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Cancer experience worse for young adults in spite of better survival odds

University of Michigan Health System studies cancer experience across the lifespan and reveals more pain flares and financial issues for young adults

-added 11/9/10

Ann Arbor - Younger adult cancer patients have the most difficulty coping with the pain and emotional issues of cancer, in spite of their potentially better survival odds, according to a University of Michigan Health System study.

The study, which included mostly breast and lung cancer patients, appears in the November issue of Pain Medicine.

Adult cancer patients age 40 and under had more pain flares and more difficulty thinking quickly and logically six months after their diagnosis compared to older adults.

Pain also affected their mood more often than adults in their 50's or 60's.

Cancer pain is common, whether it is consistent discomfort or patient flares that interrupt well-controlled pain. International studies suggest nearly 70% of people dying from cancer experience unrelieved pain.

"Our study provides evidence for the significant toll of cancer pain on overall health and well-being of young and old adults alike, but demonstrate an increased toll for younger adults, especially financially," says study lead author Carmen R. Green, M.D., a U-M professor of anesthesiology, obstetrics and gynecology, and health management and policy.

In the study, researchers revealed a trend of younger groups having pain in more locations - 4.5 locations compared to 2.2 for older adults - up to six months after diagnosis.

Older adults reported mostly spinal pain, and younger adults reported pain in the spine, back, arms, abdomen and elsewhere, according to the study.

Young adult cancer patients reported smaller incomes and, perhaps as a result had more difficulty paying health care bills.

In the survey, 75% of young patients reported having trouble paying for health care which was twice the rate reported by older adults.

Green, along with co-author Tamera Hart-Johnson, M.S., a senior research associate at U-M, surveyed about 100 patients with advanced stages of breast, lung, colorectal and prostate cancer, and multiple myeloma, a bone marrow cancer.

Among three age groups, the youngest set of those age 40 and younger had the greatest pain interference, but reported improvement over time, according to the study.

For example, 8% of young adults said pain affected their mood compared to 4.35% of adults in the 41-59 age group, and 4.14% among those age 60 and older.

"The groups did not look different mentally or emotionally at the time of diagnosis, although both cognitive functioning and depression worsened for young adults by six months as their treatments and battle with cancer continued," Green says.

The oldest group had better emotional functioning at the start, but by six months had significantly worse physical functioning.

Future studies should attempt to determine how patient age influences patient preferences and attitudes about cancer pain management.

As more people survive cancer, the authors urge that future studies attempt to determine how patient age influences patient preferences and attitudes about cancer pain management.

Additional studies might examine potential differences in support systems, coping strategies, and other factors that may impact overall health, such as caregiving, health insurance and employment, Green says.

Reference: "Cancer pain: An age-based analysis," Pain Medicine, November, 2010.

Funding: Blue Cross Blue Shield Foundation of Michigan.

Resources:
U-M Department of Anesthesiology
U-M Back and Pain Clinic
Department of Anesthesiology Research Division

Written by Shantell M. Kirkendoll congtact by phone: 734-764-2220 or E-mail: smkirk@umich.edu.

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