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Do Correlates of Pain-Related Stoicism and Cautiousness Differ in Younger and Older People With Advanced Cancer?

  • Kenneth Mah
    Affiliations
    Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada

    Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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  • Kim T. Tran
    Affiliations
    Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada

    University College Dublin, Dublin, Ireland
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  • Lynn R. Gauthier
    Affiliations
    Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada

    School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
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  • Gary Rodin
    Affiliations
    Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada

    Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • Camilla Zimmermann
    Affiliations
    Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada

    Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • David Warr
    Affiliations
    Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada

    Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • S. Lawrence Librach
    Affiliations
    Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Toronto, Ontario, Canada
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  • Malcolm Moore
    Affiliations
    BC Cancer Agency, Vancouver, British Columbia, Canada
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  • Frances A. Shepherd
    Affiliations
    Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada

    Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • Lucia Gagliese
    Correspondence
    Address reprint requests to Lucia Gagliese, PhD, School of Kinesiology and Health Science, York University, 367 Bethune, 4700 Keele Street, Toronto, Ontario, Canada, M3J 1P3.
    Affiliations
    Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada

    Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada

    School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada

    Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    Department of Anesthesia, Mount Sinai Hospital, Toronto, Ontario, Canada
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Published:November 16, 2017DOI:https://doi.org/10.1016/j.jpain.2017.11.002

      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.

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