Highlights
- •Younger and older patients showed age-related correlates of stoicism/cautiousness.
- •Activity engagement was the most common correlate for both age groups.
- •Young patients' stoicism/cautiousness were related to discomfort with dependence.
- •Older patients' stoicism/cautiousness were related to avoiding stressful thoughts.
- •Lifespan developmental issues must be considered in models of cancer pain adaptation.
Abstract
Age differences are not evident in pain-related stoicism and cautiousness in people
with cancer pain. Little is known about the factors associated with these pain-related
attitudes or age-related patterns in these associations. The present cross-sectional
study investigated the biopsychosocial correlates of the attitudes in younger and
older patients with advanced cancer. Pain-related stoicism (fortitude, concealment,
superiority) and cautiousness (self-doubt, reluctance) were assessed using the Pain
Attitudes Questionnaire-Revised (PAQ-R). Participants, 155 younger (younger than 60
years old) and 114 older (60 years old or older) patients with advanced cancer completed
the PAQ-R and measures of sociodemographic and medical characteristics, pain intensity,
cognitive-affective pain-related responses, physical functioning, psychological distress
and well-being, and psychosocial functioning. Backwards regression analyses identified
correlates for each PAQ-R factor separately for younger and older patients. Activity
engagement was a frequent correlate, but its relationship with concealment was the
only association common to both age groups. Younger and older patients exhibited different
avoidance-related constructs suggesting relational challenges in the former group
(avoidant attachment) and intrapersonal fear in the latter (cognitive avoidance).
Medical correlates also showed age differences: younger patients showed symptom-focused
correlates, whereas older patients showed aging-related correlates. Findings support
a biopsychosocial framework of cancer-pain adaptation incorporating a lifespan-developmental
perspective.
Perspective
To our knowledge, this article is the first to identify biopsychosocial correlates
of stoic and cautious attitudes toward cancer pain in younger and older patients with
advanced cancer. Findings highlight possible age-related motivations for greater pain-related
stoicism or cautiousness and can potentially inform interventions addressing challenges
in cancer-pain adaptation in advanced cancer.
Key words
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Article info
Publication history
Published online: November 16, 2017
Accepted:
November 6,
2017
Received in revised form:
October 31,
2017
Received:
June 29,
2017
Footnotes
Current address for Lynn R. Gauthier: Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval; l'Équipe de recherche Michel-Sarrazin en oncologie psychosociale et soins palliatifs, CHU de Québec-Université Laval Research Center; Université Laval Cancer Research Center; Québec Pain Research Network; Québec Research Network in Palliative and End of Life Care, Québec, Québec, Canada.
This work was supported by awards from the Canadian Institutes of Health Research (grant number MOP-62866) and the Canada Foundation for Innovation (New Opportunities Fund) to L.G. L.R.G. received PhD and Postdoctoral Fellowship funding from the Canadian Cancer Society and the Canadian Breast Cancer Foundation–Ontario Region. Funding sources had no involvement in the study design and conduct, data analyses and interpretation, the writing of this report, or the decision to submit this report for publication.
The authors have no conflicts of interest to declare.
S. Lawrence Librach is deceased.
This work was presented, in part, at the 34th Annual Scientific Meeting of the Canadian Pain Society, Winnipeg, Manitoba, Canada, 2013.
Identification
Copyright
© 2017 by the American Pain Society
