Abstract
Goals of work
Disease-related cancer pain is a multidimensional phenomenon. Psychological factors that may alter pain perception in cancer patients have not been well studied. The study purpose was to explore differences in pain, anxiety, and depression by type of primary cancer.
Patients and methods
In a cross-sectional study of consecutive patients (80% male, mean age 60.5 ± 11.5 years) undergoing radiation treatment for head/neck (HNC, n = 93), lung (LC, n = 146), or prostate (PC, n = 63) cancers, patients reported pain quality, pattern, and intensity with the McGill Pain Questionnaire. They also completed the State Trait Anxiety Inventory, Center for Epidemiologic Studies Depression Scale, and Coping Strategies Questionnaire. Comparative statistics, correlation coefficients, and multivariate regression analysis were performed.
Main results
Worst pain intensity was significantly greater in LC subjects compared to HNC (p < 0.05) and PC (p < 0.001). Pain quality ratings were significantly greater for individuals with LC compared to PC (p < 0.05), and the regression analyses indicated that pain quality ratings were partially predicted by having LC. Depression levels approached clinical significance and were greatest for individuals with LC. Catastrophizing was correlated with high levels of depression (p < 0.01) and anxiety (p < 0.01).
Conclusions
Individuals with cancer undergoing radiation treatment experienced clinically significant levels of unrelieved cancer pain despite standard pain management. Pain intensity and quality ratings were greatest for LC individuals and may contribute to symptoms of depression. Catastrophizing may contribute to psychological factors which may impact the pain experience. Tailored treatments that meet cancer patients’ psychosocial and medical needs may result in improved pain management and functional ability.
Similar content being viewed by others
References
Ahles TA, Blanchard EB, Ruckdeschel JC (1983) The multidimensional nature of cancer-related pain. Pain 17:277–288
Berry DL, Wilkie DJ, Huang HY, Blumenstein BA (1999) Cancer pain and common pain: a comparison of patient-reported intensities. Oncol Nurs Forum 26:721–726
Bishop SR, Warr D (2003) Coping, catastrophizing and chronic pain in breast cancer. J Behav Med 26:265–281
Bruera E, Schoeller T, Wenk R, MacEachern T, Marcelino S, Hanson J, Suarez-Almazor M (1995) A prospective multicenter assessment of the Edmonton staging system for cancer pain. J Pain Symptom Manage 10:348–355
Caraceni A, Portenoy RK (1999) An international survey of cancer pain characteristics and syndromes. IASP Task Force on Cancer Pain. International Association for the Study of Pain. Pain 82:263–274
Cleary JF (2000) Cancer pain management. Cancer Control 7:120–131
Cleeland C (1991) Research in cancer pain. What we know and what we need to know. Cancer 67:823–827
Cleeland CS, Gonin R, Baez L, Loehrer P, Pandya KJ (1997) Pain and treatment of pain in minority patients with cancer. The Eastern Cooperative Oncology Group Minority Outpatient Pain Study. Ann Intern Med 127:813–816
Cleeland CS, Gonin R, Hatfield AK, Edmonson JH, Blum RH, Stewart JA, Pandya KJ (1994) Pain and its treatment in outpatients with metastatic cancer. The N Engl J Med 330:592–596
Cohen E, Botti M, Hanna B, Leach S, Boyd S, Robbins J (2008) Pain beliefs and pain management of oncology patients. Cancer Nurs 31:E1–E8
de Leeuw JR, de Graeff A, Ros WJ, Blijham GH, Hordijk GJ, Winnubst JA (2000) Prediction of depressive symptomatology after treatment of head and neck cancer: the influence of pre-treatment physical and depressive symptoms, coping, and social support. Head Neck 22:799–807
