50th Annual Meeting of the American Society of Clinical Oncology (ASCO):

Depression, Anxiety, Inflammation Predict Pain After Surgery for Gynecologic Cancer

In women recovering from surgery for gynecologic cancer, depression, anxiety, and inflammation may increase the risk for pain, according to results of a prospective, longitudinal study presented by Kelsey R. Honerlaw, and colleagues, on June 1, 2014, at the Annual Meeting of the American Society of Clinical Oncology in Chicago, Illinois.

Study Subjects and Therapies
The analysis included 90 women, with a mean age of 60 years (range, 31-85 years) who had undergone surgery for endometrial cancer (70%) or ovarian cancer (30%) at the University of Wisconsin Carbone Cancer Center. Over half of patients (56%) underwent laparotomy and the remaining 44% received laparoscopic surgery. Adjuvant therapy was administered to 61% of patients, and included chemotherapy (56%), radiation therapy (22%), or both (22%). The remaining 39% of patients received no adjuvant therapy. For the current study, self-report assessments were completed and blood samples were obtained at 1 week, 1 month, and 4 months post-surgery.

Post-treatment Pain
Overall, the researchers found that recovery after surgery for gynecologic cancer may take longer than the 6 weeks typically reported as the recovery period. Although the intensity of pain stabilized by 1 month post-surgery, the effect of pain on patients’ normal daily activities continued to improve up to 4 months post-surgery, and pain interference declined significantly from 1 month to 4 months after surgery (P < .011). “Physicians typically expect that patients are fully recovered by 6 weeks,” the researchers noted. However, their findings suggest that recovery may, in fact, take longer.

Depression, Anxiety, and Pain
The researchers also reported a significant association between depression, anxiety, and pain. Patients with more severe depressive symptoms, defined as greater than 37 on the Inventory of Depression and Anxiety Symptoms (IDAS) scale, and with more severe anxiety, defined as greater than 9 on the Impact of Events Scale-R (IES-R) Avoidance or Intrusive Thoughts subscales, were significantly more likely than patients with less severe depression or anxiety to report greater pain intensity (P < .001) and pain interference with daily activities (P < .001) up to 16 weeks post-surgery.

Inflammatory Response and Depression/Anxiety
Higher levels of inflammation, as assessed by concentration of the inflammatory cytokine interleukin-6 (IL-6), were also significantly associated with greater pain intensity, but not greater pain interference. Levels of IL-10 were not significantly associated with pain, although Ms. Honerlaw, of the University of Wisconsin-Madison, noted that the samples size was relatively small. She suggested that follow-up analyses should be undertaken using a larger sample to further assess the relationship between inflammation and pain in this setting.

Additional analyses found that changes in depression status and IL-6 levels within individual patients during the postsurgical follow-up period significantly correlated with greater pain intensity and pain interference. More severe anxiety with intrusive thoughts was associated with greater pain interference.

Based on these findings, the researchers concluded that depression, anxiety, and inflammation may all exacerbate pain during the recovery period. “Clinicians can provide medical and educational interventions to target these risk factors, improving the recovery and quality-of-life of these women,” Ms. Honerlaw told endocrineweb.com.

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