Anxiety, Depression and Pain: Differences by Primary Cancer

OBJECTIVE: Disease-related cancer pain is a multidimensional phenomenon. Psychological factors that may alter pain perception in cancer patients have not been well-studied. The study purpose was to explore differences in pain, anxiety and depression by type of primary cancer and relationships between psychological factors and coping in head/neck cancer (HNC) patients. METHODS: In a cross-sectional study of consecutive patients (80% male, mean age 60.5 ± 11.5 years) undergoing radiation treatment or chemotherapy for head/neck (n=93), lung (LC, n=146), or prostate (PC, n=63) cancers, patients completed the Coping Strategies Questionnaire, State Trait Anxiety Inventory, and Center for Epidemiologic Studies Depression Scale. They also reported sensory pain characteristics (McGill Pain Questionnaire) and pain intensity. Comparative statistics and correlation coefficients (r) were performed with SPSS (Chicago, Illinois). RESULTS: Present pain intensity was significantly higher in HNC compared to PC patients (p<.05), while worst pain was significantly greater in LC compared to HNC and PC patients (p<.05). Sensory, affective, emotional, and total pain indices were highest in LC patients (p<.05). Significantly higher depression levels were reported in LC compared to PC patients, although anxiety and coping were similar between the 3 cancer types. In HNC patients, catastrophizing and having no control over pain were correlated with high levels of state (r=.55, p<.01; r=-.24, p<.05) and trait (r=.58, p<.01; r=-.26, p<.05) anxiety. Inability to decrease pain and increasing pain behavior were associated with high state anxiety levels (r=-.23, r=.23; p<.05). Reinterpreting pain sensations and using active coping strategies were related to state anxiety (r=.22, p<.05; r=.27, p<.01). CONCLUSIONS: Higher pain indices and depression were reported in LC patients. In HNC patients, less effective coping strategies were associated with higher levels of state and trait anxiety. Clinicians should consider recommending effective coping strategies for head and neck cancer patients with disease- or treatment-related pain. Funding sources: NIH, NCI (R29 CA62477); American Cancer Society (RPG-96-001-03-PBP) to DJW.