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Worst Pain Severity Profiles of Oncology Patients Are Associated With Significant Stress and Multiple Co-Occurring Symptoms

      Highlights

      • Unrelieved pain occurs in 70% of oncology patients
      • Patients with severe pain report high levels of cumulative life stress
      • Patients with severe pain have a higher comorbidity burden

      Abstract

      Little is known about the associations between pain, stress, and co-occurring symptoms in oncology patients. Purpose was to identify subgroups of patients with distinct worst pain profiles and evaluate for differences among the subgroups in demographic and clinical characteristics, as well as stress and symptom scores. Oncology outpatients (n = 1305) completed questionnaires prior to their second or third chemotherapy cycle. Worst pain intensity was assessed 6 times over 2 chemotherapy cycles using a 0 to 10 numeric rating scale. The 371 patients (28.4%) who had ≤1 occurrence of pain over the 6 assessments were classified as the None class. For the remaining 934 patients whose data were entered into the latent profile analysis, 3 distinct worst pain profiles were identified (ie Mild [12.5%], Moderate [28.6%], Severe [30.5%]). Compared to None class, Severe class had fewer years of education and a lower annual income; were less likely to be employed and married; less likely to exercise on a regular basis, had a higher comorbidity burden, and a worse functional status. Compared to None class, Severe class reported higher levels of general, disease-specific, and cumulative life stress and lower levels of resilience, as well as higher levels of depressive symptoms, anxiety, fatigue, sleep disturbance, and cognitive dysfunction. This study is the first to identify distinct worst pain profiles in a large sample of oncology patients receiving chemotherapy and associated risk factors.

      Perspective

      Unrelieved pain remains a significant problem for oncology patients receiving chemotherapy. High levels of stress and co-occurring symptoms contribute to a more severe pain profile in these patients.

      Key words

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      References

        • Ahmed Y
        • Popovic M
        • Wan BA
        • Lam M
        • Lam H
        • Ganesh V
        • Milakovic M
        • DeAngelis C
        • Malek L
        • Chow E
        Does gender affect self-perceived pain in cancer patients? -A meta-analysis.
        Ann Palliat Med. 2017; 6: 177
        • Arias Gonzalez VB
        • Crespo Sierra MT
        • Arias Martinez B
        • Martinez-Molina A
        • Ponce FP
        An in-depth psychometric analysis of the connor-davidson resilience scale: Calibration with rasch-andrich model.
        Health Qual Life Outcomes. 2015; 13: 154
        • Arnaboldi P
        • Riva S
        • Crico C
        • Pravettoni G
        A systematic literature review exploring the prevalence of post-traumatic stress disorder and the role played by stress and traumatic stress in breast cancer diagnosis and trajectory.
        Breast Cancer. 2017; 9: 473-485
        • Atallah M
        • Cooper B
        • Munoz RF
        • Paul SM
        • Anguera J
        • Levine JD
        • Hammer M
        • Wright F
        • Chen LM
        • Melisko M
        • Conley YP
        • Miaskowski C
        • Dunn LB
        Psychological symptoms and stress are associated with decrements in attentional function in cancer patients undergoing chemotherapy.
        Cancer Nurs. 2020; 43: 402-410
        • Belfer I
        • Schreiber KL
        • Shaffer JR
        • Shnol H
        • Blaney K
        • Morando A
        • Englert D
        • Greco C
        • Brufsky A
        • Ahrendt G
        • Kehlet H
        • Edwards RR
        • Bovbjerg DH
        Persistent postmastectomy pain in breast cancer survivors: Analysis of clinical, demographic, and psychosocial factors.
        J Pain. 2013; 14: 1185-1195
        • Berlin KS
        • Parra GR
        • Williams NA
        An introduction to latent variable mixture modeling (Part 2): Longitudinal latent class growth analysis and growth mixture models.
        J Pediatr Psychol. 2014; 39: 188-203
        • Berlin KS
        • Williams NA
        • Parra GR
        An introduction to latent variable mixture modeling (Part 1): Overview and cross-sectional latent class and latent profile analyses.