Di Maio M, Gridelli C, Gallo C, Manzione L, Brancaccio L, Barbera S, Robbiati SF, Ianniello GP, Ferrau F, Piazza E, Frontini L, Rosetti F, Carrozza F, Bearz A, Spatafora M, Adamo V, Isa L, Iaffaioli RV, Di Salvo E, Perrone F (2004) Prevalence and management of pain in Italian patients with advanced non-small-cell lung cancer. Br J Cancer 90:2288–2296
Dobratz MC (2001) Patterns of advanced cancer pain in home hospice patients. Cancer Nurs 24:294–299
Epstein JB, Beaumont JL, Gwede CK, Murphy B, Garden AS, Meredith R, Le QT, Brizel D, Isitt J, Cella D (2007) Longitudinal evaluation of the oral mucositis weekly questionnaire-head and neck cancer, a patient-reported outcomes questionnaire. Cancer 109:1914–1922
Epstein JB, Elad S, Eliav E, Jurevic R, Benoliel R (2007) Orofacial pain in cancer: part II—clinical perspectives and management. J Dent Res 86:506–518
Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198
Gil KM, Thompson RJ Jr, Keith BR, Tota-Faucette M, Noll S, Kinney TR (1993) Sickle cell disease pain in children and adolescents: change in pain frequency and coping strategies over time. J Pediatr psychol 18:621–637
Glover J, Dibble SL, Dodd MJ, Miaskowski C (1995) Mood states of oncology outpatients: does pain make a difference? J Pain Symptom Manage 10:120–128
Godding PR, McAnulty RD, Wittrock DA, Britt DM, Khansur T (1995) Predictors of depression among male cancer patients. J Nerv Ment Dis 183:95–98
Graham C, Bond SS, Gerkovich MM, Cook MR (1980) Use of the McGill pain questionnaire in the assessment of cancer pain: replicability and consistency. Pain 8:377–387
Grassi L, Rossi E, Sabato S, Cruciani G, Zambelli M (2004) Diagnostic criteria for psychosomatic research and psychosocial variables in breast cancer patients. Psychosomatics 45:483–491
Grassi L, Rosti G (1996) Psychiatric and psychosocial concomitants of abnormal illness behaviour in patients with cancer. Psychother Psychosom 65:246–252
Grond S, Zech D, Diefenbach C, Radbruch L, Lehmann KA (1996) Assessment of cancer pain: a prospective evaluation in 2266 cancer patients referred to a pain service. Pain 64:107–114
Henoch I, Bergman B, Gustafsson M, Gaston-Johansson F, Danielson E (2007) The impact of symptoms, coping capacity, and social support on quality of life experience over time in patients with lung cancer. J Pain Symptom Manage 34:370–379
Jacobsen PB, Butler RW (1996) Relation of cognitive coping and catastrophizing to acute pain and analgesic use following breast cancer surgery. J Behav Med 19:17–29
Jadad AR, Browman GP (1995) The WHO analgesic ladder for cancer pain management. Stepping up the quality of its evaluation. JAMA 274:1870–1873
Jensen MP, Turner JA, Romano JM, Karoly P (1991) Coping with chronic pain: a critical review of the literature. Pain 47:249–283
Keefe FJ, Abernethy AP, Campbell LC (2005) Psychological approaches to understanding and treating disease-related pain. Annu Rev Psychol 56:601–630
Keefe FJ, Lefebvre JC, Egert JR, Affleck G, Sullivan MJ, Caldwell DS (2000) The relationship of gender to pain, pain behavior, and disability in osteoarthritis patients: the role of catastrophizing. Pain 87:325–334
Langius A, Bjorvell H, Lind MG (1993) Oral- and pharyngeal-cancer patients' perceived symptoms and health. Cancer Nurs 16:214–221
Lesage P, Portenoy RK (1999) Trends in cancer pain management. Cancer Control 6:136–145
Li KK, Harris K, Hadi S, Chow E (2007) What should be the optimal cut points for mild, moderate, and severe pain? J Palliat Med 10:1338–1346
McDaniel JS, Musselman DL, Porter MR, Reed DA, Nemeroff CB (1995) Depression in patients with cancer. Diagnosis, biology, and treatment. Arch Gen Psychiatry 52:89–99
Melzack R (1975) The McGill Pain Questionnaire: major properties and scoring methods. Pain 1:277–299
Miaskowski C, Dibble SL (1995) The problem of pain in outpatients with breast cancer. Oncol Nurs Forum 22:791–797
