AccScience Publishing / JCBP / Online First / DOI: 10.36922/jcbp.4097
ORIGINAL RESEARCH ARTICLE

Biopsychosocial factors in cancer pain: A multidimensional evaluation of quality of life, mental health, and mortality

Carla Retroz-Marques1* Inês Retroz-Marques2 Acílio Marques1
Show Less
1 Department of Anesthesiology, Coimbra Hospital and University Centre (CHUC), Coimbra, Portugal
2 Department of Integrated Master’s Degree in Medicine, Faculty of Medicine, Coimbra, Portugal
Submitted: 1 July 2024 | Revised: 21 November 2024 | Accepted: 27 November 2024 | Published: 30 December 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

Patients with cancer pain are often subjected to a range of biopsychosocial conditioning factors, although the extent of their interactions remains unclear. This study aims to assess specific biopsychosocial dimensions using multidimensional questionnaires. Specifically, it analyzes the impact, correlation, and collinearity of factors such as pain, anxiety, depression, activities of daily living, and quality of life (QoL). The study focuses on the relationship between individual autonomy, depression, and anxiety, and their subsequent impact on mortality. This prospective, observational, cross-sectional study was conducted over 1 year with 120 cancer patients. Data were collected utilizing the Brief Pain Inventory, the Hospital Anxiety and Depression Scale, and the Short-Form-36 questionnaire and subsequently analyzed. The results reveal collinearity among the questionnaires and indicate that the loss of individual autonomy significantly worsens depression, though it does not have a comparable effect on anxiety. Statistically significant correlations were observed between depression and anxiety with mortality. The findings underscore the importance of early recognition of distress symptoms during the management of oncologic patients, alongside effective pain management. Mortality was strongly associated with high scores for depression and anxiety. Family caregiver support and social network involvement should be prioritized, and healthcare providers should promote individual autonomy to improve treatment outcomes. Although further research is needed, this study suggests that adopting a holistic approach to cancer care could not only improve QoL but also potentially extend life expectancy.

Keywords
Depression
Anxiety
Mental health
Cancer pain
Personal autonomy
Marital status
Surveys and questionnaires
Quality of life
Funding
None.
Conflict of interest
The authors declare that they have no conflicts of interest.
References
  1. Strang P, Qvarner H. Cancer-related pain and its influence on quality of life. Anticancer Res. 1990;10:109-112.

 

  1. Van Den Beuken-Van Everdingen MHJ, Hochstenbach LMJ, Joosten EAJ, Tjan-Heijnen VCG, Janssen DJA. Update on prevalence of pain in patients with cancer: Systematic review and meta-analysis. J Pain Symptom Manage. 2016;51:1070-1090.e9. doi: 10.1016/j.jpainsymman.2015.12.340

 

  1. Snijders RAH, Brom L, Theunissen M, van den Beuken-van Everdingen MHJ. Update on prevalence of pain in patients with cancer 2022: A systematic literature review and meta-analysis. Cancers (Basel). 2023;15:591. doi: 10.3390/cancers15030591

 

  1. Cruz M, Pinho S, Castro-Lopes JM, Sampaio R. Patients and healthcare professionals perspectives on creating a chronic pain support line in Portugal: A qualitative study protocol. PLoS One. 2022;17:e0273213. doi: 10.1371/journal.pone.0273213

 

  1. Azevedo LF, Costa-Pereira A, Mendonça L, Dias CC, Castro-Lopes JM. Epidemiology of chronic pain: A population-based nationwide study on its prevalence, characteristics and associated disability in Portugal. J Pain. 2012;13:773-783. doi: 10.1016/j.jpain.2012.05.012

 

  1. Wise EA, Price DD, Myers CD, Heft MW, Robinson ME. Gender role expectations of pain: Relationship to experimental pain perception. Pain. 2002;96:335-342. doi: 10.1016/S0304-3959(01)00473-0

 

  1. Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim- Williams B, Riley JL. Sex, gender, and pain: A review of recent clinical and experimental findings. J Pain. 2009;10:447-485. doi: 10.1016/j.jpain.2008.12.001

