Breaking Down Chronic Pain in Cancer Survivors

More than one-third of cancer survivors in the United States reported having chronic pain and approximately 16% reported having high-impact chronic pain, which is nearly twice the prevalence seen in the general population, a study published in JAMA Oncology found.

“I am not surprised at all,” G. van Londen, MD, MS, medical oncologist, geriatrician, and director of the Cancer Livewell Survivorship Program at Hillman Cancer Center at the University of Pittsburgh Medical Center in Pittsburgh, Pennslyvania, told Cancer Network. “I actually would have thought the number would be higher, but this could have been due to the relatively small sample size and the manner in which the information was captured. Nevertheless, the signal detected in this paper is likely only the tip of the iceberg.”

Using the 2016-2017 National Health Interview Survey, which included nearly 60,000 participants, the study researchers selected 4,526 cancer survivors who were adults to include in the analysis. In all, 1,648 cancer survivors (34.6%) reported experiencing chronic pain and 768 (16.1%) reported experiencing high-impact chronic pain. These findings potentially mean that more than 5 million cancer survivors in the United States have chronic pain and about 2.5 million have high-impact chronic pain.

In addition to prevalence data, the study researchers found that cancer survivors with certain socioeconomic characteristics had a higher prevalence of chronic pain or high-impact chronic pain. Specifically, cancer survivors who had a low household income (P<0.001), public insurance (P<0.001), or no paid employment (P<0.001) had a significantly higher prevalence of chronic pain or high-impact chronic pain. Cancer survivors who had less than a high school education had a higher prevalence of chronic pain that was statistically significant (P=0.04), but not high-impact chronic pain (P=0.15). Cancer survivors who had certain types of cancers-bone, kidney, throat/pharynx, or uterine-had the highest prevalence of chronic pain.

“Pain is a complex symptom," van Londen said when asked why such variables are linked to a higher prevalence of pain. "It is a subjective, patient-reported symptom that we cannot objectify, quantify, or verify.” She explained that pain is often driven by multiple factors that relate to the impact of the cancer and its treatments as well as one’s ability to tolerate pain.

Overall, van Londen said these prevalence data will help validate cancer survivors’ experiences, which often make them feel isolated, and raise awareness to the fact that quality of life issues have ripple effects beyond the survivor. She said the findings could also trigger research priorities that may lead to policy changes.

“Given the multiple factors that determine pain, there is not one simple solution. The ideal approach to meet the often dynamically changing, unmet needs of chronic pain in cancer survivors is a multifaceted approach that helps to prevent or break the vicious cycle,” said van Londen. “Patients and their caregivers should feel more empowered to share their symptom experience with their providers, because they are not minor and can have far-reaching consequences for the patient, their family, as well as society.”