Pain Common, Impacts Mental Health in Older Adults With Cancer

M. Alexander Otto, MMS, PA

April 26, 2022

The study covered in this summary was published on as a preprint and has not yet been peer reviewed.

Key Takeaway

  • Close to half of older adults with cancer report moderate to severe pain, which increases their risk for functional and cognitive impairments as well as depression and anxiety.

Why This Matters

  • Most patients with cancer report experiencing chronic pain, but it's unclear how that pain impacts cognitive and physical functioning in older adults with cancer.

  • The work highlights the importance of screening for and managing pain in older patients with cancer.

Study Design

  • The investigators surveyed 714 adults 60 years or older at enrollment in the Cancer & Aging Resilience Evaluation (CARE) Registry.

  • Patients rated their pain on a scale of 0-10, with scores of 4 or higher counting as moderate/severe pain.

  • Pain findings were correlated with a range of measures, including functional status and cognition and emotional well-being, and adjusted for sex, race, education, ethnicity, marital status, cancer type/stage, and treatment phase.

  • Most participants had not begun treatment at the time of data collection (70%) and almost half (46.7%) of patients had stage IV cancer.

  • The participants were a mean age of 70 years; 59% were men.

  • Most patients had gastrointestinal malignancies, including colorectal cancer (27.9%) and pancreatic cancer (18%).

Key Results

  • About 43% of subjects (n = 309) reported moderate to very severe pain; the rest (n = 405) reported mild to no pain.

  • Patients with moderate/severe pain were more likely to report limitations in activities of daily living (adjusted odds ratio [aOR], 3.2; P < .001), cognitive complaints (aOR, 2.9; P = .004), anxiety (aOR, 2.2; P = .004), and depression (aOR, 3.7; P < .001).

  • Moderate/severe pain was more frequently reported in patients who were Black, had lower levels of education, pancreatic cancer, and were on disability.

  • Patients with moderate/severe pain were also more likely to report limitations in walking one block and impaired performance status, to take nine or more medications per day, and have three or more comorbidities.


  • The study could not address cause and effect.

  • Participants were recruited from a single center that draws primarily from underserved areas in Alabama.

  • The study did not account for the use of pain medications or whether patients had surgical vs nonsurgical treatments.


  • The work was supported in part by the National Institutes of Health.

  • The investigators didn't report any disclosures.

This is a summary of a preprint research study, "Pain among Older Adults with Cancer – Results from the Cancer and Aging Resilience Evaluation (CARE) Registry," led by Mustafa Al-Obaidi, MD, of the University of Alabama at Birmingham. The study has not been peer reviewed. The full text can be found at

M. Alexander Otto is a physician assistant with a master's degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who has worked for several major news outlets before joining Medscape and also an MIT Knight Science Journalism fellow. Email:

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