Pain interfering with daily life in patients with cancer: stronger associations with anxiety and emotional distress than with pain intensity

Support Care Cancer. 2026 Mar 13;34(4):321. doi: 10.1007/s00520-026-10520-5.

ABSTRACT

PURPOSE: Pain interfering with daily life (PIDL) affects the quality of life of patients with cancer beyond pain intensity. This study was aimed at identifying clinical factors associated with PIDL, defined as pain interfering with mobility/posture, sleep, eating, or excretion.

METHODS: This retrospective observational study included 1798 hospitalized patients with malignancy who underwent at least one pain assessment between 2016 and 2022, yielding 5394 assessments. Associations between PIDL and clinical variables-including demographics, primary malignancy site, number of assessments, survival duration, pain severity, anxiety/worry, emotional distress during the previous week, pain medication, analgesic efficacy, and side effects-were examined using univariable and multivariable analyses.

RESULTS: The mean age was 69.5 ± 11.2 years, and 59.7% were male. The median number of assessments per patient was two (IQR 1-4). PIDL was independently more frequent in younger patients and in men and more common in those with malignancies of the female genital organs or hematologic system and in those with fewer assessments. Higher pain severity (NRS ≥ 4), anxiety/worry, and emotional distress (NRS ≥ 4) were associated with increased odds of PIDL. Opioid use, analgesic inefficacy, and medication-related side effects were also associated with a higher likelihood of PIDL. Among these variables, anxiety/worry (OR 2.36, 95% CI 2.01-2.76) and emotional distress (OR 2.19, 95% CI 1.87-2.56) showed stronger associations with PIDL than pain severity (OR 1.65, 95% CI 1.42-1.92).

CONCLUSIONS: Psychological distress was more strongly associated with PIDL than pain severity, warranting further investigation into the directionality of this relationship.

PMID:41826565 | DOI:10.1007/s00520-026-10520-5