Increased Pain in Anxious, Depressed Patients With Cancer

Anxiety and depression in patients with cancer are associated with increased pain intensity, according to a study presented at the Supportive Care in Oncology Symposium.

The study included 11,815 patients (median age, 59 years) with stage I-IV cancer who completed a routine tablet-based psychosocial distress screening at a large academic hybrid, multisite, community-based cancer institute between January 2017 and January 2019. Most patients were female (61%) and white (77%).

Factors related to pain

The following factors were associated with severe pain:

• Tumor site (gastrointestinal, gynecologic, and head and neck cancers)
• Advanced disease
• Black race
• Lower income

In addition, anxiety (P<0.001) and depression (P<0.001) were associated with pain intensity after accounting for clinicodemographic factors. The effect of depression on pain differed by level of social support (P=0.009). The effect of anxiety on pain differed in patients reporting transportation issues (P=0.035).

“Social support buffers the negative impact of anxiety/depression on pain,” the researchers noted. “Clinicians who treat cancer pain should be attuned to modifiable psychological factors, which can greatly influence a patient’s pain experience. [These] findings emphasize the need for interdisciplinary multimodal approaches for cancer pain.”