perceptions of control. We describe how the older people in our study experienced a perceived loss of control, followed by a sense of gaining control over pain through various experience of certain internal and external factors. The assessment and treatment of physical pain should be done in combination with assessment and treatment of psycho-social and spiritual pain, and interventions for cancer pain need to focus on increasing positive affect and reducing helplessness. No person should suffer with poorly controlled pain and we argue for the need for further research in this area to ensure adequate treatment for all.

Clinical Implications: Assessment and treatment of physical pain in people with cancer needs to be conducted in combination with assessment and treatment of psycho-social issues and spiritual pain. Psychological and behavioural approaches have strong evidence supporting their efficacy for reducing cancer pain. Interventions should target helplessness and focus on increasing positive affect through positive psychological states including fighting spirit and resilience. Person-centred interventions that focus on helping people with the search for meaning may help those with cancer pain derive positive benefits.


Cancer Oncology Pain Older person Coping Meaning Appraisal Self-management Systematic review Interpretative Phenomenological Analysis (IPA) 


  1. 1.
    Cipta AM, Pietras CJ, Weiss TE, Strouse TB. Cancer-related pain management in clinical oncology. J Community Support Oncol. 2015;13(10):347–55.PubMedCrossRefGoogle Scholar
  2. 2.
    Quaresma M, Coleman MP, Rachet B. 40-year trends in an index of survival for all cancers combined and survival adjusted for age and sex for each cancer in England and Wales, 1971–2011: a population-based study. Lancet. 2015;385:1206–18.PubMedCrossRefGoogle Scholar
  3. 3.
    Wiffen PJ, Wee B, Derry S, Bell RF, Moore RA. Opioids for cancer pain–an overview of Cochrane reviews. Cochrane Database Syst Rev. 2017;7:CD012592.PubMedGoogle Scholar
  4. 4.
    Van den Beuken-van Everdingen MH, Hochstenbach LM, Joosten EA, Tjan-Heijnen VC, Janssen DJ. Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. J Pain Symptom Manag. 2016;51(6):1070–90.CrossRefGoogle Scholar
  5. 5.
    Raphael J, Ahmedzai S, Hester J, Urch C, Barrie J, Williams J, et al. Cancer pain: part 1: pathophysiology; oncological, pharmacological, and psychological treatments: a perspective from the British pain society endorsed by the UK association of palliative medicine and the royal college of general practitioners. Pain Med. 2010;11(5):742–64.PubMedCrossRefGoogle Scholar
  6. 6.
    World Health Organisation. Cancer [Internet]. Switzerland: World Health Organisation; 2018 [cited 2018 Oct 6]. Available from
  7. 7.
    Sudhakar A. History of cancer, ancient and modern treatment methods. J Cancer Sci Ther. 2009;1(2):1–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):359–86.CrossRefGoogle Scholar
  9. 9.
    Cancer Research UK. Cancer statistics for the UK [Internet]. London: Cancer Research UK; 2018 [cited 2018 Aug 17]. Available from
  10. 10.
    Ward SE, Carlson-Dakes K, Hughes S, Kwekkeboom K, Donovan H. The impact on quality of life of patient-related barriers to pain management. Res Nurs Health. 1998;21(5):405–13.PubMedCrossRefGoogle Scholar
  11. 11.
    Syrjala KL, Jensen MP, Mendoza ME, Yi JC, Fisher HM, Keefe FJ. Psychological and behavioral approaches to cancer pain management. J Clin Oncol. 2014;32(16):1703–11.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Katz J, Melzack R. Measurement of pain. Surg Clin North Am. 1999;79(2):231–52.PubMedCrossRefGoogle Scholar
  13. 13.
    Leventhal H, Meyer D, Nerenz D. The common sense representation of illness danger. In: Rachman S, editor. Contributions to medical psychology, vol. II. New York: Pergamon Press; 1980. p. 7–30.Google Scholar
  14. 14.