 

  1. Spoletini I, Gianni W, Repetto L, et al. Depression and cancer: An unexplored and unresolved emergent issue in elderly patients. Crit Rev Oncol Hematol. 2008;65:143-155. doi: 10.1016/j.critrevonc.2007.10.005

 

  1. Dueñas M, Ojeda B, Salazar A, Mico JA, Failde I. A review of chronic pain impact on patients, their social environment and the health care system. J Pain Res. 2016;9:457-467. doi: 10.2147/JPR.S105892

 

  1. Jongen PJ, Ruimschotel RP, Museler-Kreijns YM, et al. Improved health-related quality of life, participation, and autonomy in patients with Treatment-Resistant chronic pain after an intensive social cognitive intervention with the participation of support partners. J Pain Res. 2017;10:2725-2738. doi: 10.2147/JPR.S137609

 

  1. Van Hecke O, Torrance N, Smith BH. Chronic pain epidemiology and its clinical relevance. Br J Anaesth. 2013;111:13-18. doi: 10.1093/bja/aet123

 

  1. Tian Dong S, Butow PN, Costa DS, Lovell MR, Agar M. Symptom clusters in patients with advanced cancer: A systematic review of observational studies. J Pain Symptom Manage. 2014;48:411-450. doi: 10.1016/j.jpainsymman.2013.10.027

 

  1. Vendrell I, Macedo D, Alho I, Dionísio MR, Costa L. Treatment of cancer pain by targeting cytokines. Mediators Inflamm. 2015;2015:984570. doi: 10.1155/2015/984570

 

  1. Ohayon MM, Caulet M, Lemoine P. Comorbidity of mental and insomnia disorders in the general population. Compr Psychiatry. 1998;39:185-197. doi: 10.1016/S0010-440X(98)90059-1

 

  1. Eyigor S, Eyigor C, Uslu R. Assessment of pain, fatigue, sleep and quality of life (QoL) in elderly hospitalized cancer patients. Arch Gerontol Geriatr. 2010;51:e57-e61. doi: 10.1016/j.archger.2009.11.018

 

  1. Hermesdorf M, Berger K, Baune BT, Wellmann J, Ruscheweyh R, Wersching H. Pain sensitivity in patients with major depression: Differential effect of pain sensitivity measures, somatic cofactors, and disease characteristics. J Pain. 2016;17:606-616. doi: 10.1016/j.jpain.2016.01.474

 

  1. Von Knorring L, Perris C, Eisemann M, Eriksson U, Perris H. Pain as a symptom in depressive disorders. I. Relationship to diagnostic subgroup and depressive symptomatology. Pain. 1983;15:19-26.

 

  1. Gatchel RJ, Dersh J. Psychological disorders and chronic pain: Are there cause-and-effect relationships? In: Psychological Approaches to Pain Management: A Practitioner’s Handbook. 2nd ed. New York, NY, US: The Guilford Press; 2002. p. 30-51.

 

  1. Liu Y, Zhao J, Fan X, Guo W. Dysfunction in serotonergic and noradrenergic systems and somatic symptoms in psychiatric disorders. Front Psychiatry. 2019;10:286. doi: 10.3389/fpsyt.2019.00286

 

  1. Miller LR, Cano A. Comorbid chronic pain and depression: Who is at risk? J Pain. 2009;10:619-627. doi: 10.1016/j.jpain.2008.12.007

 

  1. Liao C, Tan Y, Wang K, et al. The impact and correlation of anxiety and depression on pressure pain threshold of acupoints in patients with chronic pelvic inflammatory disease. Pain Res Manag. 2023;2023:3315090. doi: 10.1155/2023/3315090

 

  1. Nicholas MK, Coulston CM, Asghari A, Malhi GS. Depressive symptoms in patients with chronic pain. Med J Aust. 2009;190:S66-S70. doi: 10.5694/j.1326-5377.2009.tb02473.x

 

  1. Frankel RM. The Biopsychosocial Approach: Past, Present, Future. Rochester, NY: University of Rochester Press; 2003.

 

  1. Wiermann EG, Del Pilar Estevez Diz M, Caponero R, et al. Brazilian cancer pain management consensus. Braz J Clin Oncol. 2014;10:132-143.