        J Pediatr Psychol. 2014; 39: 174-187
        • Bieling PJ
        • Antony MM
        • Swinson RP
        The state-trait anxiety inventory, trait version: Structure and content re-examined.
        Behav Res Ther. 1998; 36: 777-788
        • Bohn MJ
        • Babor TF
        • Kranzler HR
        The alcohol use disorders identification test (AUDIT): Validation of a screening instrument for use in medical settings.
        J Stud Alcohol. 1995; 56: 423-432
        • Burke NN
        • Finn DP
        • McGuire BE
        • Roche M
        Psychological stress in early life as a predisposing factor for the development of chronic pain: Clinical and preclinical evidence and neurobiological mechanisms.
        J Neurosci Res. 2017; 95: 1257-1270
        • Campbell-Sills L
        • Forde DR
        • Stein MB
        Demographic and childhood environmental predictors of resilience in a community sample.
        J Psychiatr Res. 2009; 43: 1007-1012
        • Campbell-Sills L
        • Stein MB
        Psychometric analysis and refinement of the connor-davidson resilience scale (CD-RISC): Validation of a 10-item measure of resilience.
        J Trauma Stress. 2007; 20: 1019-1028
        • Carpenter JS
        • Andrykowski MA
        • Wilson J
        • Hall LA
        • Rayens MK
        • Sachs B
        • Cunningham LL
        Psychometrics for 2 short forms of the center for epidemiologic studies-depression scale.
        Issues Ment Health Nurs. 1998; 19: 481-494
        • Cathomas F
        • Murrough JW
        • Nestler EJ
        • Han MH
        • Russo SJ
        Neurobiology of resilience: Interface between mind and body.
        Biol Psychiatry. 2019; 86: 410-420
        • Chan RJ
        • Cooper B
        • Koczwara B
        • Chan A
        • Tan CJ
        • Paul SM
        • Dunn LB
        • Conley YP
        • Kober KM
        • Levine JD
        • Miaskowski C
        A longitudinal analysis of phenotypic and symptom characteristics associated with inter-individual variability in employment interference in patients with breast cancer.
        Support Care Cancer. 2020; 28: 4677-4686
        • Chan RJ
        • Gordon LG
        • Tan CJ
        • Chan A
        • Bradford NK
        • Yates P
        • Agbejule OA
        • Miaskowski C
        Relationships between financial toxicity and symptom burden in cancer survivors: A systematic review.
        J Pain Symptom Manage. 2019; 57: 646-660
        • Chapman CR
        • Tuckett RP
        • Song CW
        Pain and stress in a systems perspective: Reciprocal neural, endocrine, and immune interactions.
        J Pain. 2008; 9: 122-145
        • Chou PL
        • Fang SY
        • Sun JL
        • Rau KM
        • Lee BO
        Gender difference in cancer patients' adherence to analgesics and related outcomes of pain management.
        Cancer Nurs. 2018; 41: 11-18
        • Chow S
        • Ding KY
        • Wan BA
        • Brundage M
        • Meyer RM
        • Nabid A
        • Chabot P
        • Coulombe G
        • Ahmed S
        • Kuk J
        • Dar AR
        • Mahmud A
        • Fairchild A
        • Wilson CF
        • Wu JSY
        • Dennis K
        • DeAngelis C
        • Wong RKS
        • Zhu LT
        • Chow E
        Gender differences in pain and patient reported outcomes: A secondary analysis of the NCIC CTG SC. 23 randomized trial.
        Ann Palliat Med. 2017; 6: S185-S194
        • Cimprich B
        • So H
        • Ronis DL
        • Trask C
        Pre-treatment factors related to cognitive functioning in women newly diagnosed with breast cancer.
        Psycho Oncol. 2005; 14: 70-78
        • Cimprich B
        • Visovatti M
        • Ronis DL.
        The attentional function index–a self-report cognitive measure.
        Psycho Oncol. 2011; 20: 194-202
        • Cioroiu C
        • Weimer LH
        Update on chemotherapy-induced peripheral neuropathy.
        Curr Neurol Neurosci Rep. 2017; 17: 47
        • Civilotti C
        • Castelli L
        • Binaschi L
        • Cussino M
        • Tesio V
        • Di Fini G
        • Veglia F
        • Torta R
        Dissociative symptomatology in cancer patients.
