Pain and its interference with daily living in relation to cancer: a comparative population-based study of 16,053 cancer survivors and 106,345 people without cancer

Grace Joshy; Saman Khalatbari-Soltani; Kay Soga; Phyllis Butow; Rebekah Laidsaar-Powell; Bogda Koczwara; Nicole M Rankin; Sinan Brown; Marianne Weber; Carolyn Mazariego; Paul Grogan; John Stubbs; Stefan Thottunkal; Karen Canfell; Fiona M Blyth; Emily Banks

doi:10.1186/s12885-023-11214-5

Pain and its interference with daily living in relation to cancer: a comparative population-based study of 16,053 cancer survivors and 106,345 people without cancer

BMC Cancer. 2023 Sep 13;23(1):774. doi: 10.1186/s12885-023-11214-5.

Authors

Grace Joshy¹, Saman Khalatbari-Soltani², Kay Soga³, Phyllis Butow⁴, Rebekah Laidsaar-Powell⁴, Bogda Koczwara^{5

6}, Nicole M Rankin^{2

7}, Sinan Brown³, Marianne Weber⁸, Carolyn Mazariego⁹, Paul Grogan⁸, John Stubbs¹⁰, Stefan Thottunkal³, Karen Canfell⁸, Fiona M Blyth², Emily Banks³

Affiliations

¹ National Centre for Epidemiology and Population Health (NCEPH), The Australian National University, Canberra, ACT, Australia. Grace.Joshy@anu.edu.au.
² Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
³ National Centre for Epidemiology and Population Health (NCEPH), The Australian National University, Canberra, ACT, Australia.
⁴ Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia.
⁵ Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia.
⁶ Department of Medical Oncology, Flinders Medical Centre, Adelaide, SA, Australia.
⁷ Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
⁸ The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia.
⁹ School of Population Health, The University of New South Wales, Sydney, NSW, Australia.
¹⁰ Independent Cancer Consumer Advisor, Sydney, NSW, Australia.

Abstract

Background: Pain is a common, debilitating, and feared symptom, including among cancer survivors. However, large-scale population-based evidence on pain and its impact in cancer survivors is limited. We quantified the prevalence of pain in community-dwelling people with and without cancer, and its relation to physical functioning, psychological distress, and quality of life (QoL).

Methods: Questionnaire data from participants in the 45 and Up Study (Wave 2, n = 122,398, 2012-2015, mean age = 60.8 years), an Australian population-based cohort study, were linked to cancer registration data to ascertain prior cancer diagnoses. Modified Poisson regression estimated age- and sex-adjusted prevalence ratios (PRs) for bodily pain and pain sufficient to interfere with daily activities (high-impact pain) in people with versus without cancer, for 13 cancer types, overall and according to clinical, personal, and health characteristics. The relation of high-impact pain to physical and mental health outcomes was quantified in people with and without cancer.

Results: Overall, 34.9% (5,436/15,570) of cancer survivors and 31.3% (32,471/103,604) of participants without cancer reported bodily pain (PR = 1.07 [95% CI = 1.05-1.10]), and 15.9% (2,468/15,550) versus 13.1% (13,573/103,623), respectively, reported high-impact pain (PR = 1.13 [1.09-1.18]). Pain was greater with more recent cancer diagnosis, more advanced disease, and recent cancer treatment. High-impact pain varied by cancer type; compared to cancer-free participants, PRs were: 2.23 (1.71-2.90) for multiple myeloma; 1.87 (1.53-2.29) for lung cancer; 1.06 (0.98-1.16) for breast cancer; 1.05 (0.94-1.17) for colorectal cancer; 1.04 (0.96-1.13) for prostate cancer; and 1.02 (0.92-1.12) for melanoma. Regardless of cancer diagnosis, high-impact pain was strongly related to impaired physical functioning, psychological distress, and reduced QoL.

Conclusions: Pain is common, interfering with daily life in around one-in-eight older community-dwelling participants. Pain was elevated overall in cancer survivors, particularly for certain cancer types, around diagnosis and treatment, and with advanced disease. However, pain was comparable to population levels for many common cancers, including breast, prostate and colorectal cancer, and melanoma.

Keywords: Cancer; High-impact pain; Pain; Pain interference; Physical functioning; Psychological distress; Quality of life.

MeSH terms

Australia / epidemiology
Breast Neoplasms*
Cancer Survivors*
Cohort Studies
Colorectal Neoplasms*
Humans
Male
Melanoma*
Middle Aged
Pain / epidemiology
Pain / etiology
Quality of Life

Abstract

MeSH terms

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