Depression, chronic pain, and high-impact chronic pain among cancer survivors.

Abstract

12085 Background: The majority of the 17 million individuals living with a cancer diagnosis in the United States have experienced pain, either from the disease itself or from its treatment. Pain negatively impacts psychosocial quality of life and is associated with poorer overall outcome. However, the impact of pain on daily living differ among cancer survivors, and there is a paucity of research on chronic pain, especially high-impact chronic pain (HICP) in this growing population. We estimated the prevalence of chronic pain, and HICP among cancer survivors, and described the association between depression and these outcomes. Methods: This study used data from the 2015-2017 National Health Interview Survey. Outcomes of interest were chronic pain, defined as pain on most days or every day in the past six months, and HICP, defined as chronic pain that limited life or work activities on most days or every day during the past six months. Weighted, adjusted multivariable logistic regressions estimated association between depression and chronic pain and HICP among cancer survivors, while controlling for age, gender, marital status, education, employment, health insurance, smoking status, number of doctor’s visit, general health, and comorbidities. Results: Among 49,326 survey respondents, 11.7% (n = 5,335) had a cancer diagnosis. An estimated 43.6% of cancer survivors reported chronic pain; and 19.2% reported HICP. We found an association between depression and both chronic pain and HICP in unadjusted analyses. In the adjusted models, cancer survivors depressed within the last month had more than double the odds of reporting both chronic pain (aOR = 2.32; 95% CI 1.75, 3.07) and HICP (aOR = 2.12; 95% CI 1.50, 3.01). Other factors associated with both chronic pain and HICP among cancer survivors included being a current smoker (aORchronic pain = 1.63; 95% CI 1.14, 2.34; aORHICP = 1.83; 95% CI 1.18, 2.84) and being unemployed (aORchronic pain = 1.44; 95% CI 1.10,1.90; aORHICP = 3.10; 95% CI: 2.00−4.81). Cancer survivors with ≥2 comorbidities also had 55% increased odds of reporting chronic pain (aOR = 1.55; 95% CI 1.17,2.04) compared with those without comorbidities. Conclusions: Over 40% of cancer survivors may have a history of chronic pain, and survivors reporting being depressed are significantly more likely to report both chronic pain and HICP. The association between depression and pain in cancer survivors calls for personalized management of chronic pain, especially in cancer survivors with a history of depression.