        Front Psychol. 2015; 6: 118
        • Cleary JF
        Restoring balance to cancer pain management.
        Cancer. 2020; 126: 697-700
        • Cleeland CS
        • Gonin R
        • Hatfield AK
        • Edmonson JH
        • Blum RH
        • Stewart JA
        • Pandya KJ
        Pain and its treatment in outpatients with metastatic cancer.
        N Engl J Med. 1994; 330: 592-596
        • Cohen J
        Statistical Power Analysis for the Behavioral Sciences.
        Lawrence Erlbaum Associates, Hillsdale, NJ1988 (2 nd edition)
        • Cohen S
        • Kamarck T
        • Mermelstein R
        A global measure of perceived stress.
        J Health Soc Behav. 1983; 24: 385-396
        • Connor KM
        • Davidson JR
        Development of a new resilience scale: The connor-davidson resilience scale (CD-RISC).
        Depress Anxiety. 2003; 18: 76-82
        • Cox-Martin E
        • Trahan LH
        • Cox MG
        • Dougherty PM
        • Lai EA
        • Novy DM
        Disease burden and pain in obese cancer patients with chemotherapy-induced peripheral neuropathy.
        Support Care Cancer. 2017; 25: 1873-1879
        • Creamer M
        • Bell R
        • Failla S
        Psychometric properties of the impact of event scale - revised.
        Behav Res Ther. 2003; 41: 1489-1496
        • Cuevas BT
        • Hughes DC
        • Parma DL
        • Trevino-Whitaker RA
        • Ghosh S
        • Li R
        • Ramirez AG
        Motivation, exercise, and stress in breast cancer survivors.
        Support Care Cancer. 2014; 22: 911-917
        • Daut RL
        • Cleeland CS
        • Flanery RC
        Development of the wisconsin brief pain questionnaire to assess pain in cancer and other diseases.
        Pain. 1983; 17: 197-210
        • Ebner K
        • Singewald N
        Individual differences in stress susceptibility and stress inhibitory mechanisms.
        Curr Opin Behav Sci. 2017; 14: 54-64
        • Edrington JN
        • Paul S
        • Dodd M
        • West C
        • Facione N
        • Tripathy D
        • Koo P
        • Schumacher K
        • Miaskowski C
        No evidence for sex differences in the severity and treatment of cancer pain.
        J Pain Symptom Manage. 2004; 28: 225-232
        • Emerson NM
        • Nahman-Averbuch H
        • Coghill RC
        Pain Sensitivity does not Differ Between Obese and Healthy Weight Individuals.
        Cold Spring Harbor Laboratory, 2020
        • Feder A
        • Fred-Torres S
        • Southwick SM
        • Charney DS
        The biology of human resilience: Opportunities for enhancing resilience across the life span.
        Biol Psychiatry. 2019; 86: 443-453
        • Ferrari LF
        • Araldi D
        • Green PG
        • Levine JD
        Marked sexual dimorphism in neuroendocrine mechanisms for the exacerbation of paclitaxel-induced painful peripheral neuropathy by stress.
        Pain. 2020; 161: 865-874
        • Fisch MJ
        • Lee J-W
        • Weiss M
        • Wagner LI
        • Chang VT
        • Cella D
        • Manola JB
        • Minasian LM
        • McCaskill-Stevens W
        • Mendoza TR
        • Cleeland CS
        Prospective, observational study of pain and analgesic prescribing in medical oncology outpatients with breast, colorectal, lung, or prostate cancer.
        J Clin Oncol. 2012; 30: 1980-1988
        • Fletcher BS
        • Paul SM
        • Dodd MJ
        • Schumacher K
        • West C
        • Cooper B
        • Lee K
        • Aouizerat B
        • Swift P
        • Wara W
        • Miaskowski CA
        Prevalence, severity, and impact of symptoms on female family caregivers of patients at the initiation of radiation therapy for prostate cancer.
