A Comprehensive Analysis of the Cancer Chronic Pain Experience: A Narrative Review

Figures & data

Table 1 Descriptive Characteristics of the Studies Included on Patients’ Perspective

Authors, Year	Study Design	Participants^† n, M (SD)	Type of Chronic Condition	Question Relevance	Measures of QoL	Main Results
Gonçalves et al, 2020	Retrospective (quantitative design)	20, 65.3 (NE)	Different cancer syndromes: Digestive, Head/Neck, Breast, Genitourinary, Bone, CNS, Synchronous	QoL, Functionality	EQ-5D-3L PDI	Negative relationship between CP and total QoL, specifically CP has decreased daily and social activities, physical well-being, psychological well-being, family/home responsibility, recreation, life-support activities, occupation, and sexual behaviors.
Cox-Martin et al, 2020	Cross-sectional (quantitative design)	1702, NE	Breast Cancer and others (NS)	QoL, Employment status	HRQoL module of the BRFSS	Negative relationships between uncontrolled CP and all QoL domains (physical well-being, psychological well-being, daily activities).
Hamood et al, 2018	Cross-sectional (quantitative design)	305, 63.8 (13.9)	Breast Cancer	QoL, Employment status	SF-36	Negative relationships between CP and all general QoL domains (physical and mental health, physical and social functioning, emotional and physical role, vitality), CP and work re-entry and/ or maintenance.
Smith et al, 2018	Cross-sectional (qualitative design)	128, 57.5 (8.9)	Breast Cancer	QoL, Attachment	FACT-B	Negative relationships between attachment styles (anxiety, avoidance) and total QoL, attachment styles and social well-being; attachment anxiety also predicted worse functional and emotional well-being.
Barrett et al, 2017	Cross-sectional (quantitative design)	121, 63.2 (13.3)	Different cancer syndromes: Breast, Lung, Head/Neck, others (NS)	QoL	FACT-G, Version 4	A better total QoL was predicted by higher school education, having a caregiver, lower level of psychological distress, lower level of pain intensity and interference.
Feddern et al, 2015	Cross-sectional (quantitative design)	426, NE	Rectal Cancer	QoL	EORTC-QLQ-C30	Negative relationships between CP and total QoL, CP and all QoL domains (social, emotional, and physical functioning).
Mols et al, 2013	Cohort (quantitative design)	1643, 69.4 (9.4)	Colorectal Cancer	QoL	EORTC-QLQ-C30	Patients with many chronic neuropathy symptoms (upper 10%) reported worse scores in all QoL domains (general health, physical, role, cognitive, emotional, and social functioning) and more additional symptoms.
Peretti-Watel et al, 2012	Cohort (qualitative and quantitative design)	10, 48.6 (20.5)	Breast Cancer	QoL	WHOQOL-BREF	Living daily with CP has decreased total QoL, specifically the satisfaction in everyday activities and the activity limitation.
Pühse et al, 2012	Cohort (quantitative design)	238, 35.2 (9.3)	Testis Cancer	Sexuality	BSFI IIEF-5	Negative correlation between chronic testicular pain and sexual dysfunctions.
Green et al, 2011	Cross-sectional (quantitative design)	40 (current CP) 80 (CP since diagnosis), NE	Different cancer syndromes: Breast Prostate, Colorectal, Lung, Others (NS), Multiple Myeloma	QoL, Depression, Functionality	EORTC-QLQ-C30 PDI CES-D	Current CP has decreased several domains of QoL (general health, physical, social, and role functioning); while additional symptoms and financial difficulties were increased. CP since diagnosis has decreased all QoL domains (general health, physical, role, emotional, cognitive, and social functioning; while depression, additional symptoms, and financial difficulties were increased.
Burckhardt et al, 2005	Cross-sectional (quantitative design)	23, 56.8 (5.5) patients with regional pain 58.7 (8.6) patients with widespread pain	Breast Cancer	QoL	FACT-B SF-36	Poorer scores on all QoL domains (physical, emotional, functional well-being, additional concerns) in patients with widespread CP compared to patients with regional one.
Caffo et al, 2003	Retrospective (quantitative design)	210, NE	Breast Cancer	QoL	QoLQ	Poorer scores on all QoL domains (physical, social, and psychological well-being, physical autonomy).
Monga et al, 1998	Cross-sectional (quantitative design)	70, 49.9 (NE)	Different types of chronic illness: Cancer, Arthritis, Neuralgia, Headache, Diabetic Neuropathy	Sexuality, Depression	DISF CES-D HSCL-21	Negative correlations between CP and sexual functioning (drive, arousal, behaviour, orgasm, drive), except for fantasy. More sexual problems were experienced in patients with depression, distress, and those who adopted passive coping strategies than patients with active ones.

Note: ^†with chronic pain.

