Pain among Older Adults with Cancer - Results from the Cancer and Aging Resilience Evaluation (CARE) Registry

Pain among Older Adults with Cancer - Results from the Cancer and Aging Resilience Evaluation (CARE) Registry | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Pain among Older Adults with Cancer - Results from the Cancer and Aging Resilience Evaluation (CARE) Registry Mustafa AL Obaidi, Sarah Kosmicki, Christian Harmon, Mina Lobbous, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1307446/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Purpose: The impact of pain on functional status and mental health among older adults with cancer is a relevant, yet understudied. We sought to identify the prevalence of pain at diagnosis in older adults with cancer and evaluate the association of pain with functional status limitations, cognition, and mental health. Methods: This study included older adults (age ≥60) with cancer enrolled in the CARE Registry. Pain measured in numeric rating scale from 0-10. We utilized the literature based cut off for moderate-severe as ≥4. Logistic regression used to assess differences in functional status, falls, cognitive complaints, and depression/anxiety associated with moderate/severe pain, adjusted for sex, race, education, ethnicity, marital status, cancer type/stage, and treatment phase. Results: Our cohort included 714 older adults with an average mean age of 70 years and 59% male. Common diagnoses included colorectal (27.9%) and pancreatic (18%). 43.3% reported moderate/severe pain. After multivariate adjusting for covariates, participants with self-reported moderate/severe pain were more likely to report limitations in instrumental activities of daily living (adjusted Odds Ratio [aOR] 4.3 95% confidence interval [CI] 3.1-6.1, p <.001), limitation in activities of daily living (aOR 3.2 95% CI 2.0-5.1, p <.001), cognitive complaints (aOR 2.9 95% CI 1.4-6.0, p <.004), anxiety (aOR 2.2 95% CI 1.4-3.4, p <0.01), and depression (aOR 3.7 95% CI 2.2-6.5, p <.001). Conclusions: Pain is common amongst older adults with cancer and is associated with functional status limitations, cognitive complaints, and depression/anxiety. Strategies to reduce pain and minimize its potential impact on function and mental health warrant future research. pain cancer aging geriatric assessment geriatric oncology mental health functional status depression anxiety Figures Figure 1 Introduction Despite improvements in cancer prevention and therapeutics, the incidence of cancer in developed countries is increasing largely due to the shift in population demographics and population aging. Indeed, The United States (U.S.) population is aging with a projection that 20% of the population by 2030 will be above 65 years of age [ 1 ]. More than 50% of cancer cases occur in individuals older than 65 years of age and cancer is considered one of the leading causes of mortality in older individuals [ 2 ]. Compared to younger patients, the management of cancer in older patients poses several challenges including physiological decreases in organ function, the burden of comorbidities, variable functional independence, and underrepresentation in clinical trials [ 3 – 5 ]. One additional challenge of cancer care in older patients is pain management and its impact on quality of life. Unfortunately, up to 80% of patients with early- to advanced-stage cancer report chronic pain [ 6 ]. Undoubtedly, objective measurement of pain is quite challenging due to its complex subjective multimodal nature [ 7 ]. There is a compendium of research addressing assessment of pain in the older individuals as well as in patients with cancer, which is a fundamental step toward more effective chronic pain management. There are numerous available validated subjective pain measurement tools including the visual analog scale, the numeric rating scale (NRS), and the verbal descriptor scale [ 8 ]. The NRS, which measures the perceived level of pain on a scale from zero (no pain) to 10 (most severe pain ever experienced), is one of the most widely used tools in U.S. healthcare institutions and has been shown to be a valid assessment of cancer-related pain [ 9 ]. There is mounting evidence that a high prevalence of pain has a detrimental effect on quality of life in older patients including higher incidences of depression, sleep disturbances, and social isolation [10 11]. Moreover, Shega and colleagues reported that moderate or higher pain was independently associated with frailty in a cross-sectional study of persons aged 65 and older in Canada [ 12 ]. In addition, older adult survivors of blood or marrow transplantation had a 2.6 fold greater odds of reporting pain in comparison to their siblings and those reporting pain were more likely to have impaired physical performance and develop frailty [13 14]. Pain management in older patients with cancer requires a multidisciplinary approach including optimal utilization of pharmaceuticals and non-pharmaceutical resources [ 15 ]. Over the past three decades, researchers from different disciplines examined different pain assessment tools and the best approaches to the management of pain in patients with cancer, however, little is known about the impact of pain on the growing number of older adults with cancer. In this study, we sought to identify the prevalence of pain at diagnosis in older adults with cancer and evaluate the association of moderate/severe pain with functional status limitations, cognitive complaints, and mental health. Methods Study design and Participants This is an observational (cross-sectional) study of older adults diagnosed with cancer and referred to be seen by an oncologist at the University of Alabama at Birmingham (UAB) clinics, which include The Kirklin Clinic, UAB Acton Road clinic, and Colorectal Cancer multidisciplinary clinics, enrolled in the Cancer & Aging Resilience Evaluation (CARE) Registry. The CARE Registry is an ongoing prospective study that was launched in September 2017 [ 16 ]. For this study, older patients (aged 60 years and above) recruited into the CARE Registry between September 2017 and June 2021 with a diagnosis of cancer (colorectal cancer, gastroesophageal cancer, hepatobiliary cancer, pancreatic cancer, and others) who performed GA at the time of their initial consultation were included. Patients who were non-English speakers, were 59 years or younger, or declined participation were excluded from the study (Figure 1 ). The collection of data for the Registry and subsequent uses of the data for investigative and analytic pursuits such as this, was approved by the institutional review board of UAB (IRB-300000092), and all patients provided written consent. Pain As part of the GA, patients completed the National Institutes of Health's 10-item Patient-Reported Outcomes Measurement Information System (PROMIS®) global health scale (PROMIS Global 10) short-form [ 17 ]. PROMIS Global 10 utilized the question to assess perceived pain: “In the past 7 days, how would you rate your pain on average?” Responses ranged from zero representing “no pain” and 10 represented as “worst pain ever experienced” [ 17 ]. The history of this tool was initially presented back in 1991 [ 18 ]. In this pain scale, pain categorized into; no pain (0), mild pain (1-3), moderate pain (4-7), or severe pain (8-10) on a linear numeric scale [ 19 – 21 ]. Geriatric Assessment All participants submitted a self-reported GA, a modified version of the Cancer and Aging Research Group GA [16 22 23]. The CARE tool consists of various validated tools to screen for potential impairments of physical function, functional status, nutrition, cognition, social activity, polypharmacy, and performance status [16 19 24]. Data of patient-reported pain