Predictors and Consequences of Cancer and Non-Cancer-Related Pain in Those Diagnosed with Primary and Metastatic Cancers

Kriti Shah, David A. Geller, Samer Tohme, Michael Antoni, Cramer J. Kallem, Yoram Vodovotz, Rekha Ramanathan, Raam Naveen, MacKenzie Geroni, La Nita Devine, Aarshati Amin, Gauri J. Kiefer, Dan P. Zandberg, Vincent Reyes, Jennifer L. Steel*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objectives: The aims of the study were to (1) describe types of pain in cancer patients, (2) examine the predictors and consequences of pain, (3) investigate the association between type of pain and survival, and (4) examine potential biological mediators of pain and survival. Methods: This was a secondary analysis of baseline data from patients diagnosed with cancer. Patients answered questionnaires that assessed sociodemographic characteristics, pain, depression, sleep, and fatigue. Blood was collected and cytokine assays were performed. Analysis of variance, Kaplan–Meier, and Cox regression survival analyses were used to test the aims. Results: Of the 779 patients diagnosed with cancer, the mean age was 63.5 years, 57.8% male, and 90.6% White. Of those who reported pain (total 70.3%), 46.5% stated their pain was cancer-related while 53.5% stated their pain was non-cancer-related. While both cancer and non-cancer-related pain was associated with depressive symptoms, fatigue, and sleep duration, those with cancer-related pain had significantly higher rates of depressive symptoms (F(1,516) = 21.217, p < 0.001) and fatigue (F(1,516) = 30.973, p < 0.001) but not poorer sleep (F(1,497) = 0.597, p = 0.440). After adjusting for sociodemographic, disease-related characteristics, depression, sleep duration, and morphine milligram equivalent, patient reports of cancer-related pain were significantly associated with poorer survival (HR = 0.646, 95% CI = 0.459–0.910, p = 0.012) compared to those with non-cancer-related pain, which was not associated with survival (HR = 1.022, 95% CI = 0.737–1.418, p = 0.896). Cytokines did not significantly mediate the link between pain and survival. Conclusion: While nearly half of the pain reported was cancer-related, both types of pain resulted in greater symptom burden, but only cancer-related pain was associated with survival.

Original languageEnglish
Pages (from-to)8826-8840
Number of pages15
JournalCurrent Oncology
Issue number10
StatePublished - Oct 2023
Externally publishedYes


  • cancer
  • cytokines
  • depression
  • fatigue
  • inflammation
  • pain
  • sleep


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