Chronic Pain Represents Major Unmet Medical Need for Cancer Survivors in the United States

Cancer survivor suffering terrible pain.
Cancer survivor suffering terrible pain.

A rapidly growing population of cancer survivors in the United States, reaching 15.5 million in 2016, is, with the aging of the population and advances in early detection and treatment methods, expected to reach 26.1 million by 2040.[1]

However, in one in three cancer survivors (34.6%) today report having chronic pain, representing nearly 5.4 million cancer people.

The report, published as a Research Letter in JAMA Oncology, also confirms that one in six survivors (16%), representing about 2.5 million people in the United States, reported suffering from high impact chronic pain, also referred as HICP, that restricts major, daily, functioning, limiting life or work activities on most days or every day in the past 6 months. [2]

The authors of the study found that these rates were about double the rates in the general population. [3]

Long term side effects

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. Nevertheless, there is a paucity of information regarding the prevalence of, and risk factors for, the development of chronic pain among cancer survivors.

Better understanding

To gain a better understanding of the epidemiology of pain in cancer survivors and help inform future health care priorities and policies, investigators led by Changchuan (Charles) Jiang, MD, MPH, of Mount Sinai St. Luke?s and Mount Sinai West, New York, with researchers from Memorial Sloan-Kettering Cancer Center, University of Virginia, and the American Cancer Society investigated the prevalence of chronic pain among cancer survivors in the United States using data from the National Health Interview Survey (2016-2017), representing a national cross-sectional of the civilian, non-institutionalized population.

The survey collects information related to chronic pain and high impact chronic pain. Chronic pain prevalence was further calculated and stratified by sociodemographic characteristics and cancer type.

Overall, 1,648 of the 4,526 cancer survivors identified in the survey (34.6%, 95% CI, 32.7%-36.5%) reported having chronic pain; 768 of the survivors (16.1%, 95% CI, 14.8%-17.5%) reported having high impact chronic pain. Applied to the nation as a whole, those rates equal approximately 5.39 million and 2.51 million cancer survivors, respectively, in the United States.

Time since diagnosis was not significantly associated with the prevalence of either chronic pain, but, the authors of the report noted that higher prevalence of chronic and high impact chronic pain was reported among survivors with less than a high school education (39.2% for chronic pain and 18.5% for high impact chronic pain), low household income (44.6% and 22.8%, respectively), public insurance among those aged 18-64 years (43.6% and 27.1%, respectively), or no paid employment (38.5% and 20.4%, respectively).

The researchers also noted that adjusted prevalence of chronic pain was the highest among survivors of bone (54.0%), kidney (52.3%), throat-pharynx (47.9%), and uterine (44.5%) cancers.

Disparities in care

The authors also pointed to major unmet medical needs an disparities in the treatment of cancer patients, leading to cancer outcomes that vary substantially between populations defined by race/ethnicity, socioeconomic status, health insurance coverage, and geographic area of residence. Their concern is that many potentially preventable cancer deaths occur in individuals who did not receive effective cancer prevention, screening, treatment, or survivorship care.

?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,? noted Xuesong Han, PhD, American Cancer Society investigator and co-author of the report.

?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,? Han concluded.

Reference:

[1] Bluethmann SM, Mariotto AB, Rowland JH. Anticipating the “Silver Tsunami”: Prevalence Trajectories and Comorbidity Burden among Older Cancer Survivors in the United States. Cancer Epidemiol Biomarkers Prev. 2016 Jul;25(7):1029-36. doi: 10.1158/1055-9965.EPI-16-0133.

[2] Jiang C, Wang H, Wang Q, Luo Y, Sidlow R, Han X. Prevalence of Chronic Pain and High-Impact Chronic Pain in Cancer Survivors in the United States. JAMA Oncol. 2019 Jun 20. doi: 10.1001/jamaoncol.2019.1439. [Epub ahead of print]

[3] Dahlhamer J, Lucas J, Zelaya C, Nahin R, Mackey S, DeBar L, Kerns R, Von Korff M, Porter L, Helmick C. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults – United States, 2016. MMWR Morb Mortal Wkly Rep. 2018 Sep 14;67(36):1001-1006. doi: 10.15585/mmwr.mm6736a2.

[4] Yabroff KR, Gansler T, Wender RC, Cullen KJ, Brawley OW Minimizing the burden of cancer in the United States: Goals for a high-performing health care system. CA Cancer J Clin. 2019 May;69(3):166-183. doi: 10.3322/caac.21556. Epub 2019 Feb 20.