assessment were collected at the time of enrollment (at baseline) with the use of our CARE tool as well as other health information relevant to the management of patients’ cancers were retrieved from medical records. For our cohort analysis we highlighted impairments in functional status as assessed by the Older Americans Resources and Services (OARS) assessment [ 25 ]. The CARE tool contains of 6-items assessing instrumental activities of daily living (IADL) which include an assessment of ambulation capacity, ability to procure groceries for self, ability to conduct daily home maintenance, ability to successfully take own prescriptions, ability to cook and prepare own meals, and ability manage own budget; as well as 3-items assessing activities of daily living (ADL) that include ability to get in and out of bed, ability to dress and undress, and ability to bathe one-self [19 20]. The CARE tool also assesses the presence of cognitive complaints, depression, and anxiety via PROMIS 4-item short forms [ 26 – 29 ]. Depression was assessed using PROMIS® Depression Short Form 4a v1.0, which involved likert answers (Never, Rarely, Sometimes, Often, Always) to four independent disclosures : “I felt worthless,” “I felt helpless,” “I felt depressed,” and “I felt hopeless” within a week [26 27 29] Other Covariates Demographic variables included age and sex were abstracted from the medical record while race, ethnicity, educational level, and marital status were self-reported as part of the CARE tool [16 22 24]. Cancer-related variables included cancer stage, which was classified via TNM staging (stage I/II, III, and IV), and treatment phase, which was categorized as (pre-chemotherapy, during chemotherapy, and post-chemotherapy). Treatment stage and phase designation were determined by an oncologist, and extracted from the electronic medical record according to each participant [ 19 ]. Statistical Analyses We report the prevalence of moderate to severe pain in older patients with cancer, and identify associations with functional status limitations, cognition, and mental health issues. As previously indicated, depression responses were translated to the appropriate t-score, and then severity was categorized into no depression (t-score 55), mild depression (t-score 55-59), moderate depression (t-score 60-69), and severe depression (t-score 70+) [26 30]. Responses to pain scale were dichotomized as no pain to mild pain (0-3) versus moderate to severe pain (4-10). Descriptive statistics were calculated for the overall study population and according to pain status, using frequencies and proportions for categorical variables and, means and standard deviations for continuous variables. Differences in characteristics by pain status were examined using t-tests for numerical variables and Fisher’s exact test for categorical variables. To avoid multicollinearity of GA measures, separate logistic regression models were estimated to identify associations between moderate/severe pain and IADL dependence, ADL dependence, falls, cognitive complaints, anxiety, and depression. In addition to unadjusted models, adjusted models were measured for each GA measure adjusting for age, sex, race, education level, marital status, employment, cancer type, cancer stage, and treatment phase [31 32]. These covariates were selected on an a priori basis given the available literature, in association with application of clinical knowledge [19 20 24]. Analyses were performed using statistical software SAS version 9.4 (SAS Institute Inc., Cary, NC). Results Baseline Characteristics In the CARE Registry, 1,286 patients aged 60 and higher were included, with an average age of 75-79 years. After excluding cases who did not consent to the study and those with missing survey data of CARE survey for the variables of interest, 714 patients were included in our analyses (see Figure 1 ). Overall, our study population was 58.9% male, 19.1% Black, and 1.7% Hispanic (Table 1). Most participants were married (65.0%) and retired (60.0%). The most frequent cancer types included colorectal (27.9%), pancreatic (18.0%), and hepatobiliary (11.5%) tumors. Most participants had not begun treatment at the time of data collection (70.0%) and stage IV cancer was most common (46.7%). Table 1 Patient Demographics and Characteristics. Demographics & clinical variables All patients (n=714) None/mild Pain (n=405) Moderate/Very Severe Pain (n=309) p Age, mean (SD) 70, (6.8) 70.0 (6.9) 69 (7.1) 0.058 Age, n (%) 60-64 65-69 70-74 75-79 80+ 205, (28.7) 179, (25.1) 157, (22.0) 102, (14.3) 71, (9.9) 107, (26.4) 98, (24.2) 94, (23.2) 66, (16.3) 40, (9.9) 98, (31.7) 81, (26.2) 63, (20.4) 36, (11.7) 31, (10.0) 0.259 Sex, n (%) Male Female 421, (58.9) 293, (41.0) 238, (58.8) 167, (41.2) 183, (59) 126, (40.8) 0.902 Race, n (%) White Black Other 565, (79.0) 136, (19.1) 13, (1.8) 338, (83.5) 60, (14.8) 7, (1.7) 227, (73.5) 76, (24.6) 6, (1.9) 0.004 Ethnicity, n (%) Hispanic Non-Hispanic 12, (1.7) 702, (98.0) 6, (1.5) 399, (98.5) 6, (1.9) 303, (98.1) 0.636 Educational Level, n (%) Less than high school High school graduate Some College Associate/Bachelors Advanced Degree 89, (12.5) 198, (27.7) 150, (21.0) 192, (27.0) 85, (12.0) 35, (8.6) 103, (25.4) 72, (17.8) 129, (31.9) 66, (16.3) 54, (17.5) 95, (30.7) 78, (25.2) 63, (20.4) 19, (6.2) <.001 Marital Status, n (%) Single Widowed/Divorced. Married 40, (5.6) 209, (30.0) 465, (65.0) 20, (4.9) 109, (26.9) 276, (68.2) 20, (6.5) 100, (32.4) 189, (61.2) 0.148 Employment, n (%) Retired Disabled Part-time (32hr/wk) Other 425, (60.0) 84, (12.0) 23, (3.2) 95, (13.3) 87, (12.2) 248, (61.3) 27, (6.7) 17, (4.2) 71, (17.5) 42, (10.4) 177, (57.3) 57, (18.5) 6, (1.9) 24, (7.8) 45, (14.6) <.001 Cancer type, n (%) Colorectal Gastroesophageal Hepatobiliary Pancreatic Other 199, (27.9) 46, (6.4) 82, (11.5) 128, (18.0) 259, (36.3) 128, (31.6) 31, (7.7) 43, (10.6) 64, (15.8) 139, (34.3) 71, (23.0) 15, (4.9) 39, (12.6) 64, (20.7) 120, (38.8) 0.029 Cancer Stage, n (%) I/II III IV 200, (28.0) 181, (25.4) 333, (46.7) 119, (29.4) 102, (25.2) 184, (45.4) 81, (26.2) 79, (25.6) 149, (48.2) 0.628 Treatment Phase, n (%) Pre-treatment During-treatment Post-treatment 499, (70.0) 116, (16.3) 99, (14.0) 273, (67.4) 66, (16.3) 66, (16.3) 226, (73.0) 50, (16.2) 33, (10.7) 0.090 Abbreviation: SD, Standard deviation, IQR, Inter-quartile Range. * P -value is a comparison between those with and without moderate/severe pain*Abbreviations: IADL, instrumental activities of daily living; ADL; activities of daily living; ecog ps, eastern cooperative oncology group performance status; mod/sev, moderate/severe. Prevalence of pain and Association with demographic and clinical characteristics In the study population, 43.3% of participants reported moderate to severe pain and 56.7% reported mild or no pain. Participants reporting moderate to severe pain were more likely to be Black (24.6% vs 14.8%, p =0.004), have lower levels of education (advanced degree completion (6.2% vs 66%, p <0.001), report disability for employment (18.5% vs 6.7%, p <0.001), and more likely to have pancreatic cancer (20.7% vs 15.8%, p =0.029) (Table 1). Conversely, there was no association between pain and age, sex, ethnicity, marital status, cancer stage, or treatment phase. In the unadjusted odds ratios (OR) of demographic and clinical characteristics with the presence of pain, we found no differences by age sex, or ethnicity. Older black patients (unadjusted Odds Ratio [OR] =1.9, 95% CI 1.3-2.8, reference White) and older patients with pancreatic (unadjusted OR=1.8, 95% CI 1.1-2.8, and colorectal cancer (unadjusted [OR] = 1.80, 95% CI 1.15-2.83 were more likely to experience moderate to severe pain. (Table 2 ). Table 2 Unadjusted Odds Ratios of demographics and clinical variables to