 

  1. Barbosa HD, Nogueira AA, Silva JC, Poli Neto OB, Reis FJ. The influence of education and depression on autonomy of women with chronic pelvic pain: A cross-sectional study. Braz J Gynecol Obstet. 2016;38:47-51. doi: 10.1055/s-0035-1570107

 

  1. da Silva LA, Tortelli L, Motta J, et al. Effects of aquatic exercise on mental health, functional autonomy and oxidative stress in depressed elderly individuals: A randomized clinical trial. Clinics (Sao Paulo). 2019;74:e322. doi: 10.6061/clinics/2019/e322

 

  1. von Elm E, Altman DG, Egger M, et al. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. BMJ. 2007;335:806-808. doi: 10.1136/bmj.39335.541782.AD

 

  1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361-370. doi: 10.1111/j.1600-0447.1983.tb09716.x

 

  1. Pais-Ribeiro J, Silva I, Ferreira T, Martins A, Meneses R, Baltar M. Validation study of a Portuguese version of the hospital anxiety and depression scale. Psychol Health Med. 2007;12:225-237. doi: 10.1080/13548500500524088

 

  1. Turk DC, Monarch ES, Williams AD. Cancer patients in pain: Considerations for assessing the whole person. Hematol Oncol Clin North Am. 2002;16(3):511-525. doi: 10.1016/s0889-8588(02)00015-1

 

  1. Ferreira KA, Teixeira MJ, Mendonza TR, Cleeland CS. Validation of brief pain inventory to Brazilian patients with pain. Support Care Cancer. 2011;19:505-511. doi: 10.1007/s00520-010-0844-7

 

  1. Ferreira KA, Teixeira MJ, Mendonza TR, Cleeland CS. Validation of brief pain inventory to Brazilian patients with pain. Support Care Cancer. 2011;19:505-511. doi: 10.1007/s00520-010-0844-7

 

  1. Cleeland CS, Ryan KM. Pain assessment: Global use of the brief pain inventory. Ann Acad Med Singap. 1994;23:129-138.

 

  1. Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singap. 1994;23(2):129-138.

 

  1. Tan G, Jensen MP, Thornby JI, Shanti BF. Validation of the brief pain inventory for chronic nonmalignant pain. J Pain. 2004;5:133-137. doi: 10.1016/j.jpain.2003.12.005

 

  1. Stanhope J. Brief pain inventory review. Occup Med (Lond). 2016;66:496-497. doi: 10.1093/occmed/kqw041

 

  1. Ferreira PL. Creation of Portuguese version of the MOS SF-36 Part I, cultural and linguistic adaptation. Acta Med Port. 2000;13:55-66. doi: 10.20344/amp.1760

 

  1. McHorney C, Ware J, Snow K, et al. Medical outcomes study questionnaire short form 36 health survey (SF-36). Med Care. 1994;32:40-66.

 

  1. Shahid A, Wilkinson K, Marcu S, Shapiro CM. Brief Pain Inventory (BPI). STOP, THAT and One Hundred Other Sleep Scales. Vol. 1100. New York, NY: Springer New York; 2011. p. 81-88. doi: 10.1007/978-1-4419-9893-4_13

 

  1. Asmundson GJG, Wright KD. Biopsychosocial approaches to pain. In: Pain: Psychological Perspectives. Mahwah, NJ, US: Lawrence Erlbaum Associates Publishers; 2004, p. 35-57.

 

  1. Erzen E, Çikrikci Ö. The effect of loneliness on depression: A meta-analysis. Int J Soc Psychiatry. 2018;64:427-435. doi: 10.1177/0020764018776349
Share
Back to top
Journal of Clinical and Basic Psychosomatics, Electronic ISSN: 2972-4414 Print ISSN: 3060-8562, Published by AccScience Publishing