About one in three cancer survivors, representing nearly 5.4 million people in the United States, reported experiencing chronic pain, with one in six survivors enduring high-impact chronic pain that limits life or work activities, according to a research letter published in JAMA Oncology. “Chronic pain is one of the most common long-term effects of cancer treatment and has been linked with an impaired quality of life, lower adherence to treatment, and higher health care costs,” Changchuan Jiang, MD, MPH, resident in internal medicine at Mount Sinai Hospital, and colleagues wrote. “Nevertheless, there is a paucity of information regarding the prevalence of, and risk factors for, the development of chronic pain among cancer survivors.”
The number of cancer survivors in the United States is expected to rise from an estimated 15.5 million in 2016 to 26.1 million in 2040.
Jiang and colleagues investigated the prevalence of chronic pain or high-impact chronic pain among 4,526 adult cancer survivors who participated in the 2016-2017 National Health Interview Survey.
Survivors with chronic pain reported having pain most days or every day in the previous 6 months, whereas survivors with high-impact chronic pain reported severe pain that limited life or work activities most days or every day.
Most survivors (79.9%) were white, and 3.5% had no insurance.
Among the survivors, 1,648 (34.6%; 95% CI, 32.7-36.5) reported chronic pain and 768 (16.1%; 95% CI, 14.8-17.5) reported high-impact chronic pain.
When applied nationally, the data represented 5.39 million survivors with chronic pain and 2.51 million survivors with high-impact chronic pain.
Age, sex, marital status and region of residence did not appear to affect the prevalence of pain.
However, researchers observed a higher adjusted prevalence of chronic pain and high-impact chronic pain among survivors with less than a high school degree (chronic, 39.2%; high-impact chronic, 18.9%), low household income (44.6%; 22.8%), public insurance among those aged 18 to 64 years (43.6%; 27.1%) or no paid employment (38.5%; 20.4%).
“Because socioeconomic status and employment are associated with insurance coverage and access to care in the United States, the patterns of chronic pain that we observed in cancer survivors may be explained by barriers to cancer care and pain management as well as by the type and extent of cancer treatment received,” Jiang and colleagues wrote.
Those with the highest adjusted prevalence of chronic pain included survivors of bone cancer (54%), kidney cancer (52.3%), throat-pharynx cancer (47.9%) and uterine cancer (44.5%). Time since diagnosis did not significantly affect the prevalence of pain.
A potential recall error of self-reported data, limited statistical power for survivors of rare cancers, and a lack of information on treatment served as the study’s primary limitations.
“The prevalence of chronic pain and high-impact chronic pain among cancer survivors in our study was almost double that in the general population, suggesting there are important unmet needs in the large and growing community of people with a history of cancer,” Xuesong Han, PhD, epidemiologist and health services researcher at American Cancer Society and co-author of the report, said in a press release. – by John DeRosier
Disclosures: The authors report no relevant financial disclosures.