The impact of pain and impaired role performance on distress in persons with cancer.

The observed upward trend in the incidence of many cancers is expected to continue for the next 20 years despite monumental basic research efforts. There are interpersonal and intrapsychic complications associated with cancer and its treatment leading to considerable distress which, in extreme cases, becomes clinical depression and anxiety. Pain and impaired role performance have been cited as being important sources of distress in people with cancer. This paper presents data from a community sample of 1,309 people living with cancer in Prince Edward Island, Manitoba and Quebec and examines risk factors for cancer-related distress. In the model tested in this paper, pain and other symptoms and treatment side-effects as well as cancer-related fears were seen to have direct and indirect effects on psychological symptoms of distress. Impaired role performance was a central mediator for the indirect effects. The model explained 34% of the variance in distress scores (General Health Questionnaire) and was equally applicable to all three study sites, both male and female subjects, rural and urban settings, and to all stages of illness. Pain was the single most important explanatory variable. Impaired role performance had a negative effect on distress over and above the effect of pain. The results suggest that interventions directed at reducing distress in cancer should also address interpersonal issues such as the impact of the illness on family, social network a work.