    Folkman S, Lazarus RS, Gruen RJ, DeLongis A. Appraisal, coping, health status, and psychological symptoms. J Pers Soc Psychol. 1986;50:571–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Roesch SC, Rowley AA. Evaluating and developing a multidimensional, dispositional measure of appraisal. J Pers Assess. 2005;85(2):188–96.PubMedCrossRefGoogle Scholar
  16. 16.
    Lee V, Cohen SR, Edgar L, Laizner AM, Gagnon AJ. Clarifying ‘meaning’ in the context of cancer research: a systematic literature review. Palliat Support Care. 2004;2:291–303.PubMedCrossRefGoogle Scholar
  17. 17.
    Park C, Folkman S. Meaning in the context of stress and coping. Rev Gen Psychol. 1997;1(2):115–44.CrossRefGoogle Scholar
  18. 18.
    Chambers SK, Baade P, Youl P, Aitken J, Occhipinti S, Vinod S, et al. Psychological distress and quality of life in lung cancer: the role of health-related stigma, illness appraisals and social constraints. Psychooncology. 2015;24(11):1569–77.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Turk DC, Salovey P. Towards an understanding of life with cancer: personal meanings, psychosocial problems, and coping resources. Hosp J. 1985;1(1):73–84.CrossRefGoogle Scholar
  20. 20.
    Somerfield MR, McCrae RR. Stress and coping research: methodological challenges, theoretical advances, and clinical applications. Am Psychol. 2000;55(6):620–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Lazarus RS, Folkman S. Stress, appraisal and coping. New York: Springer; 1984. 456 p.Google Scholar
  22. 22.
    Jensen MP, Turner JA, Romano JM, Karoly P. Coping with chronic pain: a critical review of the literature. Pain. 1991;47(3):249–83.PubMedCrossRefGoogle Scholar
  23. 23.
    Chirico A, Serpentini S, Merluzzi T, Mallia L, Del Bianco P, Martino R, et al. Self-efficacy for coping moderates the effects of distress on quality of life in palliative cancer care. Anticancer Res. 2017;37(4):1609–15.PubMedCrossRefGoogle Scholar
  24. 24.
    Greer S. CBT for emotional distress of people with cancer: some personal observations. Psychooncology. 2007;17(2):170–3.CrossRefGoogle Scholar
  25. 25.
    Franks HM, Roesch SC. Appraisals and coping in people living with cancer: a meta-analysis. Psychooncology. 2006;15(12):1027–37.PubMedCrossRefGoogle Scholar
  26. 26.
    Endler NS, Parker JD, Summerfeldt LJ. Coping with health problems: conceptual and methodological issues. Can J Behav Sci. 1993;25(3):384–99.CrossRefGoogle Scholar
  27. 27.
    Roberts D, Calman L, Large P, Appleton L, Grande G, Lloyd-Williams M, et al. A revised model for coping with advanced cancer. Mapping concepts from a longitudinal qualitative study of patients and carers coping with advanced cancer onto Folkman and Greer’s theoretical model of appraisal and coping. Psychooncology. 2018;27(1):229–35.PubMedCrossRefGoogle Scholar
  28. 28.
    Dunkel-Schetter C, Feinstein LG, Taylor SE, Falke RL. Patterns of coping with cancer. Health Psychol. 1992;11(2):79–87.PubMedCrossRefGoogle Scholar
  29. 29.
    Bower JE, Epel E, Moskowitz JT. Biological correlates: how psychological components of benefit finding may lead to physiological benefits. In: Park C, Lechner S, Stanton A, Antoni M, editors. Medical illness and positive life change: can crisis lead to personal transformation? Washington, DC: APA Press; 2009. p. 155–72.CrossRefGoogle Scholar
  30. 30.
