Psychosocial distress in patients treated for cancer pain: a prospective observational study

Untreated emotional distress negatively impacts the management of cancer pain.

The authors evaluated 64 patients with cancer pain who completed baseline and follow-up measures to identify if (1) measures of psychosocial wellbeing, pain intensity, and pain management were associated with survival time; (2) higher opioid doses were associated with less psychosocial distress; and (3) intrasubject correlations across time altered the relationship between pain, depression, social support, spirituality, and increased desire for hastened death (DHD).

The main outcome measures included the Brief Pain Inventory (BPI), Daily Morphine Equivalent Dose (DMED), Beck Depression Inventory-II (BDI-II), DHD scale, Bottomley Social Support Scale, FACIT Spiritual Well-Being Scale (FACIT-Sp), Karnofsky Performance Rating Scale (KPRS), and State-Trait Anxiety Inventory (STAI).

There were significant differences between baseline and follow-up DHD (0.84 vs. 1.38, p = 0.021) and BPI scores (6.36 vs. 4.86, p < 0.001). Lower existential wellbeing was associated with reduced survival (HR = 0.78, p = 0.019); improvement in pain was associated with longer survival (HR = 1.33, p = 0.034). Higher religious wellbeing was associated with higher probability of survival to 1 year (HR = 0.41, p = 0.014), as was higher KPRS (HR = 0.97, p = 0.001) but not DMED >300 mg. Higher existential distress and lower Bottomley scores were associated with higher hazard ratios for death at 1 year (HR = 2.78, p = 0.02) and (HR = 14.94, p = 0.002). There were significant diferences in average BDI-J for persons with BPI > 7 versus those with moderate or mild pain (12.12 vs. 6.82, p < 0.0001) and in DHD (1.71 vs. 0.64, p = 0.002). Depression decreased in persons with DMED >300 mg between baseline and follow-up (-1.67 vs. 2.72, p = 0.024). Mean DHD was lower forpersons whose pain improved versus others (0.96 vs. 2.0, p = 0.026). A generalized linear model was conducted with DHD as the dependent variable and the other above variables as predictors. Higher existential wellbeing and KPRS were associated with lower DHD (beta = -0.135, p = 0.049) and (P = -0.79, p = 0.006), respectively.

The major findings of this study are that in persons with cancer pain, lower social support and existential wellbeing, but not higher DMED, were associated with shorter survival time. Treatment of cancer pain was associated with lessening of emotional distress. Lower levels of existential wellbeing and physical performance status appear to be associated with greater DHD.