October 23, 2019
2 min read

Anxiety, depression linked to pain intensity among patients with cancer

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Declan Walsh, MD
Declan Walsh

Higher levels of anxiety and depression among patients with cancer appeared to be associated with more severe disease-related pain, according to study results scheduled for presentation at Supportive Care in Oncology Symposium.

Social support, however, appeared to mitigate the effects of anxiety and depression on cancer-related pain.

Researchers also identified independent associations between severe pain and tumor site — specifically gastrointestinal, gynecological and head and neck tumors — advanced disease, black race and lower income.

“The standard practice is to evaluate [all] symptoms, but each practice varies, and many symptoms can go unrecognized partly because there are so many [among patients with cancer],” Declan Walsh, MD, chair of the department of supportive oncology at Levine Cancer Institute at Atrium Health and HemOnc Today Editorial Board Member, told HemOnc Today. “Specific mental health evaluation, however, would not be a standard practice [for oncologists].”

Recognizing that pain is a common cancer symptom, Walsh and colleagues analyzed clinicodemographic factors that may affect cancer-related pain and the role of social support in mitigating the impact of anxiety and depression on pain among 11,815 patients (median age, 59 years; range, 18-101) with stage I to stage IV cancer. Seventy-seven percent of the patients were white and 61% were women. All completed psychological distress screening surveys between 2017 and January 2019.

Lasso regression models accounted for clinicodemographic factors and identified pain predictors from self-reported anxiety, depression and social support.

Results showed significant relationships between anxiety and depression (P < .001 for both) and pain severity, even when accounting for patient factors such as race, tumor site, disease staging and income status. These factors all appeared independently predictive of pain intensity.

Researchers found the impact of depression on pain varied with the level of social support perceived by patients (P = .009), whereas the impact of anxiety on pain varied among those who reported transportation issues (P = .035).

Social support from family, friends or the community can help minimize the impact of depression and anxiety on pain, researchers noted. Because of this, they suggested that physicians who treat cancer pain be aware of the patients’ psychological state.

“It’s important [to have] a good rapport and open communication [between the clinician and patient],” Walsh told HemOnc Today. “Antidepressants have a role, as well as management of other symptoms like pain and insomnia.”


Many patients with excellent support systems still experience anxiety and depression, and clinicians with specific training in psychology can help patients develop skills to improve mood, anxiety and chronic pain, Sarah Kathryn Galloway, PhD, psychologist at Levine Cancer Institute at Atrium Health, told HemOnc Today.

“Both pharmaceutical and nonpharmaceutical treatments — such as cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness strategies — are useful for addressing patient mental health needs,” Galloway said. “Quality social support certainly can [also] serve as a buffer against the development of clinically significant anxiety and depression.” by John DeRosier


Galloway SK, et al. Abstract 76. Scheduled for presentation at: Supportive Care in Oncology Symposium; Oct. 25-26, 2019; San Francisco.

For more information:

Sarah Kathryn Galloway, PhD, can be reached at The Center for Supportive Care and Survivorship, 711 E. Morehead St., Charlotte, NC 28202; email: sarah.galloway@atriumhealth.org.

Declan Walsh, MD, can be reached at declan.walsh@atriumhealth.org.

Disclosures: Walsh reports a consultant/advisory role with and honoraria and travel expenses from Tesaro, and a leadership role with, stock and other ownership interests in and research funding from Nualtra. Galloway reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.