        J Clin Oncol. 2008; 26: 599-605
        • Fowler H
        • Belot A
        • Ellis L
        • Maringe C
        • Luque-Fernandez MA
        • Njagi EN
        • Navani N
        • Sarfati D
        • Rachet B
        Comorbidity prevalence among cancer patients: A population-based cohort study of four cancers.
        BMC Cancer. 2020; 20: 2
        • Fujii A
        • Yamada Y
        • Takayama K
        • Nakano T
        • Kishimoto J
        • Morita T
        • Nakanishi Y
        Longitudinal assessment of pain management with the pain management index in cancer outpatients receiving chemotherapy.
        Support Care Cancer. 2017; 25: 925-932
        • Gay CL
        • Lee KA
        • Lee SY
        Sleep patterns and fatigue in new mothers and fathers.
        Biol Res Nurs. 2004; 5: 311-318
        • Holtzman S
        • Newth S
        • Delongis A
        The role of social support in coping with daily pain among patients with rheumatoid arthritis.
        J Health Psychol. 2004; 9: 677-695
        • Horowitz M
        • Wilner N
        • Alvarez W
        Impact of event scale: A measure of subjective stress.
        Psychosom Med. 1979; 41: 209-218
        • Humphreys J
        • Cooper BA
        • Miaskowski C
        Differences in depression, posttraumatic stress disorder, and lifetime trauma exposure in formerly abused women with mild vs moderate to severe chronic pain.
        J Interpers Violence. 2010; 25: 2316-2338
        • Humphreys JC
        • Bernal De Pheils P
        • Slaughter RE
        • Uribe T
        • Jaramillo D
        • Tiwari A
        • Canaval GE
        • Amaya P
        • Mendoza Flores ME
        • Belknap RA
        Translation and adaptation of the life stressor checklist-revised with Colombian women.
        Health Care Women Int. 2011; 32: 599-612
        • IBM Corporation
        IBM SPSS Statistics for Windows.
        IBM Corp, Armonk, NY2020
        • Karnofsky D
        Performance Scale.
        Plenum Press, New York1977
        • Kennedy BL
        • Schwab JJ
        • Morris RL
        • Beldia G
        Assessment of state and trait anxiety in subjects with anxiety and depressive disorders.
        Psychiatr Q. 2001; 72: 263-276
        • Kim HJ
        • Malone PS
        Roles of biological and psychosocial factors in experiencing a psychoneurological symptom cluster in cancer patients.
        Eur J Oncol Nurs. 2019; 42: 97-102
        • Kimerling R
        • Calhoun KS
        • Forehand R
        • Armistead L
        • Morse E
        • Morse P
        • Clark R
        • Clark L
        Traumatic stress in HIV-infected women.
        AIDS Educ Prev. 1999; 11: 321-330
        • Klengel T
        • Binder EB
        Epigenetics of stress-related psychiatric disorders and gene x environment interactions.
        Neuron. 2015; 86: 1343-1357
        • Kober KM
        • Cooper BA
        • Paul SM
        • Dunn LB
        • Levine JD
        • Wright F
        • Hammer MJ
        • Mastick J
        • Venook A
        • Aouizerat BE
        • Miaskowski C
        Subgroups of chemotherapy patients with distinct morning and evening fatigue trajectories.
        Support Care Cancer. 2016; 24: 1473-1485
        • Kwekkeboom KL
        • Tostrud L
        • Costanzo E
        • Coe CL
        • Serlin RC
        • Ward SE
        • Zhang Y
        The role of inflammation in the pain, fatigue, and sleep disturbance symptom cluster in advanced cancer.
        J Pain Symptom Manage. 2018; 55: 1286-1295
        • Lacourt TE
        • Heijnen CJ
        Mechanisms of neurotoxic symptoms as a result of breast cancer and its treatment: Considerations on the contribution of stress, inflammation, and cellular bioenergetics.
        Curr Breast Cancer Rep. 2017; 9: 70-81
        • Langford DJ
        • Cooper B
        • Paul S
        • Humphreys J
        • Hammer MJ
        • Levine J
        • Conley YP
        • Wright F
        • Dunn LB
        • Miaskowski C
        Distinct stress profiles among oncology patients undergoing chemotherapy.
