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Adverse Childhood Experiences Are Associated With Severe Pain and Decrements in Cognitive Function in Patients Receiving Chemotherapy

Abstract

Unrelieved pain and cognitive impairment are common symptoms in oncology patients that exhibit a large amount of inter-individual variability. However, limited information is available on the co-occurrence of these two symptoms and their relationship with stress. Purposes were to identify subgroups of patients (n=1342) with distinct joint profiles of worst pain AND cognitive function (CF) and evaluate for differences in demographic and clinical characteristics, as well as the severity of three distinct types of stress, resilience, and coping. Measures of pain and CF were evaluated six times over two cycles of chemotherapy. The other measures were completed at enrollment (i.e., prior to the second or third cycle of chemotherapy). Using latent profile analysis, four distinct profiles were identified (i.e., No Pain+Moderate CF (27.6%), Moderate Pain+High CF (22.4%) Moderate Pain and Moderate CF (32.4%, Both Moderate), Severe Pain and Low CF (17.5%, Both Severe)). Both Moderate and Both Severe classes reported higher global, cancer-specific, and cumulative life stress, lower levels of resilience, and greater use of disengagement coping strategies. These two class had higher occurrence rates and effect scores for a number of adverse childhood experiences. Risk factors associated with membership in these two profiles included: being female, having a lower annual income, having a higher comorbidity burden, and a poorer functional status. Findings suggest that 72.4% of the patients reported pain scores in the moderate to severe range and 77.6% reported low to moderate levels of CF. Clinicians need to assess for both symptoms and ACEs on a routine basis.

Perspective: Over 50% of oncology patients have moderate to severe pain and impairments in cognitive function. These patients have higher levels of global, cancer-specific, and cumulative life stress, including higher occurrence rates for adverse childhood experiences.

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