pain Demographics & clinical variables Unadjusted OR (95% CI) Age group 60-64 65-69 70-74 75-74 80+ REF 0.90 (0.60-1.35) 0.73 (0.480-1.11) 0.60 (0.37-0.97) 0.85 (0.49-1.46) Sex Female Male REF 1.02 (0.75-1.38) Race White Black Other REF 1.89 (1.29-2.75) 1.28 (0.42-3.85) Ethnicity, n (%) Non-Hispanic Hispanic REF 1.32 (0.42-4.12) Education Level Less than high school High school graduate Some college Associate/Bachelors Advance Degree REF 0.60 (0.36-1.00) 0.70 (0.41-1.20) 0.32 (0.19-0.53) 0.19 (0.10-0.37) Marital Status Single Separated/Divorced Married REF 0.92 (0.47-1.81) 0.69 (0.36-1.31) Employment Full-time (>32hr/wk) Retired Disabled Part-time (<32hr/wk) Other REF 2.11 (1.28- 3.49) 6.25 (3.26- 11.98) 1.04 (0.37- 2.95) 3.17 (1.70- 5.92) Cancer Type Colorectal Pancreatic Hepatobiliary Gastroesophageal Other REF 1.80 (1.15-2.83) 1.64 (0.97-2.75) 0.87 (0.44-1.72) 1.56 (1.07-2.27) Cancer Stage I/II III IV REF 1.14 (0.76-1.71) 1.19 (0.83-1.70) Treatment Phase Pre-treatment During-treatment Post-treatment REF 0.92 (0.61-1.38) 0.60 (0.38-0.95) Association of pain with functional status limitations, mental health, and other geriatric assessment impairments Pain was associated with all GA impairments included in this study (Table 3 ). Participants with moderate to severe pain were more likely to report IADL dependence (70.6% vs 33.3%; p <0.001), ADL dependence (25.2% vs 8.6%; p <0.001), falls (30.1% vs 15.1%; p <0.001), and limitations in walking one block (72.0% vs 31.1%; p <0.001). They were also more likely to have impaired self-reported ECOG performance status (48.5% vs 13.8%; p <0.001), take ≥ 9 medications per day (33.3% vs 15.6%; p <0.001), report ≥3 comorbidities (59.2% vs 42.7%; p <0.001), and have malnutrition (46.9% vs 36.3%; p =0.004). Those with moderate to severe pain reported more cognitive complaints (10.0% vs 3.0%; p <0.001), limitations in social activities (42.7% vs 16.3%; p <0.001), anxiety (24.6% vs 12.4%; p <0.001), and depression (19.7% vs 5.7%; p <0.001). Table 3 Geriatric assessment impairments in those with and without moderate/severe pain. Variable Overall (n=714) None / Mild pain (n=405) Moderate / Severe pain (n=309) p* Geriatric Assessment Domain Any IADL dependence , n (%) 353, (50) 135, (33.3) 218, (70.6) <.001 Any ADL dependence , n (%) 113, (16.0) 35, (8.6) 78, (25.2) <.001 Falls (≥1), n (%) 154, (21.6) 61, (15.1) 93, (30.1) <.001 Reported limitations in walking on block , n (%) 348, (49) 126, (31.1) 222, (72.0) <.001 Impaired ecog ps (≥2), n (%) 206, (29) 56, (13.8) 150, (48.5) <.001 Medications (≥9 daily), n (%) 166, (23.3) 63, (15.6) 103, (33.3) <.001 Comorbidities (≥3), n (%) 356, (50) 173, (42.7) 183, (59.2) <.001 Malnutrition , n (%) 292, (41) 147, (36.3) 145, (46.9) 0.004 Cognitive complaints (mod/sev.), n (%) 43, (6.0) 12, (3.0) 31, (10.0) <.001 Limitations in social activities , n (%) 198, (28.0) 66, (16.3) 132, (42.7) <.001 Anxiety (mod/sev.), n (%) 126, (18.0) 50, (12.4) 76, (24.6) <.001 Depression (mod/sev.), n (%) 84, (12.0) 23, (5.7) 61, (19.7) <.001 * p -value from the bivariate comparison of those with moderate/severe versus none/mild pain Logistic regression analyses adjusting for demographic and cancer-related variables showed an association between moderate to severe pain and IADL dependence (adjusted Odds Ratio [aOR]=4.3, 95% CI 3.0-6.1, p <0.001), ADL dependence (aOR=3.2, 95% CI 2.0-5.1, p <0.001), falls (aOR=2.4, 95% CI 1.6-3.6, p <0.001), cognitive complaints (aOR=2.9, 95% CI 1.4-6.0, p =0.004), anxiety (aOR=2.2, 95% CI 1.4-3.4, p =0.004), and depression (aOR=3.7, 95% CI 2.2-6.5, p <0.001) .(Table 4 ). Table 4 Multivariable model of associations of moderate/severe pain with impairments in instrumental activities of daily living and activities of daily living, falls, and psycho-neurological disorders. Variable Unadjusted OR (95% CI) Adjusted OR (95% CI) p* IADL dependence 4.79 (3.48-6.60) 4.28 (3.01- 6.09) <.001 ADL dependence 3.57 (2.32-5.49) 3.15 (1.96-5.06) <.001 Falls 2.43 (1.67-3.50) 2.41 (1.61-3.59) <.001 Cognition 3.65 (1.84-7.23) 2.91 (1.41-6.02) 0.004 Anxiety 2.32 (1.56-3.43) 2.18 (1.42-3.36) 0.004 Depression 4.09 (2.46-6.77) 3.74 (2.16-6.50) <.001 Abbreviations: IADL, Instrumental Activities of Daily Living; ADL, Activities of Daily Living; OR (Odds Ratio). * p -values for individual regression models adjusted for age, sex, race, ethnicity, education level, marital status, employment, cancer type, cancer stage, and treatment phase Discussion This study found that 43% of older adults with primarily gastrointestinal malignancies report moderate to severe pain, and the presence of moderate-severe pain is associated with functional status limitations, cognitive complaints, anxiety, and depression. the prevalence of pain among older adults and the association of pain with Regression models found IADL dependence, ADL dependence, falls, cognitive complaints, anxiety, and depression were associated with pain after adjusting for demographic and cancer-related clinical factors. The prevalence of moderate to severe pain in our study population was 43%, which is consistent with previous findings. Notably, a 2016 meta-analysis examined 122 studies published between 2005-2014, on the prevalence of pain in patients of all ages with cancer and found that overall, 38% of participants reported moderate to severe pain [ 33 ]. Similarly, a 2007 meta-analysis including 52 studies looked at pain prevalence grouped by cancer stage and type and found overall rates of moderate to severe pain reported in 31%- 45% of participants [ 31 ]. While previous literature has found that female patients with cancer report higher levels of pain compared to male cancer patients, our analyses did not find any differences in pain by sex [32 34]. These inconsistencies may be explained by discrepancies in proportions of cancer type between study populations. For instance, previous studies have found that patients with breast cancer are more likely to report pain than patients with other cancer types [33 34]. Importantly, studies which found that females report more pain also had large proportions of patients with breast cancer in their study. In contrast, patients with breast cancer were not included in our study population, which could explain the inconsistency of this finding [32 34]. Our study found that respondents aged 75-79 were less likely to report moderate to severe pain compared to patients between 60-64 years. No other differences were found between age categories. These results are not surprising as previous research on age and cancer pain has produced inconsistent findings [ 31 ]. Also congruent with previous literature, our study found that patients on disability reported significantly more pain than those working full-time [ 35 ]. It is important to note that the measurement of pain in our study does not specify pain related to cancer. Consequently, when considering the relationship between pain and functional impartments in patients with cancer, it is unclear whether cancer-related pain increases the likelihood of being functionally impaired, or if people with functional impairments simply tend to report greater pain in general. Black participants were significantly more likely to report moderate to severe pain compared to White participants. Previous research suggests several possible explanations for this discrepancy including that Black patients are less likely to be prescribed pain relieving medication and that pain medication adherence is poorer among Black patients [36 37]. Black patients also may have an increased difficulty in obtaining pain medications given pharmacies in many predominantly Black neighborhoods often inadequately stock opioids as well as potential financial barriers in obtaining pain medications[38 39]. These