        J Pain Symptom Manage. 2020; 59: 646-657
        • Langford DJ
        • Paul SM
        • Cooper B
        • Kober KM
        • Mastick J
        • Melisko M
        • Levine JD
        • Wright F
        • Hammer MJ
        • Cartwright F
        • Lee KA
        • Aouizerat BE
        • Miaskowski C
        Comparison of subgroups of breast cancer patients on pain and co-occurring symptoms following chemotherapy.
        Support Care Cancer. 2016; 24: 605-614
        • Langford DJ
        • Theodore BR
        • Balsiger D
        • Tran C
        • Doorenbos AZ
        • Tauben DJ
        • Sullivan MD
        Number and type of post-traumatic stress disorder symptom domains are associated with patient-reported outcomes in patients with chronic pain.
        J Pain. 2018; 19: 506-514
        • Lawson KM
        • Back SE
        • Hartwell KJ
        • Moran-Santa Maria M
        • Brady KT
        A comparison of trauma profiles among individuals with prescription opioid, nicotine, or cocaine dependence.
        Am J Addict. 2013; 22: 127-131
        • Lee KA
        Self-reported sleep disturbances in employed women.
        Sleep. 1992; 15: 493-498
        • Lee KA
        • DeJoseph JF
        Sleep disturbances, vitality, and fatigue among a select group of employed childbearing women.
        Birth. 1992; 19: 208-213
        • Lee KA
        • Hicks G
        • Nino-Murcia G
        Validity and reliability of a scale to assess fatigue.
        Psychiatry Res. 1991; 36: 291-298
        • Lee KA
        • Portillo CJ
        • Miramontes H
        The fatigue experience for women with human immunodeficiency virus.
        J Obstet Gynecol Neonatal Nurs. 1999; 28: 193-200
        • Li H
        • Marsland AL
        • Conley YP
        • Sereika SM
        • Bender CM.
        Genes involved in the HPA axis and the symptom cluster of fatigue, depressive symptoms, and anxiety in women with breast cancer during 18 months of adjuvant therapy.
        Biol Res Nurs. 2020; 22: 277-286
        • Liang SY
        • Wang TJ
        • Wu SF
        • Chao TC
        • Chuang YH
        • Tsay SL
        • Tung HH
        • Lee MD
        Gender differences associated with pain characteristics and treatment in Taiwanese oncology outpatients.
        Asian Pac J Cancer P. 2013; 14: 4077-4082
        • Mahoney 3rd, JJ
        • Thompson-Lake DG
        • Cooper K
        • Verrico CD
        • Newton TF
        • De La
        • Garza R
        A comparison of impulsivity, depressive symptoms, lifetime stress and sensation seeking in healthy controls vs participants with cocaine or methamphetamine use disorders.
        J Psychopharmacol. 2015; 29: 50-56
        • Markovitz SE
        • Schrooten W
        • Arntz A
        • Peters ML
        Resilience as a predictor for emotional response to the diagnosis and surgery in breast cancer patients.
        Psycho Oncol. 2015; 24: 1639-1645
        • Matzka M
        • Mayer H
        • Kock-Hodi S
        • Moses-Passini C
        • Dubey C
        • Jahn P
        • Schneeweiss S
        • Eicher M
        Relationship between resilience, psychological distress and physical activity in cancer patients: A cross-sectional observation study.
        PLoS One. 2016; 110154496
        • Maxwell JC
        The prescription drug epidemic in the United States: A perfect storm.
        Drug Alcohol Rev. 2011; 30: 264-270
        • Miaskowski C
        • Cooper BA
        • Melisko M
        • Chen L-M
        • Mastick J
        • West C
        • Paul SM
        • Dunn LB
        • Schmidt BL
        • Hammer M
        • Cartwright F
        • Wright F
        • Langford DJ
        • Lee K
        • Aouizerat BE
        Disease and treatment characteristics do not predict symptom occurrence profiles in oncology outpatients receiving chemotherapy.
        Cancer. 2014; 120: 2371-2378
        • Miaskowski C
        • Cooper BA
        • Paul SM
        • Dodd M
        • Lee K
        • Aouizerat BE
        • West C
        • Cho M
        • Bank A
        Subgroups of patients with cancer with different symptom experiences and quality-of-life outcomes: a cluster analysis.