Abbreviations: NE, not estimable; NS, not specified; CP, chronic pain; CNS, central nervous system; QoL, quality of life; QoLQ, Quality of Life Questionnaire; FACT-B, Functional Assessment of Cancer Therapy-Breast; FACT-G, Functional Assessment of Cancer Therapy-General; WHOQOL-BREF, World Health Organization Quality of Life; EQ-5D-3L, European Quality of Life Five Dimensions Questionnaire; PDI, Pain Disability Index; EORTC-QLQ-C30, European Organization for Research and Treatment of Cancer – 30-item Quality of Life Questionnaire; IIEF-5, International Index of Erectile Function; BSFI, Brief Sexual Functioning Inventory; DISF, Derogatis Inventory of Sexual Functioning; CES-D, Center for Epidemiological Studies Depression Scale; HSCL-21, Hopkins Symptom Checklist.

Table 2 Descriptive Characteristics of the Studies Included on Caregivers’ Perspective

Authors, Year	Study Design	Participants^† n, M (SD)	Type of Chronic Condition	Question Relevance	Measures of QoL	Main Results
Kizza & Muliira, 2020	Cross-sectional (quantitative design)	284, 36 (13.8)	Cancer (NS)	Family	CQoL-I-C	The key determinants of better overall caregivers’ QoL were their knowledge and self-efficacy for cancer pain management. Burden, disruptiveness, and support were the most afflicted areas damaged of caregivers’ QoL; conversely, positive adaptation and lower financial concerns enhanced their QoL.
West et al, 2012	Cross-sectional (qualitative design)	9, NE	NS	Family	Interviews	The impact of CP is extended on the entire family, resulting in physical, social, and emotional changes. Four themes were captured: family losses; life changes; emotional impact; future plans’ concerns.
Ferrell et al, 1999	Quasi-experimental (quantitative design)	231, 21–86	Different cancer syndromes: Lung, Others (NS), Breast, Prostate, Pancreatic, Colorectal, Myeloma, Liver, Bladder, Ovarian, Renal, Melanoma, Uterine/Cervical, Oesophageal	Family	QoLFT	The impact of CP is extended on the entire family, resulting in poorer scores on all caregivers’ QoL domains (social, psychological, spiritual, and physical well-being).

Note: ^†with chronic pain.

Abbreviations: NE, not estimable; NS, not specified; CP, chronic pain; QoL, quality of life; QoLFT, Quality of Life Family Tool; CQoL-I-C, Caregiver Quality of Life-Index-Cancer.

Table 3 Descriptive Characteristics of the Studies Included on Patient–Caregiver Perspective

Authors, Year	Study Design	Participants^† n, M (SD)	Type of Chronic Condition	Question Relevance	Measures of QoL	Main Results
De Laurentis et al, 2019	Cross-sectional (quantitative design)	76 (38 dyads), 58.5 (13.4) patients 54.4 (14.8) caregivers	Different cancer syndromes: Breast, Gastric, Head/Neck Lung, Bones, Dermatologic, Gynecologic, Genitourinary, Hodgkin’s	Family, Emotional Distress	DT BEES BLRI-EUs	Caregivers’ distress level was predicted by patients’ pain intensity, caregivers’ emotional problems and patients’ pain intensity.
Izzo et al, 2019	Cross-sectional (quantitative design)	26 (15 patients), 60.7 (9.5) patients 48.07 (16.07) caregivers	Cancer (NS)	QoL, Family, Burden	EORTC-QLQ-C30 OARS ZBI	CP negatively affected the patients’ QoL and their functionality extending this impact also to the family environment. Functional capacity positively correlated with caregivers’ overload.
Rigoni et al 2016	Cross-sectional (quantitative design)	60 (30 dyads), 56.6 (NE) patients 45.4 (NE) caregivers	Head and Neck Cancer	QoL, Family	EORTC-QLQ-C30 ADL CSI	Patients and caregivers demonstrated a similar impairment in all their QoL domains (physical health, psychological well-being, daily activities, social activities, changes in health, and overall health).
Ojeda et al, 2014	Cross-sectional (qualitative design)	361 (325 patients), 56.5 (15.2) patients 53.4 (20.1) caregivers	Cancer (NS)	Family, Employment status	Interviews	Both patients and caregivers reported a negative experience of CP on their QoL (daily activities limitations, sadness, anxiety, economic problems, job loss, sleep disturbances, modification in leisure activities).
Kowal et al, 2012	Cross-sectional (quantitative design)	318 (238 patients) 47.1 (9.8) patients 48.7 (10.9) caregivers	NS	Family, Burden, Functionality, Depression, Attachment	SPBS BCOS-R FLS PHQ-9	Positive correlations between caregivers’ burden and patients’ anxiety attachment, caregivers’ burden and patients’ depressive symptoms were demonstrated.

Note: ^†with chronic pain.

Abbreviations: NE, not estimable; NS, not specified; CP, chronic pain; QoL, quality of life; EORTC-QLQ-C30, European Organization for Research and Treatment of Cancer – 30-item Quality of Life Questionnaire; DT, distress thermometer; BEES, balanced emotional empathy scale; BLRI-EUs, Barrett-Lennard Relationship Inventory - Empathy Understanding subscale; OARS, Older Americans Resources and Services; ZBI, Zarit Caregiver Burden Interview; FLS, Functional Limitations Scale; SPBS, Self-Perceived Burden Scale; BCOS-R, Bakas Caregiving Outcomes scale-Revised; PHQ-9, Patient Health Questionnaire-9; ADL, activities of daily living; CSI, caregiver strain index.