findings highlight the need to ensure that Black patients with cancer are thoroughly assessed for pain and provided assistance in accessing pain medications if a pain prescription is warranted. Bivariate and multivariate analyses revealed significant association between IADL and ADL dependence and moderate to severe pain. While there is a robust literature examining pain and IADL dependence in non-cancer populations, limited research has evaluated the relationship between the presence of pain and IADL/ADLs dependence in older adults with cancer [ 40 – 42 ]. Patients in our cohort with moderate to severe pain experienced more cognitive complaints and anxiety. Our study is not without limitations. Perhaps most importantly, we employed a cross-sectional study design and therefore we cannot establish causality between pain and outcome variables. Participants were recruited from a single center. This solitary source of collection exists in primarily underserved areas in Alabama, which is located in the “Deep South” region of the Southeastern United States (a historically underserved and disadvantaged region). Therefore, the results of this study may not be generalizable to other populations. Our study did not account for pain medications, or other analgesics, prescriptions or administration among participants, which could have theoretically impacted the levels of pain perceived by study subjects. Furthermore, while we did control for treatment phase with regard to chemotherapy in our regression model, we did not include consideration of patients who received surgical vs non-surgical treatments. Moderate to severe pain was frequently reported in our study population. Pain was more frequently reported in patients who were Black, had lower levels of education, had pancreatic cancer, and were on disability. Additionally, moderate to severe pain was associated with several important GA impairments that are known predictors of adverse outcomes. Notably, our findings suggest that pain is associated with IADL and ADL dependence in older adults with malignancies. Given functional independence is a recognized priority of older adults, these results highlight the potential importance of screening for and managing pain in older patients with cancer [ 43 ]. Future longitudinal research is necessary to better understand the relationship between pain and GA impairments with a specific focus on the source(s) of pain and the impact of pain management. Declarations Funding : Supported in part by the National Institutes of Health (K08CA234225 – GW). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Conflict of interest statement: The authors have no conflicts to disclose relevant to the content of this article. Availability of data and material : All data is available per written individual request to University of Alabama at Birmingham (UAB). Code availability: Any software programming code is available per written individual request to UAB. Code availability : Any software programming code is available per written individual request to University of Alabama at Birmingham (UAB). Authors’ contributions : All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [Grant R. Williams], [Mustafa AL-Obaidi], and [Sarah Kosmicki], and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Ethics approval : Ethical considerations were presented to and approved by the UAB IRB per review. Study subjects were determined to be exposed to minimal risk. Consent to participate : All enrolled participants have been consented by IRB-approved study personnel, according to UAB IRB rules and regulations. Consent for publication: All authors reviewed and agreed to submission with an intent for publication. References Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA (2009) Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol 27(17):2758–2765. doi: 10.1200/JCO.2008.20.8983 [published Online First: Epub Date]| Marosi C, Koller M (2016) Challenge of cancer in the elderly. ESMO Open 1(3):e000020 : 10.1136/esmoopen-2015-000020[published Online First: Epub Date]| Sawhney R, Sehl M, Naeim A (2005) Physiologic aspects of aging: impact on cancer management and decision making, part I. 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J Am Geriatr Soc 60(1):113–117. doi: 10.1111/j.1532-5415.2011.03769 x[published Online First: Epub Date]| Farrukh N, Hageman L, Chen Y et al (2020) Pain in older survivors of hematologic malignancies after blood or marrow transplantation: A BMTSS report. Cancer 126(9):2003–2012. doi: 10.1002/cncr.32736 [published Online First: Epub Date]| Kenzik K, Pisu M, Johns SA et al (2015) Unresolved Pain Interference among Colorectal Cancer Survivors: Implications for Patient Care and Outcomes. Pain Med 16(7):1410–1425. doi: 10.1111/pme.12727 [published Online First: Epub Date]| Persons AGSPoPPiO (2002) The management of persistent pain in older persons. J Am Geriatr Soc 50(6 Suppl):S205–S224. doi: 10.1046/j.1532-5415.50.6s.1 x[published Online First: Epub Date]| Williams GR, Kenzik KM, Parman M et al (2020) Integrating geriatric assessment into routine gastrointestinal (GI) consultation: The Cancer and Aging Resilience Evaluation (CARE). J Geriatr Oncol 11(2):270–273. doi: 10.1016/j.jgo.2019.04.008 [published Online First: Epub Date]| Hays RD, Bjorner JB, Revicki DA, Spritzer KL, Cella D (2009) Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Qual Life Res 18(7):873–880. doi: 10.1007/s11136-009-9496-9 [published Online First: Epub Date]| Tesler MD, Savedra MC, Holzemer WL, Wilkie DJ, Ward JA, Paul SM (1991) The word-graphic rating scale as a measure of children's and adolescents' pain intensity. Res Nurs Health 14(5):361–371. doi: 10.1002/nur.4770140507 [published Online First: Epub Date]| Williams GR, Al-Obaidi M, Dai C et al (2021) Fatigue is independently associated with functional status limitations in older adults with gastrointestinal malignancies-results from the CARE registry. Support Care Cancer 29(11):6793–6800. doi: 10.1007/s00520-021-06273- y[published Online First: Epub Date]| Williams GR, Al-Obaidi M, Dai C et al (2020) Association of malnutrition with geriatric assessment impairments and health-related quality of life among older adults with gastrointestinal malignancies. Cancer 126(23):5147–5155. doi: 10.1002/cncr.33122 [published Online First: Epub Date]| Williamson A, Hoggart B (2005) Pain: a review of three commonly used pain rating scales. J Clin Nurs 14(7):798–804. doi: 10.1111/j.1365-2702.2005.01121 .x[published Online First: Epub Date]| DuMontier C, Sedrak MS, Soo WK et al (2020) Arti Hurria and the progress in integrating the geriatric assessment into oncology: Young International Society of Geriatric Oncology review paper. J Geriatr Oncol 11(2):203–211 [published Online First: Epub Date]| Williams GR, Deal AM, Jolly TA et al (2014) Feasibility of geriatric assessment in community oncology clinics. J Geriatr Oncol 5(3):245–251. doi: 10.1016/j.jgo.2014.03.001 [published Online First: Epub Date]| Giri S, Al-Obaidi M, Weaver A et al Association Between Chronologic Age and Geriatric Assessment-Identified Impairments: Findings From the CARE Registry.J Natl Compr Canc Netw2021:1–6doi: 10.6004/jnccn.2020.7679 [published Online First: Epub Date]|. Fillenbaum GG, Smyer MA (1981) The Development, Validity, and Reliability of the Oars Multidimensional Functional Assessment Questionnaire1. J Gerontol 36(4):428–434. doi: 10.1093/geronj/36.4.428 [published Online First: Epub Date]| Godby RC, Dai C, Al-Obaidi M et al (2021) Depression among older adults with gastrointestinal malignancies. J Geriatr Oncol 12(4):599–604. doi: 10.1016/j.jgo.2020.10.020 [published Online First: Epub Date]| Mir N, MacLennan P, Al-Obaidi M et al (2020) Patient-reported cognitive complaints in older adults