Factors associated with pain among rural cancer survivors: Findings from an Australian longitudinal study

PURPOSE: This longitudinal study explored the prevalence and cumulative incidence of pain among rural cancer survivors, assessed the prevalence of persistent pain over time, and identified sociodemographic, clinical, and psychological factors associated with worse outcomes. METHODS: This study was a secondary analysis of data from the Travelling for Treatment study. Adult cancer survivors living in Queensland, Australia, who had travelled ≥ 50 kms for cancer treatment were included (N = 659). Pain outcomes (intensity, interference, frequency) were assessed at baseline, three months, 12 months, and annually for up to five years using the Adjusted Quality of Life 8-Dimension Tool (AQoL-8D). Sociodemographic, clinical, and psychological factors were assessed at baseline. Prevalence and cumulative incidence of pain, and the proportion of cancer survivors reporting persistent pain was calculated. Cumulative link mixed models and binary logistic regression explored factors associated with pain outcomes and likelihood of experiencing persistent pain. RESULTS: Across follow-up (median 3 years), 84% of rural cancer survivors reported moderate to unbearable pain, 64% reported serious pain at least weekly, and 66% reported that pain interfered with activities at least sometimes. Higher psychological distress was associated with worse pain intensity (aOR = 2.80, CI 2.24, 3.49), interference (aOR = 3.09, CI 2.56, 3.74) and more frequent serious pain (aOR = 2.46, CI 2.44, 2.47). Persistent pain was reported by 21% of rural cancer survivors and was also associated with increased psychological distress (aOR = 1.18, CI 2.56, 3.74). CONCLUSION: Pain is common among rural cancer survivors. Comprehensive interventions that address co-occurring mental and physical health comorbidities and facilitate open communication about pain are needed to ensure effective pain management and support for this population.