A Multimethod Approach to Understanding the Biopsychosocial Underpinnings of Chronic Cancer Pain

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Project Summary For many of the 26 million cancer survivors living in the United States today, lingering treatment-related symptoms pose a considerable problem. One such symptom is chronic pain, which is twice as prevalent in cancer survivors than in the general population, and has been shown to reduce quality of life (QoL), lower treatment adherence to cancer surveillance, and contribute to higher healthcare utilization. Although there is increased awareness of the magnitude and ramification of chronic cancer pain, what is not known are the unique cancer-specific factors that contribute to the chronic-cancer pain experience. Biological, social, and psychological (BPS) factors heavily influence chronic pain in non-cancer populations. However, cancer pain has typically been excluded from chronic pain studies, and as such, multimodal treatment strategies for cancer survivors are lacking. Due to a lack of alternative treatments, chronic cancer pain management relies on a biomedical model with opioid management being the cornerstone of treatment. As a consequence and despite little evidence to support this practice, cancer survivors are prescribed long-term opioid therapy at five times the rate of the general population but continue to report undertreated pain. Although psychological approaches such as cognitive-behavioral therapy and pain self-management have shown promising results in the general population, these have not been adapted to cancer survivors who likely have a unique chronic pain experience, due to cancer-specific factors, including the fear of recurrence and cancer-related distress. Without a clear understanding of the cancer-specific factors that drive the experience of chronic cancer pain and a deeper understanding of the lived experience of cancer survivors with chronic pain, the ability to develop effective multimodal treatments to reduce pain and improve function and quality of life is extremely limited. This fellowship award will allow the applicant to gain the knowledge and skills needed to work towards the achievement of her long-term goal; to produce actionable knowledge to improve pain management, quality of life and enhance opioid safety in individuals with cancer. The short-term goal of this study is to use a multimethod approach to 1) describe the lived experience of chronic pain in cancer survivors and 2) identify the unique biopsychosocial factors that are associated with the pain experience among cancer survivors with chronic pain. The central hypothesis is that unique cancer-specific factors will impact the chronic cancer pain experience, and therefore, can be targets of future interventions. This training award will allow the applicant to build on her clinical background in the management of cancer pain and expand her research skills in symptom science through the use of quantitative and qualitative methods. The applicant has assembled a mentoring team composed of interdisciplinary experts with strong methodologic backgrounds in cancer pain research, symptom science, and cancer distress. The applicant's career development goals are to become an independent nurse scientist and a leader in the field of cancer pain research.