with gastrointestinal malignancies at diagnosis- Results from the Cancer & Aging Resilience Evaluation (CARE) study. J Geriatr Oncol 11(6):982–988. doi: 10.1016/j.jgo.2020.02.008 [published Online First: Epub Date]| Wilford J, Osann K, Hsieh S, Monk B, Nelson E, Wenzel L (2018) Validation of PROMIS emotional distress short form scales for cervical cancer. Gynecol Oncol 151(1):111–116. doi: 10.1016/j.ygyno.2018.07.022 [published Online First: Epub Date]| Yost KJ, Eton DT, Garcia SF, Cella D (2011) Minimally important differences were estimated for six Patient-Reported Outcomes Measurement Information System-Cancer scales in advanced-stage cancer patients. J Clin Epidemiol 64(5):507–516 [published Online First: Epub Date]| Cella D, Choi SW, Condon DM et al (2019) PROMIS((R)) Adult Health Profiles: Efficient Short-Form Measures of Seven Health Domains. Value Health 22(5):537–544. doi: 10.1016/j.jval.2019.02.004 [published Online First: Epub Date]| de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J (2007) ; 18 (9):1437-49 doi: 10.1093/annonc/mdm056 [published Online First: Epub Date]| Brunello A, Ahcene-Djaballah S, Lettiero A et al (2019) Prevalence of pain in patients with cancer aged 70years or older: A prospective observational study. J Geriatr Oncol 10(4):637–642. doi: 10.1016/j.jgo.2019.01.005 [published Online First: Epub Date]| Hochstenbach LM, Joosten EA, Tjan-Heijnen VC, Janssen DJ (2016) ; 51 (6):1070-90 e9 doi: 10.1016/j.jpainsymman.2015.12.340[published Online First: Epub Date]| Enting RH, Oldenmenger WH, Van Gool AR, van der Rijt CC, Sillevis Smitt PA (2007) The effects of analgesic prescription and patient adherence on pain in a dutch outpatient cancer population. J Pain Symptom Manage 34(5):523–531. doi: 10.1016/j.jpainsymman.2007.01.007 [published Online First: Epub Date]| Rustoen T, Fossa SD, Skarstein J, Moum T (2003) The impact of demographic and disease-specific variables on pain in cancer patients. J Pain Symptom Manage 26(2):696–704. doi: 10.1016/s0885-3924(03)00239-2 [published Online First: Epub Date]| Lamba N, Mehanna E, Kearney RB et al (2020) Racial disparities in supportive medication use among older patients with brain metastases: a population-based analysis. Neuro Oncol 22(9):1339–1347. doi: 10.1093/neuonc/noaa054 [published Online First: Epub Date]| Yeager KA, Williams B, Bai J et al (2019) Factors Related to Adherence to Opioids in Black Patients With Cancer Pain. J Pain Symptom Manage 57(1):28–36. doi: 10.1016/j.jpainsymman.2018.10.491 [published Online First: Epub Date]| Jefferson K, Quest T, Yeager KA (2019) Factors Associated with Black Cancer Patients' Ability to Obtain Their Opioid Prescriptions at the Pharmacy. J Palliat Med 22(9):1143–1148. doi: 10.1089/jpm.2018.0536 [published Online First: Epub Date]| Giri S, Clark D, Al-Obaidi M et al (2021) Financial Distress Among Older Adults With Cancer. JCO Oncol Pract 17(6):e764–e73. doi: 10.1200/OP.20.00601 [published Online First: Epub Date]| Connolly D, Garvey J, McKee G (2017) Factors associated with ADL/IADL disability in community dwelling older adults in the Irish longitudinal study on ageing (TILDA). Disabil Rehabil 39(8):809–816. doi: 10.3109/09638288.2016.1161848 [published Online First: Epub Date]| Cwirlej-Sozanska A, Wisniowska-Szurlej A, Wilmowska-Pietruszynska A, Sozanski B (2019) Determinants of ADL and IADL disability in older adults in southeastern Poland. BMC Geriatr 19(1):297. doi: 10.1186/s12877-019-1319-4 [published Online First: Epub Date]| Park J (2019) A study on the sleep quality, pain, and instrumental activities of daily living of outpatients with chronic stroke. J Phys Ther Sci 31(2):149–152. doi: 10.1589/jpts.31.149 [published Online First: Epub Date]| Fried TR, Bradley EH, Towle VR, Allore H (2002) Understanding the treatment preferences of seriously ill patients. N Engl J Med 346(14):1061–1066 : 10.1056/NEJMsa012528[published Online First: Epub Date]| Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 11 Apr, 2022 Reviewers invited by journal 11 Apr, 2022 Editor invited by journal 26 Feb, 2022 Editor assigned by journal 31 Jan, 2022 First submitted to journal 28 Jan, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1307446","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":97799392,"identity":"4c7886f3-7686-4ef7-b649-50f307f14d74","order_by":0,"name":"Mustafa AL Obaidi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYNACGwYZBgkGhgM8BjYMIAYhwNjAkMbAA9WSRqIWIHmYsBbdGenPH/xIsOPhl25+eOBNwfnE/tnNBx8w1NhE49JidiPHsLEnIZlHcs4xg4NzDG4nzrhzLNmA4VhabgNuLYwNvD+YeQxuJBgc5gFqabiRYybB2HAYj5b0h41/EuqBWtI/ALWcS5xPWEuCYTNPAlDxjRyQLQcSNxDUcuaN4WyZhONAv5wpAPol2XjjjbRkgwR8fjme/uDjm4RqOX7p9s0f3vyxk513I/nggw81Nji1YABHsMoEYpWDgD0pikfBKBgFo2BkAACC5WOHAmcQIwAAAABJRU5ErkJggg==","orcid":"","institution":"The University of Alabama at Birmingham","correspondingAuthor":true,"prefix":"","firstName":"Mustafa","middleName":"AL","lastName":"Obaidi","suffix":""},{"id":97799393,"identity":"38041d9c-5094-4797-9ea2-6c97dd645da2","order_by":1,"name":"Sarah Kosmicki","email":"","orcid":"","institution":"The University of Alabama at Birmingham Department of Epidemiology","correspondingAuthor":false,"prefix":"","firstName":"Sarah","middleName":"","lastName":"Kosmicki","suffix":""},{"id":97799394,"identity":"f53155bb-6d34-4c42-bef3-dadfb47ef2a9","order_by":2,"name":"Christian Harmon","email":"","orcid":"","institution":"The University of Alabama at Birmingham","correspondingAuthor":false,"prefix":"","firstName":"Christian","middleName":"","lastName":"Harmon","suffix":""},{"id":97799395,"identity":"76931283-8cf7-4170-b68a-4ef0967afead","order_by":3,"name":"Mina Lobbous","email":"","orcid":"","institution":"The University of Alabama at Birmingham","correspondingAuthor":false,"prefix":"","firstName":"Mina","middleName":"","lastName":"Lobbous","suffix":""},{"id":97799396,"identity":"60f57204-9276-4884-9392-d2a29fe25ac5","order_by":4,"name":"Darryl Outlaw","email":"","orcid":"","institution":"University of Alabama at Birmingham","correspondingAuthor":false,"prefix":"","firstName":"Darryl","middleName":"","lastName":"Outlaw","suffix":""},{"id":97799397,"identity":"b698344f-2f89-48cc-93be-7e37dbb1760a","order_by":5,"name":"Moh’d Khushman","email":"","orcid":"","institution":"University of Alabama at Birmingham","correspondingAuthor":false,"prefix":"","firstName":"Moh’d","middleName":"","lastName":"Khushman","suffix":""},{"id":97799398,"identity":"9bc3838f-6bfb-41bf-aac3-d609be5deac5","order_by":6,"name":"Gerald McGwin","email":"","orcid":"","institution":"University of Alabama at Birmingham","correspondingAuthor":false,"prefix":"","firstName":"Gerald","middleName":"","lastName":"McGwin","suffix":""},{"id":97799399,"identity":"8991c07e-6845-4d9a-8181-bcd68b7c7842","order_by":7,"name":"Smita Bhatia","email":"","orcid":"","institution":"The University of Alabama at Birmingham","correspondingAuthor":false,"prefix":"","firstName":"Smita","middleName":"","lastName":"Bhatia","suffix":""},{"id":97799400,"identity":"f6c6e05b-47d0-4f8a-9b44-84584c59ac11","order_by":8,"name":"Smith Giri","email":"","orcid":"","institution":"The University of Alabama at Birmingham","correspondingAuthor":false,"prefix":"","firstName":"Smith","middleName":"","lastName":"Giri","suffix":""},{"id":97799401,"identity":"df4c7ddc-0de9-43eb-b6db-50b0b193f587","order_by":9,"name":"Grant R. Williams","email":"","orcid":"","institution":"The University of Alabama at Birmingham","correspondingAuthor":false,"prefix":"","firstName":"Grant","middleName":"R.","lastName":"Williams","suffix":""}],"badges":[],"createdAt":"2022-01-28 18:09:54","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1307446/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1307446/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":20310922,"identity":"71c57c10-9fed-4c42-ba05-cd2039cc1463","added_by":"auto","created_at":"2022-04-13 18:36:01","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":50105,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSelection of participant flow chart (Consort figure) \u003c/strong\u003e\u003c/p\u003e\u003cp\u003eFlow Chart showing the process of study cohort selection. This figure illustrated how we excluded the patients who were not eligible in our study’s criteria.