A daily diary study of cancer-related pain and associated difficulties: The role of psychological flexibility

Introduction: Chronic pain is among the most common side effects of cancer in cancer patients and survivors, often co-occurring with fatigue, emotional distress and elevated fears of cancer recurrence. Both pain and the associated difficulties are associated with poorer outcomes. Longitudinal studies are needed that identify psychosocial factors that mitigate the effects of chronic cancer-related pain (CRP) and associated difficulties so that these may be more effectively targeted in treatment. This daily diary study investigates the relationship between chronic CRP, fatigue and fear of cancer recurrence (FCR), functioning and psychological flexibility (PF) in cancer patients/survivors.Methods: Fifteen participants selected because of the presence of chronic CRP completed bi-daily diary recordings of severity and interference frompain, fatigue, FCR, overall functioning and PF for 21 days, with a total of 574 datapoints.Results: As expected, there was significant variability in the levels of symptoms, symptom interference, and PF, as well as in the relationship between these variables, on a day-to-day basis. Participants found the daily recordings acceptable and mixed-level models suggested that daily PF was a significant predictor of interference from symptoms with small to medium effect sizes.Conclusion: The data reveal the importance of moving beyond group-level analyses to better understand individual variation in the intensity and interrelationships between CRP, functioning, and PF in cancer patients and survivors. Consistent with research on non-cancer pain, higher levels of psychological flexibility were associated with less functional impairment from pain, fatigue, and worry about cancer in cancer patients/survivors, suggest that treatments targeting PF may be helpful in this population. However, modifying treatment to better target individual patient profiles may be necessary to improve outcomes.