Survivorship care plan helps improve the continuity of care and manage ongoing pain that affects up to 46% of cancer survivors by promoting health behaviors, including physical activity. However, perceived discrimination may decrease the likelihood of cancer survivors participating in physical activities and negatively influence their pain status. Thus, this study aimed to examine the mediating role of physical activity and perceived discrimination in the relationship between receiving a survivorship care plan and cancer pain.
This cross-sectional, correlational study utilized data from the 2012–2019 Behavioral Risk Factor Surveillance System. Analyses accounted for the complex survey design. Logistic regression was utilized to analyze the association among survivorship care plans, discrimination, physical activity, and pain. Generalized structural equation modeling was conducted to test a hypothesized model in which survivorship care plans and discrimination affect physical activity, and subsequently influence pain status.
Forty-two and 81% of survivors reported receiving treatment summaries and follow-up care plans, respectively, and 8% experienced cancer pain. After controlling for covariates, the highest discrimination quintile was three times more likely to report cancer pain than the lowest quintile. While receiving follow-up care plans was positively related to cancer pain, respondents in the third- to fifth- quintiles were less likely to report cancer pain when receiving follow-up care plans than the first quintile respondents. Physical activity mediated the association between discrimination and cancer pain.
Reverse relationships between receiving follow-up care plans and cancer pain existed; however, discrimination and physical activity mediated these relationships.
- • The highest discriminated group had pain three times more than the lowest group.
- • Reverse relationships between receiving follow-up care plans and pain existed.
- • Discrimination and exercise mediated the relationships between care plans and pain.
- • Higher discriminated groups tended to have lower pain when receiving care plans.
As of January 2019, there were approximately 16.9 million cancer survivors in the U.S. . Due to advances in cancer treatment, the overall five-year survival rate has increased to 68%, with 56% for ten or more years . Given the increased duration of cancer survivorship, later effects of cancer treatment and comorbidities are expected . This trend demands increased attention to during- and after-cancer health issues, including pain. Cancer survivors’ pain can result from cancer, including tumor cells pressing on nerves or internal organs, or from cancer treatment(s). Furthermore, 40% of cancer survivors experience pain and 66% of survivors with advanced conditions report some degree of pain , which negatively affects cancer survivors’ social and physical functioning and psychological well-being . Minimizing pain, which is vital for improving survivors’ quality of life , can be achieved through education, lifestyle modification, medication therapies, and integrative methods .
Physical activity is one of the most salient modifiable factors for improving pain management in cancer survivorship . The 2018 Physical Activity Guidelines for Americans highlighted that physical activity lowers cancer survivors’ mortality rates and enhances their quality of life . Additionally, the level of physical activity influences symptoms experienced by cancer survivors, including pain . Despite the advantages of regular physical activity, one in three cancer survivors report no leisure-time physical activity . As a component of the survivorship care plan (SCP), the level of engagement in physical activity should be addressed to promote cancer survivors’ quality of life.
Building trusting patient-provider relationships is the foundation of effective pain management . The Institute of Medicine’s Report on Cancer Survivorship highlighted that the essence of cancer survivorship care is a personalized approach, including effective patient-provider communication. Furthermore, the report recommended providing each cancer survivor with treatment summaries across survivorship trajectory, including information regarding the later effects and referrals . Yet, one in three cancer survivors received SCPs . This underutilization likely results in survivors not having high-quality communication with their providers as characterized by discussions of care plans, wellness recommendations, and social-emotional needs . Additionally, survivors’ characteristics, including race/ethnicity and perceived discrimination, are related to the quality of patient-provider communication .
Perceived discrimination is defined as perceived unfair treatment due to sex, gender, race, and other factors . A conceptual model proposed by Pascoe and Smart Richman delineated the pathways through which discrimination influences stress responses or lifestyle factors, including physical activity, thereby affecting health. In pain management, the suggested pathways have been partially verified in non-cancer patients . Discrimination led to lower physical activity levels, increased stress , and contributed to chronic pain among U.S. middle-aged adults . Additionally, discrimination was an independent barrier to patient satisfaction with pain treatment among older Black and White cancer survivors (B= −0.29, p < .05) . However, no prior research has investigated the mediation pathways through which discrimination affects cancer pain, including receiving SCPs and physical activity, which is associated with cancer survivors’ mental and physical health . This study aimed to determine the associations among patients receiving SCPs, perceived discrimination, physical activity, and pain among cancer survivors. Our hypotheses were as