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1307446/v1/ada7ae27ceaf626250a431d2.jpg"},{"id":20310926,"identity":"a200bb8f-58f1-4de1-8831-21feb2728df2","added_by":"auto","created_at":"2022-04-13 18:36:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":634883,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1307446/v1/903faafd-27cf-4b9a-8bf8-4d39fd3fa0fb.pdf"}],"financialInterests":"","formattedTitle":"Pain among Older Adults with Cancer - Results from the Cancer and Aging Resilience Evaluation (CARE) Registry","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDespite improvements in cancer prevention and therapeutics, the incidence of cancer in developed countries is increasing largely due to the shift in population demographics and population aging. Indeed, The United States (U.S.) population is aging with a projection that 20% of the population by 2030 will be above 65 years of age [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. More than 50% of cancer cases occur in individuals older than 65 years of age and cancer is considered one of the leading causes of mortality in older individuals [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Compared to younger patients, the management of cancer in older patients poses several challenges including physiological decreases in organ function, the burden of comorbidities, variable functional independence, and underrepresentation in clinical trials [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. One additional challenge of cancer care in older patients is pain management and its impact on quality of life. Unfortunately, up to 80% of patients with early- to advanced-stage cancer report chronic pain [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUndoubtedly, objective measurement of pain is quite challenging due to its complex subjective multimodal nature [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. There is a compendium of research addressing assessment of pain in the older individuals as well as in patients with cancer, which is a fundamental step toward more effective chronic pain management. There are numerous available validated subjective pain measurement tools including the visual analog scale, the numeric rating scale (NRS), and the verbal descriptor scale [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The NRS, which measures the perceived level of pain on a scale from zero (no pain) to 10 (most severe pain ever experienced), is one of the most widely used tools in U.S. healthcare institutions and has been shown to be a valid assessment of cancer-related pain [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere is mounting evidence that a high prevalence of pain has a detrimental effect on quality of life in older patients including higher incidences of depression, sleep disturbances, and social isolation [10 11]. Moreover, Shega and colleagues reported that moderate or higher pain was independently associated with frailty in a cross-sectional study of persons aged 65 and older in Canada [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In addition, older adult survivors of blood or marrow transplantation had a 2.6 fold greater odds of reporting pain in comparison to their siblings and those reporting pain were more likely to have impaired physical performance and develop frailty [13 14]. Pain management in older patients with cancer requires a multidisciplinary approach including optimal utilization of pharmaceuticals and non-pharmaceutical resources [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOver the past three decades, researchers from different disciplines examined different pain assessment tools and the best approaches to the management of pain in patients with cancer, however, little is known about the impact of pain on the growing number of older adults with cancer. In this study, we sought to identify the prevalence of pain at diagnosis in older adults with cancer and evaluate the association of moderate/severe pain with functional status limitations, cognitive complaints, and mental health.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and Participants\u003c/h2\u003e \u003cp\u003eThis is an observational (cross-sectional) study of older adults diagnosed with cancer and referred to be seen by an oncologist at the University of Alabama at Birmingham (UAB) clinics, which include The Kirklin Clinic, UAB Acton Road clinic, and Colorectal Cancer multidisciplinary clinics, enrolled in the Cancer \u0026amp; Aging Resilience Evaluation (CARE) Registry. The CARE Registry is an ongoing prospective study that was launched in September 2017 [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. For this study, older patients (aged 60 years and above) recruited into the CARE Registry between September 2017 and June 2021 with a diagnosis of cancer (colorectal cancer, gastroesophageal cancer, hepatobiliary cancer, pancreatic cancer, and others) who performed GA at the time of their initial consultation were included. Patients who were non-English speakers, were 59 years or younger, or declined participation were excluded from the study (Figure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The collection of data for the Registry and subsequent uses of the data for investigative and analytic pursuits such as this, was approved by the institutional review board of UAB (IRB-300000092), and all patients provided written consent.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003ePain\u003c/h2\u003e \u003cp\u003eAs part of the GA, patients completed the National Institutes of Health's 10-item Patient-Reported Outcomes Measurement Information System (PROMIS\u0026reg;) global health scale (PROMIS Global 10) short-form [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. PROMIS Global 10 utilized the question to assess perceived pain: \u0026ldquo;In the past 7 days, how would you rate your pain on average?\u0026rdquo; Responses ranged from zero representing \u0026ldquo;no pain\u0026rdquo; and 10 represented as \u0026ldquo;worst pain ever experienced\u0026rdquo; [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The history of this tool was initially presented back in 1991 [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In this pain scale, pain categorized into; no pain (0), mild pain (1-3), moderate pain (4-7), or severe pain (8-10) on a linear numeric scale [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eGeriatric Assessment\u003c/h2\u003e \u003cp\u003eAll participants submitted a self-reported GA, a modified version of the Cancer and Aging Research Group GA [16 22 23]. The CARE tool consists of various validated tools to screen for potential impairments of physical function, functional status, nutrition, cognition, social activity, polypharmacy, and performance status [16 19 24]. Data of patient-reported pain assessment were collected at the time of enrollment (at baseline) with the use of our CARE tool as well as other health information relevant to the management of patients\u0026rsquo; cancers were retrieved from medical records. For our cohort analysis we highlighted impairments in functional status as assessed by the Older Americans Resources and Services (OARS) assessment [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The CARE tool contains of 