title: Unresolved Pain Interference among Colorectal Cancer Survivors: Implications for Patient Care and Outcomes.
abstract: OBJECTIVE
  Using a large sample of colorectal cancer (CRC) survivors we 1) describe pain interference (PI) prevalence across the cancer continuum; 2) identify demographic and clinical factors associated with PI and changes in PI; and 3) examine PI's relationship with survivors' job changes.
  
  
  METHODS
  CRC participants of the Cancer Care Outcomes Research and Surveillance Consortium completed surveys during the initial phase of care (baseline, < 1 year, n = 2,961) and follow-up (about 1-year postdiagnosis, n = 2,303). PI was measured using the SF-12 item. Multiple logistic regression was used to identify predictors of PI. Model 1 evaluated moderate/high PI at baseline, Model 2 evaluated new/continued/increasing PI postdiagnosis follow-up, and Model 3 restricted to participants with baseline PI (N = 603) and evaluated predictors of equivalent/increasing PI. Multivariable logistic regression was also used to examine whether PI predicted job change.
  
  
  RESULTS
  At baseline and follow-up, 24.7% and 23.7% of participants reported moderate/high PI, respectively. Among those with baseline PI, 46% had equivalent/increasing PI at follow-up. Near diagnosis and at follow-up, female gender, comorbidities, depression, chemotherapy and radiation were associated with moderate/high PI while older age was protective of PI. Pulmonary disease and heart failure comorbidities were associated with equivalent/increasing PI. PI was significantly associated with no longer having a job at follow-up among employed survivors.
  
  
  CONCLUSIONS
  Almost half of survivors with PI during the initial phase of care had continued PI into post-treatment. Comorbidities, especially cardiovascular and pulmonary conditions, contributed to continued PI. PI may be related to continuing normal activities, that is, work, after completed treatment.
authors: Center for Outcomes and Effectiveness Research and Education, University of Alabama at Birmingham, School of Medicine, MT617, Birmingham, Alabama, 35233, USA.
authors: Kelly
authors: K
authors: Kenzik
authors: Division of Preventive Medicine, University of Alabama at Birmingham, School of Medicine, MT617, Birmingham, Alabama, 35233, USA.
authors: Maria
authors: M
authors: Pisu
authors: Division of General Internal Medicine and Geriatrics, Indiana University, School of Medicine, Indianapolis, Indiana, 46202-3082, USA.
authors: Shelley A
authors: SA
authors: Johns
authors: Department of Psychology, University of Kansas, College of Liberal Arts and Science, Lawrence, USA.
authors: Tamara
authors: T
authors: Baker
authors: Division of Preventive Medicine, University of Alabama at Birmingham, School of Medicine, MT617, Birmingham, Alabama, 35233, USA.
authors: Robert A
authors: RA
authors: Oster
authors: University of Alabama at Birmingham, School of Medicine, MT617, Birmingham, Alabama, 35233, USA.
authors: Elizabeth
authors: E
authors: Kvale
authors: Division of Preventive Medicine, University of Alabama at Birmingham, School of Medicine, MT617, Birmingham, Alabama, 35233, USA.
authors: Mona N
authors: MN
authors: Fouad
authors: Division of Preventive Medicine, University of Alabama at Birmingham, School of Medicine, MT617, Birmingham, Alabama, 35233, USA.
authors: Michelle Y
authors: MY
authors: Martin
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000523:psychology* / Q000532:radiotherapy; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D004651:Employment / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D008171:Lung Diseases / Q000453:epidemiology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D010147:Pain Measurement / Q000379:methods; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology*; D012044:Regression Analysis; D012737:Sex Factors; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data
keywords: Colorectal Cancer; Comorbidity; Pain Interference; Survivor; Work