title: The relationship between pain management and psychospiritual distress in patients with advanced cancer following admission to a palliative care unit.
abstract: BACKGROUND
  Although many cross-sectional studies have demonstrated the association between cancer pain and psychospiritual distress, the time-dependent relationship has not been fully explored. For that reason, this study aims to investigate the time-dependent relationship between psychospiritual distress and cancer pain management in advanced cancer patients.
  
  
  METHODS
  This is a prospective observational study. Two hundred thirty-seven advanced cancer patients were recruited from a palliative care unit in Taiwan. Demographic and clinical data were retrieved at admission. Pain and psychospiritual distress (i.e.: anxiety, depression, anger, level of family and social support, fear of death) were assessed upon admission and one week later, by using a "Symptom Reporting Form". Patients were divided into two groups according to the pain status one week post-admission (improved versus not improved groups).
  
  
  RESULTS
  One hundred sixty-three (68.8 %) patients were assigned to the improved group, and 74 (31.2 %) patients were assigned to the not improved group. There were no differences in the psychospiritual variables between groups upon admission. In overall patients, all psychospiritual variables improved one week post-admission, but the improvement of depression and family/social support in the not improved group was not significant. Consistent with this, for depression scores, there was a statistically significant pain group x time interaction effect detected, meaning that the pain group effect on depression scores was dependent on time.
  
  
  CONCLUSIONS
  We demonstrated a time-dependent relationship between depression and pain management in advanced cancer patients. Our results suggest that poor pain management may be associated with intractable depression. The inclusion of interventions that effectively improve psychospiritual distress may contribute to pain management strategies for advanced cancer patients.
authors.affiliation: Division of Family Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan. b91401032@ntu.edu.tw.|Department of Family Medicine, Hospice and Palliative Care Unit, College of Medicine and Hospital, National Taiwan University, 7 Chung-Shan South Road, Taipei, Taiwan. b91401032@ntu.edu.tw.
authors.forename: Ya-Ping
authors.initials: YP
authors.lastname: Lee
authors.affiliation: Department of Family Medicine, Hospice and Palliative Care Unit, College of Medicine and Hospital, National Taiwan University, 7 Chung-Shan South Road, Taipei, Taiwan. wuyehsun@gmail.com.|Department of Psychology, National Chengchi University, Taipei, Taiwan. wuyehsun@gmail.com.
authors.forename: Chih-Hsun
authors.initials: CH
authors.lastname: Wu
authors.affiliation: Department of Family Medicine, Hospice and Palliative Care Unit, College of Medicine and Hospital, National Taiwan University, 7 Chung-Shan South Road, Taipei, Taiwan. tychiu@ntuh.gov.tw.
authors.forename: Tai-Yuan
authors.initials: TY
authors.lastname: Chiu
authors.affiliation: Department of Family Medicine, Hospice and Palliative Care Unit, College of Medicine and Hospital, National Taiwan University, 7 Chung-Shan South Road, Taipei, Taiwan. chency@nhri.org.tw.|Division of Geriatric Research, Institute of Population Health Science, National Health Research Institutes, Ju-Nan, Taiwan. chency@nhri.org.tw.
authors.forename: Ching-Yu
authors.initials: CY
authors.lastname: Chen
authors.affiliation: Palliative and Supportive Care Division, Seirei Mikatahara Hospital, Mikatahara, Kita, Hamamatsu, Japan. tmorita@sis.seirei.or.jp.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.affiliation: Department of Community and Family Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan. chaomei@ms14.hinet.net.
authors.forename: Shou-Hung
authors.initials: SH
authors.lastname: Hung
authors.affiliation: Department of Palliative Care, Changhua Christian Hospital, Changhua, Taiwan. heartbao@gmail.com.|Department of Family Medicine, Changhua Christian Hospital, Changhua, Taiwan. heartbao@gmail.com.
authors.forename: Sin-Bao
authors.initials: SB
authors.lastname: Huang
authors.affiliation: Department of Community and Family Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan. omigodokuo@gmail.com.
authors.forename: Chia-Sheng
authors.initials: CS
authors.lastname: Kuo
authors.affiliation: Department of Family Medicine, Hospice and Palliative Care Unit, College of Medicine and Hospital, National Taiwan University, 7 Chung-Shan South Road, Taipei, Taiwan. jawshiun@ntu.edu.tw.|Center for Complementary and Integrated Medicine, National Taiwan University Hospital, Taipei, Taiwan. jawshiun@ntu.edu.tw.
authors.forename: Jaw-Shiun
authors.initials: JS
authors.lastname: Tsai
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000628:therapy*; D010146:Pain / Q000523:psychology*; D059408:Pain Management / Q000379:methods* / Q000523:psychology; D010166:Palliative Care / Q000379:methods* / Q000523:psychology; D011446:Prospective Studies; D012944:Social Support; D026443:Spiritual Therapies; D013624:Taiwan