        Oncol Nurs Forum. 2006; 33: 79-89
        • Miaskowski C
        • Lee KA.
        Pain, fatigue, and sleep disturbances in oncology outpatients receiving radiation therapy for bone metastasis: A pilot study.
        J Pain Symptom Manage. 1999; 17: 320-332
        • Miaskowski C
        • Paul SM
        • Cooper BA
        • Lee K
        • Dodd M
        • West C
        • Aouizerat BE
        • Swift PS
        • Wara W
        Trajectories of fatigue in men with prostate cancer before, during, and after radiation therapy.
        J Pain Symptom Manage. 2008; 35: 632-643
        • Miaskowski C
        • Paul SM
        • Mastick J
        • Abrams G
        • Topp K
        • Smoot B
        • Kober KM
        • Chesney M
        • Mazor M
        • Mausisa G
        • Schumacher M
        • Conley YP
        • Sabes JH
        • Cheung S
        • Wallhagen M
        • Levine JD
        Associations between perceived stress and chemotherapy-induced peripheral neuropathy and otoxicity in adult cancer survivors.
        J Pain Symptom Manage. 2018; 56: 88-97
        • Miaskowski C
        • Wong ML
        • Cooper BA
        • Mastick J
        • Paul SM
        • Possin K
        • Steinman M
        • Cataldo J
        • Dunn LB
        • Ritchie C
        Distinct physical function profiles in older adults receiving cancer chemotherapy.
        J Pain Symptom Manage. 2017; 54: 263-272
        • Mohammed A
        • Alshamarri T
        • Adeyeye T
        • Lazariu V
        • McNutt LA
        • Carpenter DO
        A comparison of risk factors for osteo- and rheumatoid arthritis using NHANES data.
        Prev Med Rep. 2020; 20101242
        • Moore DC
        • Pellegrino AE
        Pegfilgrastim-induced bone pain: A review on incidence, risk factors, and evidence-based management.
        Ann Pharmacother. 2017; 51: 797-803
        • Muthen B
        • Shedden K
        Finite mixture modeling with mixture outcomes using the EM algorithm.
        Biometrics. 1999; 55: 463-469
        • Muthén L
        • Muthén B.
        Mplus: Statistical analysis with latent variables.
        User's Guide. 2009; 7
        • Muthen LK
        • Muthen BO
        Mplus User's Guide (8th ed.).
        8th edition. Muthen & Muthen, Los Angeles, CA2020 (1998)
        • Norman GR
        • Sloan JA
        • Wyrwich KW
        Interpretation of changes in health-related quality of life: The remarkable universality of half a standard deviation.
        Med Care. 2003; 41: 582-592
        • Openshaw M
        • Thompson LM
        • de Pheils PB
        • Mendoza-Flores ME
        • Humphreys J
        Childhood trauma is associated with depressive symptoms in Mexico City women.
        Rev Panam Salud Publica. 2015; 37: 308-315
        • Parker KP
        • Kimble LP
        • Dunbar SB
        • Clark PC
        Symptom interactions as mechanisms underlying symptom pairs and clusters.
        J Nurs Scholar. 2005; 37: 209-215
        • Paul SM
        • Zelman DC
        • Smith M
        • Miaskowski C
        Categorizing the severity of cancer pain: Further exploration of the establishment of cutpoints.
        Pain. 2005; 113: 37-44
        • Pereira D
        • Peleteiro B
        • Araujo J
        • Branco J
        • Santos RA
        • Ramos E
        The effect of osteoarthritis definition on prevalence and incidence estimates: A systematic review.
        Osteoarthr Cartil. 2011; 19: 1270-1285
        • Phongtankuel V
        • Amorapanth PX
        • Siegler EL.
        Pain in the geriatric patient with advanced chronic disease.
        Clin Geriatr Med. 2016; 32: 651-661
        • Poole JC
        • Dobson KS
        • Pusch D
        Childhood adversity and adult depression: The protective role of psychological resilience.