Orme JG, Reis J, Herz EJ (1986) Factorial and discriminant validity of the Center for Epidemiological Studies Depression (CES-D) scale. J Clin Psychol 42:28–33
Paice JA, Toy C, Shott S (1998) Barriers to cancer pain relief: fear of tolerance and addiction. J Pain Symptom Manage 16:1–9
Pargeon KL, Hailey BJ (1999) Barriers to effective cancer pain management: a review of the literature. J Pain Symptom Manage 18:358–368
Porcelli P, Tulipani C, Maiello E, Cilenti G, Todarello O (2007) Alexithymia, coping, and illness behavior correlates of pain experience in cancer patients. Psychooncology 16:644–650
Portenoy RK (1989) Cancer pain. Epidemiology and syndromes. Cancer 63:2298–2307
Portenoy RK, Miransky J, Thaler HT, Hornung J, Bianchi C, Cibas-Kong I, Feldhamer E, Lewis F, Matamoros I, Sugar MZ et al (1992) Pain in ambulatory patients with lung or colon cancer. Prevalence, characteristics, and effect. Cancer 70:1616–1624
Radloff LS (1977) The CES-D Scale: a self-report depression scale for research in a general population. Appl Psychol Meas 1:385–401
Reich M (2008) Depression and cancer: recent data on clinical issues, research challenges and treatment approaches. Curr Opin Oncol 20:353–359
Rosenstiel AK, Keefe FJ (1983) The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment. Pain 17:33–44
Sist TC, Florio GA, Miner MF, Lema MJ, Zevon MA (1998) The relationship between depression and pain language in cancer and chronic non-cancer pain patients. J Pain Symptom Manage 15:350–358
Spiegel D, Sands S, Koopman C (1994) Pain and depression in patients with cancer. Cancer 74:2570–2578
Spielberger CG, Gorsuch F, Luchene R (1971) STAI Manual for the S-T-A-I-(self-evaluation questionnaire). Consulting Psychologist, Palo Alto
Sullivan MJ, Thorn B, Haythornthwaite JA, Keefe F, Martin M, Bradley LA, Lefebvre JC (2001) Theoretical perspectives on the relation between catastrophizing and pain. The Clin J Pain 17:52–64
Turk DC, Feldman CS (1992) Noninvasive approaches to pain control in terminal illness: the contribution of psychological variables. The Hosp J 8:1–23
Turk DC, Fernandez E (1990) On the putative uniqueness of cancer pain: do psychological principles apply? Behav Res Ther 28:1–13
Turk DC, Kerns RD (1983) Conceptual issues in the assessment of clinical pain. Int J Psychiatry Med 13:57–68
Turner JA, Jensen MP, Romano JM (2000) Do beliefs, coping, and catastrophizing independently predict functioning in patients with chronic pain? Pain 85:115–125
Wilkie DJ, Huang HY, Reilly N, Cain KC (2001) Nociceptive and neuropathic pain in patients with lung cancer: a comparison of pain quality descriptors. J Pain Symptom Manage 22:899–910
Wilkie DJ, Keefe FJ (1991) Coping strategies of patients with lung cancer-related pain. The Clin J Pain 7:292–299
Wilkie DJ, Keefe FJ, Dodd MJ, Copp LA (1992) Behavior of patients with lung cancer: description and associations with oncologic and pain variables. Pain 51:231–240
Wilkie DJ, Savedra MC, Holzemer WL, Tesler MD, Paul SM (1990) Use of the McGill Pain Questionnaire to measure pain: a meta-analysis. Nurs Res 39:36–41
Zaza C, Baine N (2002) Cancer pain and psychosocial factors: a critical review of the literature. J Pain Symptom Manage 24:526–542
Acknowledgements
This research was made possible by grant R29 CA62477 from the National Cancer Institute and grant RPG-96-001-03-PBP from the American Cancer Society. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute or American Cancer Society. The authors thank Kevin Grandfield for editorial assistance.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fischer, D.J., Villines, D., Kim, Y.O. et al. Anxiety, depression, and pain: differences by primary cancer. Support Care Cancer 18, 801–810 (2010). https://doi.org/10.1007/s00520-009-0712-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-009-0712-5