A Daily Diary Study of Cancer-Related Pain and Associated Difficulties: The Role of Psychological Flexibility

Background: Approximately 40% of cancer patients/survivors develop chronic cancer-related pain (CRP), which is often associated with greater levels of fatigue and cancer worry, all of which are associated with poorer functioning, wellbeing, and greater healthcare costs. Psychological Flexibility (PF) refers to one’s level of openness to and acceptance of physical/emotional experiences and willingness to engage in sometimes difficult activities in pursuit of one’s values. A large body of research has shown that patient groups with higher levels of PF tend to have better day-to-day functioning, general wellbeing, and lower social/healthcare costs despite the presence of chronic symptoms. However, the relationship between PF, symptoms, and symptom-specific impairment within individuals is less well understood.Objective: This study aimed to investigate the intra- and inter-individual relationships between PF, CRP, fatigue, cancer worry, and symptom-specific impairment in cancer patients/survivors. Method: Fifteen participants with chronic CRP completed bi-daily diary recordings of the severity of pain, fatigue, cancer worry, interference from these symptoms, and the six facets of PF via a smartphone application, for 21 days. A total of 574 data points were analyzed using mixed-level models, treating participant ID as a fixed effect.Results: The diary recordings were well tolerated with little missing data. Overall, intra-individual differences were more substantial than inter-individual differences. Higher PF levels were associated with lower levels of interference from pain, fatigue and cancer worry. After controlling for daily fluctuations in symptoms, changes in PF explained a significant proportion of the variance in symptom-specific interference. PF levels at baseline did not moderate these associations. Conclusion: Higher levels of PF appear to lessen the functional impacts of CRP, fatigue and cancer worry. Treatments targeting PF may be of use to cancer patients/survivors suffering from these types of ...