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Greater Social Support May Help Alleviate Pain in Patients with Cancer

TOP - March 2020, Vol 13, No 2

San Francisco, CA—According to results from a retrospective analysis of nearly 12,000 patients with cancer, increased social support may function as an analgesic and help to mitigate pain.

Findings from the study, which were presented at the 2019 Supportive Care in Oncology Symposium, revealed that although higher levels of anxiety and depression contributed to pain intensity; the effect of these factors on pain varied according to the level of social support that patients received. In other words, social support may buffer the negative impact of anxiety and depression on pain, explained Sarah K. Galloway, PhD, Psychologist, Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, and lead investigator of the study.

“Clinicians who treat cancer pain should be attuned to modifiable psychological factors which can greatly influence a patient’s pain experience,” said Dr Galloway. “Evaluating patients’ emotional health after a cancer diagnosis can help alleviate pain from their cancer and its treatment.”

According to Dr Galloway, pain is one of the most common symptoms associated with cancer and its treatment, and feelings of anxiety and depression can intensify the level of pain patients experience. Furthermore, she said that although patients with cancer frequently use social support to help them cope with their disease and its treatment, the evidence linking cancer pain intensity and social support is lacking.

For their analysis, Dr Galloway and colleagues included patients with stage I-IV cancer (N = 11,815) 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. The researchers then matched participants to their hospital cancer registry (N = 7333) and incorporated clinical and demographic factors into lasso regression models. The models identified pain predictors from self-reported anxiety, depression, and social support, and analyses examined whether the effect of anxiety and depression on pain differed by levels of social support.

Family, Interpersonal Relationships, and Community Can Affect Pain Intensity

As Dr Galloway reported, the mean level of pain reported by patients in the study was 3 of 10, but 17% of patients experienced severe pain (a score of ≥7), and this percentage was even higher among certain populations. Patients with thoracic, musculoskeletal, gastrointestinal, and gynecologic cancers were more likely to report severe pain, as were those with advanced-stage disease and lower income. A higher percentage of African Americans, Native Americans, and Latinos also experienced severe pain compared with white patients.

The data also showed that anxiety, depression, and social support were significant factors affecting pain intensity, and these associations remained after accounting for patient characteristics. Interestingly, said Dr Galloway, for patients completing distress screening 1 year from the time of diagnosis, the effect of anxiety and depression on pain varied by level of perceived social support.

“To my knowledge, this is the largest study to date across all of the different variables in cancer pain,” said Dr Galloway. “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.”

According to Dr Galloway, although there is no way to determine whether the patients’ pain resulted from cancer, its treatment, or other factors, these findings demonstrate the need for interdisciplinary and multimodal—both pharmaceutical and nonpharmaceutical—interventions for pain.

Specific tools such as mindfulness, cognitive behavioral therapy, and acceptance and commitment therapy can help alleviate psychologic distress and pain and improve quality of life, said Dr Galloway, who also encouraged patients to discuss feelings of depression and anxiety, as well as issues of social support, with their physicians.

Dr Galloway and colleagues aim to analyze these data in a longitudinal format to examine how the impact of social support differentially affects mood, anxiety, and pain across the course of cancer therapy—from diagnosis to acute treatment and survivorship. They are also planning prospective interventional trials that target some of these modifiable psychosocial factors with the goal of reducing pain intensity.

Expert’s Commentary

Commenting on these findings, Richard T. Lee, MD, Director, Supportive and Integrative Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH, emphasized that simply identifying symptoms is not enough. Rather, clinicians must determine the optimal intervention to help reduce symptom burden.

“Whatever the symptom burden may be, we have to keep in mind that these patients are also undergoing active cancer treatment,” Dr Lee added. “The interventions that we decide to pursue could have a short- and long-term impact on our patients, which is why I’m looking forward to more research in this area.”

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