    Coyne JC, Tennen H. Positive psychology in cancer care: bad science, exaggerated claims, and unproven medicine. Ann Behav Med. 2010;39(1):16–26.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Somers TJ, Keefe FJ, Pells JJ, Dixon KE, Waters S, Riordan PA. Pain catastrophizing and pain-related fear in osteoarthritis patients: relationship to pain and disability. J Pain Symptom Manag. 2009;37(5):863–72.CrossRefGoogle Scholar
  32. 32.
    Benyon K, Muller S, Hill S, Mallen C. Coping strategies as predictors of pain and disability in older people in primary care: a longitudinal study. BMC Fam Pract. 2013;14(1):67.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Appleyard SE, Clarke C. A systematic literature review of self-initiated coping strategies: who chooses what? In: Appleyard SE, Self-management of cancer pain [doctoral thesis] University of Hull, UK; 2014. Available from
  34. 34.
    Breivik H, Cherny N, Collett B, de Conno F, Filbet M, Foubert AJ, et al. Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol. 2009;20(8):1420–33.PubMedCrossRefGoogle Scholar
  35. 35.
    Popay J, Roberts HM, Sowden A, Petticrew M, Arai L, Rodgers M, et al. Guidance on the conduct of narrative synthesis in systematic reviews: a product from the ESRC Methods Programme. London: Institute for Health Research; 2006. 281 p.Google Scholar
  36. 36.
    Bennett MI, Closs SJ, Chatwin J. Cancer pain management at home (I): do older patients experience less effective management than younger patients? Support Care Cancer. 2008;17(7):787–92.PubMedCrossRefGoogle Scholar
  37. 37.
    Gagliese L, Jovellanos M, Zimmermann C, Shobbrook C, Warr D, Rodin G. Age related patterns in adaptation to cancer pain: a mixed methods study. Pain Med. 2009;10(6):1050–61.PubMedCrossRefGoogle Scholar
  38. 38.
    Haozous EA, Knobf MT, Brant JM. Understanding the cancer pain experience in American Indians of the Northern Plains. Psychooncology. 2011;20(4):404–10.PubMedCrossRefGoogle Scholar
  39. 39.
    Reddick BK, Nanda JP, Campbell L, Ryman DG, Gaston-Johansson F. Examining the influence of coping with pain on depression, anxiety, and fatigue among women with breast cancer. J Psychosoc Oncol. 2005;23(2/3):137–57.PubMedGoogle Scholar
  40. 40.
    Im EO, Lee SH, Liu Y, Lim HJ, Guevara E, Chee W. A national online forum on ethnic differences in cancer pain experience. Nurs Res. 2009;58(2):86–94.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Whale Z, Lyne PA, Papanikolaou P. Pain experience following radical treatment for head and neck cancer. Eur J Oncol Nurs. 2001;5(2):112–20.PubMedCrossRefGoogle Scholar
  42. 42.
    Kwekkeboom KL. Pain management strategies used by patients with breast and gynaecologic cancer with postoperative pain. Cancer Nurs. 2001;24(5):378–86.PubMedCrossRefGoogle Scholar
  43. 43.
    Fischer DJ, Villines D, Kim YO, Epstein JB, Wilkie DJ. Anxiety, depression, and pain: differences by primary cancer. Support Care Cancer. 2009;18(7):801–10.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Gaston-Johansson F, Ohly KV, Fall-Dickson JM, Nanda JP, Kennedy MJ. Pain, psychological distress, health status, and coping in patients with breast cancer scheduled for autotransplantation. Oncol Nurs Forum. 1999;26(8):1337–45.PubMedGoogle Scholar
  45. 45.
    Miaskowski C, Lee KA. Pain, fatigue, and sleep disturbances in oncology outpatients receiving radiation therapy for bone metastasis: a pilot study. J Pain Symptom Manag. 1999;17(5):320–32.CrossRefGoogle Scholar
  46. 46.
