Unique associations of pain frequency and pain-related worry with health-related quality of life in survivors of childhood cancer

Lauren C Heathcote; Sarah J Cunningham; Michaela Patton; Fiona Schulte

doi:10.1097/PR9.0000000000001000

Unique associations of pain frequency and pain-related worry with health-related quality of life in survivors of childhood cancer

Pain Rep. 2022 Apr 5;7(3):e1000. doi: 10.1097/PR9.0000000000001000. eCollection 2022 May-Jun.

Authors

Lauren C Heathcote^{1

2}, Sarah J Cunningham², Michaela Patton³, Fiona Schulte^{3

4

5}

Affiliations

¹ Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
² Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
³ Departments of Psychology and.
⁴ Oncology, University of Calgary, Calgary, AB, Canada.
⁵ Division of Psychosocial Oncology, Alberta Children's Hospital, Calgary, AB, Canada.

Abstract

Introduction: Pain is common during childhood cancer treatment, can persist into survivorship, and can negatively affect health-related quality of life in survivors of childhood cancers (SCCs).

Objective: The objective of this brief report was to assess pain frequency, pain-related worry, and their (unique) associations with health-related quality of life in SCCs.

Methods: One hundred eleven SCCs (52% female individuals, M age: 17.67 years, range 8-25 years) completed self-report measures of pain frequency, pain-related worry, and health-related quality of life.

Results: More than two-thirds (70%) of SCCs reported pain in the previous month (M = 1.39, SD = 1.17), and 15% reported experiencing pain often or almost always. More than one-third (39%) reported worrying about pain as a sign of cancer recurrence (M = 0.73, SD = 1.07), and 9% reported worrying about pain a lot or a whole lot. In multivariate regression models that controlled for sex, age at diagnosis, and time off treatment, both pain frequency and pain-related worry were significantly associated with physical health-related quality of life, indicating that they contribute unique variance to health-related quality of life after childhood cancer. For emotional health-related quality of life, pain frequency was no longer a significant predictor once pain-related worry was added to the model, indicating that pain-related worry may be particularly important for understanding emotional health-related quality of life.

Conclusion: Postcancer pain may contribute to health-related quality of life through multiple mechanisms, including by triggering concerns of recurrence. There is a need for clinical interventions that target both the frequency of pain (eg, behavioral interventions) and pain-related worry (eg, psychoeducation and cognitive interventions) to improve health-related quality of life after childhood cancer.

Keywords: Cancer; Childhood cancer survivors; Fear of cancer recurrence; Pain; Quality of life.