The association of depression and pain with health-related quality of life, disability, and health care use in cancer patients

Kurt Kroenke, Dale Theobald, Jingwei Wu, Julie K. Loza, Janet Carpenter, Wanzhu Tu

Research output: Contribution to journalArticle

92 Citations (Scopus)

Abstract

Context: Pain and depression are two of the most prevalent and treatable cancer-related symptoms, each present in at least 20%-30% of oncology patients. Objective: To determine the associations of pain and depression with health-related quality of life (HRQL), disability, and health care use in cancer patients. Methods: The Indiana Cancer Pain and Depression study is a randomized clinical trial comparing telecare management vs. usual care for patients with cancer-related pain and/or clinically significant depression. In this article, baseline data on patients enrolled from 16 urban or rural community-based oncology practices are analyzed to test the associations of pain and depression with HRQL, disability, and health care use. Results: Of the 405 participants, 32% had depression only, 24% pain only, and 44% both depression and pain. The average Hopkins Symptom Checklist 20-item depression score in the 309 depressed participants was 1.64 (on 0-4 scale), and the average Brief Pain Inventory (BPI) severity score in the 274 participants with pain was 5.2 (on 0-10 scale), representing at least moderate levels of symptom severity. Symptom-specific disability was high, with participants reporting an average of 16.8 of the past 28 days (i.e., 60% of their days in the past four weeks) in which they were either confined to bed (5.6 days) or had to reduce their usual activities by 50% (11.2 days) because of pain or depression. Moreover, 176 (43%) participants reported being unable to work because of health-related reasons. Depression and pain had both individual and additive adverse associations with quality of life. Most patients were currently not receiving care from a mental health or pain specialist. Conclusion: Depression and pain are prevalent and disabling across a wide range of types and phases of cancer, commonly co-occur, and have additive adverse effects. Enhanced detection and management of this disabling symptom dyad is warranted.

Original languageEnglish
Pages (from-to)327-341
Number of pages15
JournalJournal of Pain and Symptom Management
Volume40
Issue number3
DOIs
StatePublished - Sep 2010

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Quality of Life
Depression
Delivery of Health Care
Pain
Neoplasms
Rural Population
Checklist
Patient Care
Mental Health
Randomized Controlled Trials
Equipment and Supplies
Health

Keywords

  • Cancer
  • depression
  • disability
  • health care use
  • pain
  • quality of life

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Clinical Neurology
  • Nursing(all)

Cite this

The association of depression and pain with health-related quality of life, disability, and health care use in cancer patients. / Kroenke, Kurt; Theobald, Dale; Wu, Jingwei; Loza, Julie K.; Carpenter, Janet; Tu, Wanzhu.

In: Journal of Pain and Symptom Management, Vol. 40, No. 3, 09.2010, p. 327-341.

Research output: Contribution to journalArticle

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abstract = "Context: Pain and depression are two of the most prevalent and treatable cancer-related symptoms, each present in at least 20{\%}-30{\%} of oncology patients. Objective: To determine the associations of pain and depression with health-related quality of life (HRQL), disability, and health care use in cancer patients. Methods: The Indiana Cancer Pain and Depression study is a randomized clinical trial comparing telecare management vs. usual care for patients with cancer-related pain and/or clinically significant depression. In this article, baseline data on patients enrolled from 16 urban or rural community-based oncology practices are analyzed to test the associations of pain and depression with HRQL, disability, and health care use. Results: Of the 405 participants, 32{\%} had depression only, 24{\%} pain only, and 44{\%} both depression and pain. The average Hopkins Symptom Checklist 20-item depression score in the 309 depressed participants was 1.64 (on 0-4 scale), and the average Brief Pain Inventory (BPI) severity score in the 274 participants with pain was 5.2 (on 0-10 scale), representing at least moderate levels of symptom severity. Symptom-specific disability was high, with participants reporting an average of 16.8 of the past 28 days (i.e., 60{\%} of their days in the past four weeks) in which they were either confined to bed (5.6 days) or had to reduce their usual activities by 50{\%} (11.2 days) because of pain or depression. Moreover, 176 (43{\%}) participants reported being unable to work because of health-related reasons. Depression and pain had both individual and additive adverse associations with quality of life. Most patients were currently not receiving care from a mental health or pain specialist. Conclusion: Depression and pain are prevalent and disabling across a wide range of types and phases of cancer, commonly co-occur, and have additive adverse effects. Enhanced detection and management of this disabling symptom dyad is warranted.",
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