Pain in cancer patients is common and does not only affect the quality of life, but may also be a predictor of survival. Screening for distress has become an important issue for oncologists. This study investigated the relationship between psychological distress and pain in cancer patients.
Two hundred and forty nine outpatients with cancer who visited National Health Insurance Service Ilsan Hospital between April 2013 and March 2014 were evaluated with Modified Distress Thermometer (MDT) and Modified Impact Thermometer (MIT). Each scale was divided into three subscales targeting separate symptoms: insomnia, anxiety, and depression. For each particular symptom, MDT was instructed as to indicate the severity and MIT was to indicate how much impact the distress has had on patient's daily life activity. Psychological distress was defined as those who scored above the cutoff values in at least one of all six subscales.
Univariate logistic regression analysis showed that pain, compliance, and two subscale scores of Hospital Anxiety and Depression Scale (HADS) were significantly associated with psychological distress. Multivariate logistic regression analysis showed that pain and HADS anxiety subscale score maintained a statistically significant association with psychological distress adjusting for variables including age, gender, years of education, Eastern Cooperative Oncology Group (ECOG) performance status, cancer stage, Charlson Comorbidity Index, compliance, and HADS depression subscale score. One point increase in pain was 1.305 times more likely to cause psychological distress. Among the six subscales, MDT-depression subscale showed highest odds ratio with pain (OR = 1.356).
This study suggests that psychological distress reflects pain. We recommend that physicians screen cancer patients for any psychological distress which provides comprehensive evaluation of various factors regarding quality of life.
Clinical trial identification
All authors have declared no conflicts of interest.