        Child Abuse Negl. 2017; 64: 89-100
        • Posternak V
        • Dunn LB
        • Dhruva A
        • Paul SM
        • Luce J
        • Mastick J
        • Levine JD
        • Aouizerat BE
        • Hammer M
        • Wright F
        • Miaskowski C
        Differences in demographic, clinical, and symptom characteristics and quality of life outcomes among oncology patients with different types of pain.
        Pain. 2016; 157: 892-900
        • Radloff LS
        The CES-D Scale: A self-report depression scale for research in the general population.
        Appl Psychol Meas. 1977; 1: 385-401
        • Rosenberg AR
        • Syrjala KL
        • Martin PJ
        • Flowers ME
        • Carpenter PA
        • Salit RB
        • Baker KS
        • Lee SJ
        Resilience, health, and quality of life among long-term survivors of hematopoietic cell transplantation.
        Cancer. 2015; 121: 4250-4257
        • Russo SJ
        • Murrough JW
        • Han MH
        • Charney DS
        • Nestler EJ
        Neurobiology of resilience.
        Nat Neurosci. 2012; 15: 1475-1484
        • Rutsch A
        • Kantsjo JB
        • Ronchi F
        The gut-brain axis: How microbiota and host inflammasome influence brain physiology and pathology.
        Front Immunol. 2020; 11604179
        • Sangha O
        • Stucki G
        • Liang MH
        • Fossel AH
        • Katz JN
        The self-administered comorbidity questionnaire: A new method to assess comorbidity for clinical and health services research.
        Arthritis Rheum. 2003; 49: 156-163
        • Sarfati D
        • Koczwara B
        • Jackson C
        The impact of comorbidity on cancer and its treatment.
        CA Cancer J Clin. 2016; 66: 337-350
        • Savard J
        • Morin CM
        Insomnia in the context of cancer: A review of a neglected problem.
        J Clin Oncol. 2001; 19: 895-908
        • Serlin RC
        • Mendoza TR
        • Nakamura Y
        • Edwards KR
        • Cleeland CS
        When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function.
        Pain. 1995; 61: 277-284
        • Sheehan TJ
        • Fifield J
        • Reisine S
        • Tennen H
        The measurement structure of the center for epidemiologic studies depression scale.
        J Pers Assess. 1995; 64: 507-521
        • Shi Q
        • Mendoza TR
        • Dueck AC
        • Ma H
        • Zhang J
        • Qian Y
        • Bhowmik D
        • Cleeland CS
        Determination of mild, moderate, and severe pain interference in patients with cancer.
        Pain. 2017; 158: 1108-1112
        • Sibille KT
        • Langaee T
        • Burkley B
        • Gong Y
        • Glover TL
        • King C
        • Riley JL
        • Leeuwenburgh C
        • Staud R
        • Bradley LA
        • Fillingim RB
        Chronic pain, perceived stress, and cellular aging: an exploratory study.
        Mol Pain. 2012; 8: 12
        • Spielberger CG
        • Gorsuch RL
        • Suchene R
        • Vagg PR
        • Jacobs GA
        Manual for the State-Anxiety (Form Y): Self Evaluation Questionnaire.
        Consulting Psychologists Press, Palo Alto, CA1983
        • Staurengo-Ferrari L
        • Green PG
        • Araldi D
        • Ferrari LF
        • Miaskowski C
        • Levine JD
        Sexual dimorphism in the contribution of neuroendocrine stress axes to oxaliplatin-induced painful peripheral neuropathy.
        Pain. 2021; 162: 907-918
        • Sturgeon JA
        • Langford D
        • Tauben D
        • Sullivan M
        Pain intensity as a lagging indicator of patient improvement: Longitudinal relationships with sleep, psychiatric distress, and function in multidisciplinary care.
        J Pain. 2021; 22: 313-321
        • Sudo N
        Role of gut microbiota in brain function and stress-related pathology.
        Biosci Microbiota Food Health. 2019; 38: 75-80
        • Sundin EC
        • Horowitz MJ
        Impact of event scale: Psychometric properties.
