Cancer pain and quality of life structural equation model based on the biopsychosocial model

This study employed a biopsychosocial framework to develop structural equation models(SEM)quantifying the multidimensional impact of pain on quality of life in cancer patients, aiming to provide scientific evidence and novel clinical perspectives for evidence-based pain management strategies.

This cross-sectional study recruited participants experiencing chronic cancer-related pain using convenience sampling from a tertiary cancer hospital in Shandong Province, China, between January and February 2024. Data collection involved face-to-face administration of the Brief Pain Inventory-Short Form and the Quality of Life Questionnaire-Function 17. Descriptive statistics and reliability analyses (Cronbach's α) were performed using SPSS 27.0. Confirmatory factor analysis and SEM were subsequently conducted using AMOS 23.0, with parameters estimated via the maximum likelihood method.

Two SEMs were developed to elucidate relationships between cancer pain and quality of life. The first-phase SEM demonstrated acceptable fit (χ²/df= 2.653, GFI = 0.826, RMSEA = 0.078, TLI = 0.902, CFI = 0.916), with all indices meeting established thresholds without modification. In this model, pain intensity significantly impaired cognitive function (B = 0.165, P < 0.001) but showed no significant associations with other quality-of-life domains. Pain interference with activity substantially compromised physical (B = 0.576), role (B = 0.585), cognitive (B = 0.273), and social functioning (B = 0.260), all P < 0.001. While pain interference with affectivity improved physical (B = -0.467) and role functioning (B = -0.455), both P < 0.001. The refined second-phase SEM exhibited improved fit (χ²/df= 2.691, GFI = 0.826, RMSEA = 0.078, TLI = 0.900, CFI = 0.912) after modification. In this model, pain significantly impaired cross-domain quality of life: physical function (B = 0.480), role function (B = 0.540), emotional function (B = 0.195), cognitive function (B = 0.715), and social function (B = 0.369), all P < 0.001.

Pain has a negative impact on all aspects of quality of life, and different dimensions of pain interference have varying effects on the dimensions of quality of life. These insights advocate for a multidimensional approach to pain management in cancer care to improve patient quality of life.