Frequency, Characteristics, and Correlates of Pain in a Pilot Study of Colorectal Cancer Survivors 1–10 Years Post-Treatment

Abstract

Objective The long-term effects of disease and treatment in colorectal cancer (CRC) survivors are poorly understood. This study examined the prevalence and characteristics of pain in a sample of CRC survivors up to 10 years post-treatment. Design One hundred cancer-free CRC survivors were randomly chosen from an institutional database and completed a telephone survey using the Brief Pain Inventory, Neuropathic Pain Questionnaire-Short Form, Quality of Life Cancer Survivor Summary, Brief Zung Self-Rating Depression Scale, Zung Self-Rating Anxiety Scale, and Fear of Recurrence Questionnaire. Results Participants were primarily Caucasian (90%) married (69%) males (53.5%) with a mean age of 64.7 years. Chronic pain was reported in 23% of CRC survivors, with a mean moderate intensity rating (mean = 6.05, standard deviation = 2.66) on a 0–10 rating scale. Over one-third (39%) of those with pain attributed it to their cancer or treatment. Chi-square and t-test analyses showed that survivors with pain were more likely to be female, have lower income, be more depressed and more anxious, and show a higher endorsement of suicidal ideation than CRC survivors without chronic pain. On average, pain moderately interfered with daily activity. Conclusions Chronic pain is likely a burdensome problem for a small but not inconsequential minority of CRC survivors requiring a biopsychosocial treatment approach to improve recognition and treatment. Open dialogue between clinicians and survivors about physical and emotional symptoms in long-term follow-up is highly recommended.

The cost of survival: an exploration of colorectal cancer survivors’ experiences of pain

“…Furthermore, pain has been shown to occur in clusters with fatigue, insomnia [19], depression [8,11] and anxiety [11]. The influence of age on pain is the subject of debate.…”

“…Many studies of cancer survivors' pain focus on samples which include multiple tumor groups and varying inclusion criteria [8,9,[13][14][15], resulting in small samples of each tumor group or a lack of analysis of data pertaining to particular tumor groups. Meanwhile, studies which evaluate the pain of CRC survivors' have limited generalizability and scope due to small samples sizes [11,16], lack of clear definition of cancer survivorship [15], or sampling of older [12,19], early stage (<2 years) [18,19] or long-term cancer survivors (>5 years) [12]. Therefore, the present study sought to explore the prevalence and experience of pain in a sample of CRC survivors up to five years following diagnosis.…”

“…Several factors have demonstrated an influence on the presence and intensity of pain, including age [9,13,18], female gender [10,11,13,14,16,18], ethnicity [13,14], symptom clusters [13], previous chemotherapy treatment [13,18], previous radiotherapy treatment [18], time since treatment [13,16], stage of disease [19] and income [11]. Furthermore, pain has been shown to occur in clusters with fatigue, insomnia [19], depression [8,11] and anxiety [11].…”

“…However, it is estimated one third of cancer survivors experience pain following curative cancer treatment [5,[7][8][9][10][11], compared to almost two thirds of those receiving anti-cancer treatment, or living with advanced, metastatic or terminal cancer [7]. Pain is ranked as one of the most common symptoms experienced by cancer survivors [4,9,10], and has been associated with poorer physical [12] functional [11][12][13][14], psychological [14,15] and overall [16] QoL, and may contribute to social isolation in survivorship [17].…”

“…The influence of age on pain is the subject of debate. Although almost one third of cancer survivors report pain [5,[7][8][9][10][11], approximately one tenth of older CRC survivors attribute pain to cancer-related factors [9], compared to almost two fifths of general CRC survivor samples [11]. Studies have revealed older cancer survivors are reluctant to attribute symptoms of pain, fatigue or cognitive dysfunction to cancer [17], whereas age-related factors have greater predictive ability than cancer-related factors for symptoms of pain, low energy levels and weakness [13].…”