        Br J Psychiatry. 2002; 180: 205-209
        • Swarm RA
        • Paice JA
        • Anghelescu DL
        • Are M
        • Bruce JY
        • Buga S
        • Chwistek M
        • Cleeland C
        • Craig D
        • Gafford E
        • Greenlee H
        • Hansen E
        • Kamal AH
        • Kamdar MM
        • LeGrand S
        • Mackey S
        • McDowell MR
        • Moryl N
        • Nabell LM
        • Nesbit S
        • O'Connor N
        • Rabow MW
        • Rickerson E
        • Shatsky R
        • Sindt J
        • Urba SG
        • Youngwerth JM
        • Hammond LJ
        • Gurski LA
        Adult cancer pain, Version 3.2019, NCCN clinical practice guidelines in oncology.
        J Natl Compr Canc Netw. 2019; 17: 977-1007
        • Tashani OA
        • Astita R
        • Sharp D
        • Johnson MI
        Body mass index and distribution of body fat can influence sensory detection and pain sensitivity.
        Eur J Pain. 2017; 21: 1186-1196
        • Tejada M
        • Viele C
        • Kober KM
        • Cooper BA
        • Paul SM
        • Dunn LB
        • Hammer MJ
        • Wright F
        • Conley YP
        • Levine JD
        • Miaskowski C
        Identification of subgroups of chemotherapy patients with distinct sleep disturbance profiles and associated co-occurring symptoms.
        Sleep. 2019; 42: 151
        • Tenti S
        • Correale P
        • Cheleschi S
        • Fioravanti A
        • Pirtoli L
        Aromatase inhibitors—induced musculoskeletal disorders: Current knowledge on clinical and molecular aspects.
        Int J Mol Sci. 2020; 21: 5625
        • Torensma B
        • Thomassen I
        • Van Velzen M
        • In ‘T Veld BA
        Pain experience and perception in the obese subject systematic review (Revised Version).
        Obes Sur. 2016; 26: 631-639
        • Utne I
        • Loyland B
        • Grov EK
        • Paul S
        • Wong ML
        • Conley YP
        • Cooper BA
        • Levine JD
        • Miaskowski C
        Co-occuring symptoms in older oncology patients with distinct attentional function profiles.
        Eur J Oncol Nurs. 2019; 41: 196-203
        • van den Beuken-van Everdingen MH
        • Hochstenbach LM
        • Joosten EA
        • Tjan-Heijnen VC
        • Janssen DJ
        Update on prevalence of pain in patients with cancer: Systematic review and meta-analysis.
        J Pain Symptom Manage. 2016; 51: 1070-1090
        • Weiss DS
        • Marmar CR
        The impact of event scale - revised.
        Guilford Press, New York1997
        • Wolfe J
        • Kimmerling R
        Gender issues in the assessment of posttraumatic stress disorder.
        Guilford, New York1997
        • Woopen H
        • Richter R
        • Inci G
        • Alavi S
        • Chekerov R
        • Sehouli J
        The prognostic and predictive role of pain before systemic chemotherapy in recurrent ovarian cancer: An individual participant data meta-analysis of the North-Eastern German Society of Gynecological Oncology (NOGGO) of 1226 patients.
        Support Care Cancer. 2020; 28: 1997-2003
        • Wright F
        • Cooper BA
        • Conley YP
        • Hammer MJ
        • Chen LM
        • Paul SM
        • Levine JD
        • Miaskowski C
        • Kober KM
        Distinct evening fatigue profiles in oncology outpatients receiving chemotherapy.
        FatigueBiomedHealth Behav. 2017; 5: 131-144
        • Wright F
        • Dunn LB
        • Paul SM
        • Conley YP
        • Levine JD
        • Hammer MJ
        • Cooper BA
        • Miaskowski C
        • Kober KM
        Morning fatigue severity profiles in oncology outpatients receiving chemotherapy.
        Cancer Nurs. 2019; 42: 355-364
        • Yehuda R
        • Hoge CW
        • McFarlane AC
        • Vermetten E
        • Lanius RA
        • Nievergelt CM
        • Hobfoll SE
        • Koenen KC
        • Neylan TC
        • Hyman SE
        Post-traumatic stress disorder.
        Nat Rev DisUnrelieved Patient Primers. 2015; 1: 15057