6-items assessing instrumental activities of daily living (IADL) which include an assessment of ambulation capacity, ability to procure groceries for self, ability to conduct daily home maintenance, ability to successfully take own prescriptions, ability to cook and prepare own meals, and ability manage own budget; as well as 3-items assessing activities of daily living (ADL) that include ability to get in and out of bed, ability to dress and undress, and ability to bathe one-self [19 20]. The CARE tool also assesses the presence of cognitive complaints, depression, and anxiety via PROMIS 4-item short forms [\u003cspan additionalcitationids=\"CR27 CR28\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Depression was assessed using PROMIS\u0026reg; Depression Short Form 4a v1.0, which involved likert answers (Never, Rarely, Sometimes, Often, Always) to four independent disclosures : \u0026ldquo;I felt worthless,\u0026rdquo; \u0026ldquo;I felt helpless,\u0026rdquo; \u0026ldquo;I felt depressed,\u0026rdquo; and \u0026ldquo;I felt hopeless\u0026rdquo; within a week [26 27 29]\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eOther Covariates\u003c/h2\u003e \u003cp\u003eDemographic variables included age and sex were abstracted from the medical record while race, ethnicity, educational level, and marital status were self-reported as part of the CARE tool [16 22 24]. Cancer-related variables included cancer stage, which was classified via TNM staging (stage I/II, III, and IV), and treatment phase, which was categorized as (pre-chemotherapy, during chemotherapy, and post-chemotherapy). Treatment stage and phase designation were determined by an oncologist, and extracted from the electronic medical record according to each participant [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analyses\u003c/h2\u003e \u003cp\u003eWe report the prevalence of moderate to severe pain in older patients with cancer, and identify associations with functional status limitations, cognition, and mental health issues. As previously indicated, depression responses were translated to the appropriate t-score, and then severity was categorized into no depression (t-score 55), mild depression (t-score 55-59), moderate depression (t-score 60-69), and severe depression (t-score 70+) [26 30]. Responses to pain scale were dichotomized as no pain to mild pain (0-3) versus moderate to severe pain (4-10). Descriptive statistics were calculated for the overall study population and according to pain status, using frequencies and proportions for categorical variables and, means and standard deviations for continuous variables. Differences in characteristics by pain status were examined using t-tests for numerical variables and Fisher\u0026rsquo;s exact test for categorical variables. To avoid multicollinearity of GA measures, separate logistic regression models were estimated to identify associations between moderate/severe pain and IADL dependence, ADL dependence, falls, cognitive complaints, anxiety, and depression. In addition to unadjusted models, adjusted models were measured for each GA measure adjusting for age, sex, race, education level, marital status, employment, cancer type, cancer stage, and treatment phase [31 32]. These covariates were selected on an a priori basis given the available literature, in association with application of clinical knowledge [19 20 24]. Analyses were performed using statistical software SAS version 9.4 (SAS Institute Inc., Cary, NC).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv class=\"Section2\" id=\"Sec9\"\u003e\n \u003ch2\u003eBaseline Characteristics\u003c/h2\u003e\n \u003cp\u003eIn the CARE Registry, 1,286 patients aged 60 and higher were included, with an average age of 75-79 years. After excluding cases who did not consent to the study and those with missing survey data of CARE survey for the variables of interest, 714 patients were included in our analyses (see Figure \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Overall, our study population was 58.9% male, 19.1% Black, and 1.7% Hispanic (Table 1). Most participants were married (65.0%) and retired (60.0%). The most frequent cancer types included colorectal (27.9%), pancreatic (18.0%), and hepatobiliary (11.5%) tumors. Most participants had not begun treatment at the time of data collection (70.0%) and stage IV cancer was most common (46.7%).\u003c/p\u003e\n \u003ctable border=\"1\" width=\"0\"\u003e\n \u003ccaption\u003e\n \u003cp\u003eTable 1\u003c/p\u003e\n \u003cp\u003ePatient Demographics and Characteristics.\u003c/p\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"209\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemographics \u0026amp; clinical variables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll patients\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=714)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e\u003cstrong\u003eNone/mild Pain\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=405)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"138\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate/Very Severe Pain\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=309)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"209\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, mean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e70, (6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e70.0 (6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"138\"\u003e\n \u003cp\u003e69 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84\"\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"209\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e60-64\u003c/p\u003e\n \u003cp\u003e65-69\u003c/p\u003e\n \u003cp\u003e70-74\u003c/p\u003e\n \u003cp\u003e75-79\u003c/p\u003e\n \u003cp\u003e80+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e205, (28.7)\u003c/p\u003e\n \u003cp\u003e179, (25.1)\u003c/p\u003e\n \u003cp\u003e157, (22.0)\u003c/p\u003e\n \u003cp\u003e102, (14.3)\u003c/p\u003e\n \u003cp\u003e71, (9.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e107, (26.4)\u003c/p\u003e\n \u003cp\u003e98, (24.2)\u003c/p\u003e\n \u003cp\u003e94, (23.2)\u003c/p\u003e\n \u003cp\u003e66, (16.3)\u003c/p\u003e\n \u003cp\u003e40, (9.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"138\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e98, (31.7)\u003c/p\u003e\n \u003cp\u003e81, (26.2)\u003c/p\u003e\n \u003cp\u003e63, (20.4)\u003c/p\u003e\n \u003cp\u003e36, (11.7)\u003c/p\u003e\n \u003cp\u003e31, (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.259\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"209\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e421, (58.9)\u003c/p\u003e\n \u003cp\u003e293, (41.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e238, (58.8)\u003c/p\u003e\n \u003cp\u003e167, (41.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"138\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e183, (59)\u003c/p\u003e\n \u003cp\u003e126, (40.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.902\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"209\"\u003e\n \u003cp\u003e\u003cstrong\u003eRace, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003cp\u003eBlack\u003c/p\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e565, (79.0)\u003c/p\u003e\n \u003cp\u003e136, (19.1)\u003c/p\u003e\n \u003cp\u003e13, (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e338, (83.5)\u003c/p\u003e\n \u003cp\u003e60, (14.8)\u003c/p\u003e\n \u003cp\u003e7, (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"138\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e227, (73.5)\u003c/p\u003e\n \u003cp\u003e76, (24.6)\u003c/p\u003e\n \u003cp\u003e6, (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"209\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthnicity, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eHispanic\u003c/p\u003e\n \u003cp\u003eNon-Hispanic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12, (1.7)\u003c/p\u003e\n \u003cp\u003e702, (98.