    Buck R, Morley S. A daily process design study of attentional pain control strategies in the self-management of cancer pain. Eur J Pain. 2006;10(5):385–98.PubMedCrossRefGoogle Scholar
  47. 47.
    Lin CC. Comparison of the effects of perceived self-efficacy on coping with chronic cancer pain and coping with chronic low back pain. Clin J Pain. 1998;14(4):303–10.PubMedCrossRefGoogle Scholar
  48. 48.
    Prasertsri N, Holden J, Keefe FJ, Wilkie DJ. Repressive coping style: relationships with depression, pain and pain coping strategies in lung cancer outpatient. Lung Cancer. 2011;71(2):235–40.PubMedCrossRefGoogle Scholar
  49. 49.
    Rosenstiel AK, Keefe FJ. The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment. Pain. 1983;17(1):33–44.PubMedPubMedCentralCrossRefGoogle Scholar
  50. 50.
    Wilkie DJ, Keefe FJ. Coping strategies of patients with lung cancer related pain. Clin J Pain. 1991;7(4):292–9.PubMedCrossRefGoogle Scholar
  51. 51.
    Arathuzik MD. The appraisal of pain and coping in cancer patients. West J Nurs Res. 1991;13(6):714–31.PubMedCrossRefGoogle Scholar
  52. 52.
    Bandura A, O'Leary A, Taylor CB, Gauthier J, Gossard D. Perceived self-efficacy and pain control: opioid and nonopioid mechanisms. J Pers Soc Psychol. 1987;53(3):563–71.PubMedCrossRefGoogle Scholar
  53. 53.
    Leung L. Pain catastrophizing: an updated review. Indian J Psychol Med. 2012;34(3):204–17.PubMedPubMedCentralCrossRefGoogle Scholar
  54. 54.
    Dalton JA, Keefe FJ, Carlson J, Youngblood R. Tailoring cognitive behavioural treatment for cancer pain. Pain Manag Nurs. 2004;5(1):3–18.PubMedCrossRefGoogle Scholar
  55. 55.
    Chatwin J, Closs J, Bennett M. Pain in older people with cancer: attitudes and self management strategies. Eur J Cancer Care. 2009;18(2):124–30.CrossRefGoogle Scholar
  56. 56.
    Deshields TL, Tait RC, Manwaring J, Trinkaus KM, Naughton M, Hawkins J, et al. The cancer pain inventory: preliminary development and validation. Psychooncology. 2010;19(7):684–92.PubMedCrossRefGoogle Scholar
  57. 57.
    Knight BG, McCallum TJ. Adapting psychotherapeutic practice for older clients: implications of the contextual, cohort-based, maturity, specific challenge model. Prof Psychol Res Pract. 1998;29(1):15–22.CrossRefGoogle Scholar
  58. 58.
    Abdulla A, Adams N, Bone M, Elliott AM, Gaffin J, Jones D, et al. Guidance on the management of pain in older people. Age Ageing. 2013;42(1):1–57.CrossRefGoogle Scholar
  59. 59.
    McPherson CJ, Hadjistavropoulos T, Lobchuk MM, Kilgour KN. Cancer-related pain in older adults receiving palliative care: patient and family caregiver perspectives on the experience of pain. Pain Res Manag. 2013;18(6):293–300.PubMedPubMedCentralCrossRefGoogle Scholar
  60. 60.
    Foster C, Fenlon D. Recovery and self-management support following primary cancer treatment. Br J Cancer. 2011;105(1):21–8.CrossRefGoogle Scholar
  61. 61.
    Ferrell BR, Schneider C. Experience and management of cancer pain at home. Cancer Nurs. 1988;11(2):84-90.PubMedCrossRefGoogle Scholar
  62. 62.
    Rockett MP, Simpson G, Crossley R, Blowey S. Characteristics of pain in hospitalized medical patients, surgical patients, and outpatients attending a pain management centre. Br J Anaesth. 2013;110(6):1017–23.PubMedCrossRefGoogle Scholar
  63. 63.
