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Study emphasizes need to evaluate psychological symptoms early when addressing cancer pain

 A new study from the Levine Cancer Institute finds that patients with cancer who report higher levels of anxiety and depression experience more intense pain associated with their diseases. Furthermore, patients with higher social support report lower levels of pain. These findings were presented at the 2019 Supportive Care in Oncology Symposium, which was held on October 25-26 in San Francisco.

At the first appointment with a cancer specialist, nearly 12,000 patients with cancer in stages I–IV used a tablet to input their responses to a series of questions about their psychosocial distress, common cancer symptoms, and unmet needs. Statistical models then identified pain predictors from self-reported anxiety, depression, and social support.

"To my knowledge, this is the largest study to date across all of the different variables in cancer pain," said lead author Sarah Kathryn Galloway, PhD, a psychologist at Levine Cancer Institute in Charlotte, North Carolina, USA. "It emphasizes the need to evaluate psychological symptoms early when addressing cancer pain, which is something that is not assessed regularly and should be. It also underscores the importance of family, interpersonal relationships, and community on pain and illness."

The authors found that patient characteristics of race, lower income, tumor site, and advanced disease were predictive of pain intensity. In addition, anxiety, depression, and social support were significant factors impacting pain intensity; these associations remained after accounting for patient characteristics. Interestingly, for patients completing distress screening one year from their diagnosis, the effect of anxiety and depression on pain differed by level of perceived social support.

Though there is no way to determine whether the pain results from the cancer, the treatment for the cancer, or something else, the pain may be reduced with specific actions that patients can take to protect their psychological health. The authors encourage patients to discuss low mood, worry, and issues of social support with their physicians. Specific tools learned from interventions such as Cognitive Behavioral Therapy, mindfulness, and Acceptance and Commitment Therapy can help alleviate psychological distress and pain and improve quality of life.

"Anxiety, depression, and social support are modifiable factors that can greatly impact a patient's cancer pain experience," said Dr. Galloway. "Study results demonstrate the need for interdisciplinary, multimodal—pharmaceutical and non-pharmaceutical—interventions for cancer related pain."

"Clinicians are trained and eager to alleviate patients' pain, but what we often overlook is an assessment of their psychological health," said Monica S. Krishnan, MD, 2019 Supportive Care in Oncology Symposium News Planning Team member. "This study finds that emotional health has a direct relationship to physical health and symptoms, emphasizing the importance of examining the totality of the patient's health."

Based upon follow-up data the authors collected, in future analyses they will be examining how the impact of social support differentially impacts mood, anxiety, and pain across diagnosis, acute treatment, and survivorship.


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