TORONTO, August 5, 2009 -- Seniors with cancer pain cope better than their middle-aged counterparts and report personal growth – including strengthened marriages – says a joint York University-University Health Network study.
The study looked at chronic cancer-related pain in patients in their late forties and early fifties, contrasted with those in their seventies. While seniors carried on with life goals and forged stronger relationships with their spouses, younger patients put their lives on hold and often experienced marital discord. Unmarried, middle-aged patients reported the most difficulty dealing with their illness.
“Despite similar levels of pain, the impact and adjustment made is very different for younger and older cancer patients,” says study lead author Lucia Gagliese, an associate professor in York’s School of Kinesiology & Health Science, and Senior Scientist in Psychosocial Oncology and Palliative Care at Princess Margaret Hospital, University Health Network.
“In particular, younger patients experience a more negative adjustment and go through many losses, while older patients are able to modify their activities to maintain some control over how the pain impacts their lives,” she says.
Researchers saw two themes emerge amongst the patient groups: Younger patients were more likely than older patients to be “waiting to live,” rather than “living despite pain.” They felt that complete pain relief was necessary before their lives could move forward, and reported feeling out of control, angry, and unable to accept their pain. Many reported loss of previously-valued roles, dimensions of identity, and goals. Feelings of helplessness pertained both to controlling the pain and carrying on usual activities.
Among younger, married patients, 66.7 per cent reported marital strain arising from their ongoing struggle with cancer pain. These patients believed they were not getting the support they needed from their partners, who did not understand their pain. They also described pressure to protect their partners from the burden of their illness, and to maintain their marital and parental roles.
Older patients more frequently adopted an attitude of “living despite pain.” These patients accepted pain as an inevitable part of cancer, and engaged in activities despite their illness.
“This group tended to focus on what was left in life,” Gagliese says. “They accepted pain as an inevitable part of the disease, and chose not to allow it to become their primary focus.” She notes that older patients often modified goals and activities to accommodate their illness, working with their pain, rather than against it.
According to study results, all of the couples in this age group reported strengthened relationships and increased intimacy as a result of coping with their pain. Many had older spouses with significant health issues, leading to an increased understanding between partners. Older patients also reported wanting to protect their spouses from the burden of their illness.
Gagliese attributes the differences between older and younger patients to multiple life-stage factors, including normal neurobiological and psychological aging, life experience, and health status. She stresses that patients in both age groups describe their pain medications as being essential tools in being able to maintain their activities.
“Living despite pain does not imply that older people do not require effective and safe pain management," says Gagliese. "However, our results suggest that psychosocial support can maximize their function and quality of life while living with cancer pain day-to-day."
Study respondents were from outpatient clinics at Princess Margaret Hospital; researchers employed one-on-one interviews, along with quantitative measures including the Brief Pain Inventory and Pain Management Index.
“Age-Related Patterns in Adaptation to Cancer Pain: A Mixed-Method Study,” was published online in the journal, Pain Medicine, in July 2009.
It is co-authored by researchers from the Behavioural Sciences and Health Research Division, Toronto General Research Institute; Psychosocial Oncology and Palliative Care, The Ontario Cancer Institute; The University of Toronto’s Faculty of Medicine and Lawrence Bloomberg Faculty of Nursing, and the Cancer Pain Program at the University Health Network.
The study was supported by funding from the Canadian Institutes of Health Research (CIHR), and the Canada Foundation for Innovation (CFI).
About University Health Network
University Health Network consists of Toronto General, Toronto Western and Princess Margaret Hospitals. The scope of research and complexity of cases at University Health Network has made it a national and international source for discovery, education and patient care. It has the largest hospital-based research program in Canada, with major research in cardiology, transplantation, neurosciences, oncology, surgical innovation, infectious diseases, and genomic medicine. University Health Network is a research hospital affiliated with the University of Toronto.
About York University
York University is the leading interdisciplinary research and teaching university in Canada. York offers a modern, academic experience at the undergraduate and graduate level in Toronto, Canada’s most international city. The third largest university in the country, York is host to a dynamic academic community of 50,000 students and 7,000 faculty and staff, as well as more than 200,000 alumni worldwide. York’s 10 faculties and 26 research centres conduct ambitious, groundbreaking research that is interdisciplinary, cutting across traditional academic boundaries. This distinctive and collaborative approach is preparing students for the future and bringing fresh insights and solutions to real-world challenges. York University is an autonomous, not-for-profit corporation.
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