    Department of Health. Improving outcomes: a strategy for cancer. London: Department of Health and Social Care; 2011 [cited 2012 Nov 2]. Available from
  64. 64.
    Appleyard SE, Clarke C. An interpretative phenomenological analysis of the experiences of older people self-managing cancer pain at home. J Psychosoc Oncol. 2018;36(3):333–49.PubMedCrossRefGoogle Scholar
  65. 65.
    Snelgrove S. An interpretative phenomenological analysis of non-malignant chronic low back pain. In: van Rysewyk S, editor. Meanings of pain, vol. 1. Cham: Springer; 2016. p. 129–47.CrossRefGoogle Scholar
  66. 66.
    Smith JA, Osborn M. Interpretative phenomenological analysis. In: Smith JA, editor. Qualitative psychology: a practical guide to research methods. London: Sage; 2003.Google Scholar
  67. 67.
    Brocki JM, Wearden AJ. A critical evaluation of the use of interpretative phenomenological analysis (IPA) in health psychology. Psychol Health. 2006;21(1):87–108.CrossRefGoogle Scholar
  68. 68.
    Peterson C, Seligman MEP. Character strengths and virtues: a handbook and classification, vol. 800. Oxford: Oxford University Press; 2004.Google Scholar
  69. 69.
    Smith JA, Osborn M. Pain as an assault on the self: an interpretative phenomenological analysis of the psychological impact of chronic benign low back pain. Psychol Health. 2007;22(5):517–34.CrossRefGoogle Scholar
  70. 70.
    Chapman CR, Gavrin J. Suffering: the contributions of persistent pain. Lancet. 1999;353(9171):2233–7.PubMedCrossRefGoogle Scholar
  71. 71.
    Haley WE. Family caregivers of elderly patients with cancer: understanding and minimising the burden of care. J Support Oncol. 2003;1(2):25–9.PubMedGoogle Scholar
  72. 72.
    Murray G, Judd F, Jackson H, Fraser C, Komiti A, Pattison P, et al. Big boys don’t cry: an investigation of stoicism and its mental health outcomes. Pers Individ Dif. 2008;44(6):1369–81.CrossRefGoogle Scholar
  73. 73.
    Ferrell BR, Taylor EJ, Grant M, Fowler M, Corbisiero RM. Pain management at home: struggle, comfort, and mission. Cancer Nurs. 1993;16(3):169–78.PubMedCrossRefGoogle Scholar
  74. 74.
    Crisson JE, Keefe FJ. The relationship of locus of control to pain coping strategies and psychological distress in chronic pain patients. Pain. 1988;35(2):147–54.PubMedCrossRefGoogle Scholar
  75. 75.
    Usta YY. Importance of social support in cancer patients. Asian Pac J Cancer Prev. 2012;13(8):3569–72.PubMedCrossRefGoogle Scholar
  76. 76.
    Watson M, Kissane DW. Handbook of psychotherapy in cancer care. Oxford: Wiley; 2011. 284 p.CrossRefGoogle Scholar
  77. 77.
    Tatrow K, Montgomery GH. Cognitive behavioral therapy techniques for distress and pain in breast cancer patients: a meta-analysis. J Behav Med. 2006;29(1):17–27.PubMedCrossRefGoogle Scholar
  78. 78.
    Ong CK, Forbes D. Embracing cicely Saunders’s concept of total pain. BMJ. 2005;331(7516):576.PubMedPubMedCentralCrossRefGoogle Scholar
  79. 79.
    Puchalski CM, Vitillo R, Hull SK, Reller N. Improving the spiritual dimension of whole person care: reaching national and international consensus. J Palliat Med. 2014;17(6):642–56.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Clinical Psychology for Older People, Humber Teaching NHS Foundation TrustHullUK
  2. 2.Department of Psychological Health & WellbeingUniversity of HullHullUK

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