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6, (1.5)\u003c/p\u003e\n \u003cp\u003e399, (98.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"138\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6, (1.9)\u003c/p\u003e\n \u003cp\u003e303, (98.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.636\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"209\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational Level, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eLess than high school\u003c/p\u003e\n \u003cp\u003eHigh school graduate\u003c/p\u003e\n \u003cp\u003eSome College\u003c/p\u003e\n \u003cp\u003eAssociate/Bachelors\u003c/p\u003e\n \u003cp\u003eAdvanced Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e89, (12.5)\u003c/p\u003e\n \u003cp\u003e198, (27.7)\u003c/p\u003e\n \u003cp\u003e150, (21.0)\u003c/p\u003e\n \u003cp\u003e192, (27.0)\u003c/p\u003e\n \u003cp\u003e85, \u0026nbsp;(12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e35, (8.6)\u003c/p\u003e\n \u003cp\u003e103, (25.4)\u003c/p\u003e\n \u003cp\u003e72, (17.8)\u003c/p\u003e\n \u003cp\u003e129, (31.9)\u003c/p\u003e\n \u003cp\u003e66, (16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"138\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e54, (17.5)\u003c/p\u003e\n \u003cp\u003e95, (30.7)\u003c/p\u003e\n \u003cp\u003e78, (25.2)\u003c/p\u003e\n \u003cp\u003e63, (20.4)\u003c/p\u003e\n \u003cp\u003e19, (6.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"209\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003cp\u003eWidowed/Divorced.\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e40, (5.6)\u003c/p\u003e\n \u003cp\u003e209, (30.0)\u003c/p\u003e\n \u003cp\u003e465, (65.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e20, (4.9)\u003c/p\u003e\n \u003cp\u003e109, (26.9)\u003c/p\u003e\n \u003cp\u003e276, (68.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"138\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e20, (6.5)\u003c/p\u003e\n \u003cp\u003e100, (32.4)\u003c/p\u003e\n \u003cp\u003e189, (61.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.148\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"209\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;\u003c/strong\u003eRetired\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Disabled\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Part-time (\u0026lt;32hr/wk)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Full-time (\u0026gt;32hr/wk)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e425, (60.0)\u003c/p\u003e\n \u003cp\u003e84, (12.0)\u003c/p\u003e\n \u003cp\u003e23, (3.2)\u003c/p\u003e\n \u003cp\u003e95, (13.3)\u003c/p\u003e\n \u003cp\u003e87, (12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e248, (61.3)\u003c/p\u003e\n \u003cp\u003e27, (6.7)\u003c/p\u003e\n \u003cp\u003e17, (4.2)\u003c/p\u003e\n \u003cp\u003e71, (17.5)\u003c/p\u003e\n \u003cp\u003e42, (10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"138\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e177, (57.3)\u003c/p\u003e\n \u003cp\u003e57, (18.5)\u003c/p\u003e\n \u003cp\u003e6, (1.9)\u003c/p\u003e\n \u003cp\u003e24, (7.8)\u003c/p\u003e\n \u003cp\u003e45, (14.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"209\"\u003e\n \u003cp\u003e\u003cstrong\u003eCancer type, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Colorectal\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Gastroesophageal\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Hepatobiliary\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Pancreatic\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e199, (27.9)\u003c/p\u003e\n \u003cp\u003e46, (6.4)\u003c/p\u003e\n \u003cp\u003e82, (11.5)\u003c/p\u003e\n \u003cp\u003e128, (18.0)\u003c/p\u003e\n \u003cp\u003e259, (36.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e128, (31.6)\u003c/p\u003e\n \u003cp\u003e31, (7.7)\u003c/p\u003e\n \u003cp\u003e43, (10.6)\u003c/p\u003e\n \u003cp\u003e64, (15.8)\u003c/p\u003e\n \u003cp\u003e139, (34.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"138\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e71, (23.0)\u003c/p\u003e\n \u003cp\u003e15, (4.9)\u003c/p\u003e\n \u003cp\u003e39, (12.6)\u003c/p\u003e\n \u003cp\u003e64, (20.7)\u003c/p\u003e\n \u003cp\u003e120, (38.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.029\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"209\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Cancer Stage, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;I/II\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;III\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e200, (28.0)\u003c/p\u003e\n \u003cp\u003e181, (25.4)\u003c/p\u003e\n \u003cp\u003e333, (46.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e119, (29.4)\u003c/p\u003e\n \u003cp\u003e102, (25.2)\u003c/p\u003e\n \u003cp\u003e184, (45.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"138\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e81, (26.2)\u003c/p\u003e\n \u003cp\u003e79, (25.6)\u003c/p\u003e\n \u003cp\u003e149, (48.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.628\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"209\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment Phase, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Pre-treatment\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;During-treatment\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Post-treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e499, (70.0)\u003c/p\u003e\n \u003cp\u003e116, (16.3)\u003c/p\u003e\n \u003cp\u003e99, (14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"108\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e273, (67.4)\u003c/p\u003e\n \u003cp\u003e66, (16.3)\u003c/p\u003e\n \u003cp\u003e66, (16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"138\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e226, (73.0)\u003c/p\u003e\n \u003cp\u003e50, (16.2)\u003c/p\u003e\n \u003cp\u003e33, (10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.090\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" width=\"209\"\u003eAbbreviation: SD, Standard deviation, IQR, Inter-quartile Range. *\u003cem\u003eP\u003c/em\u003e-value is a comparison between those with and without moderate/severe pain*Abbreviations: IADL, instrumental activities of daily living; ADL; activities of daily living; ecog ps, eastern cooperative oncology group performance status; mod/sev, moderate/severe.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec10\"\u003e\n \u003ch2\u003ePrevalence of pain and Association with demographic and clinical characteristics\u003c/h2\u003e\n \u003cp\u003eIn the study population, 43.3% of participants reported moderate to severe pain and 56.7% reported mild or no pain. Participants reporting moderate to severe pain were more likely to be Black (24.6% vs 14.8%, \u003cem\u003ep\u003c/em\u003e=0.004), have lower levels of education (advanced degree completion (6.2% vs 66%, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), report disability for employment (18.5% vs 6.7%, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), and more likely to have pancreatic cancer (20.7% vs 15.8%, \u003cem\u003ep\u003c/em\u003e=0.029) (Table 1). Conversely, there was no association between pain and age, sex, ethnicity, marital status, cancer stage, or treatment phase. In the unadjusted odds ratios (OR) of demographic and clinical characteristics with the presence of pain, we found no differences by age sex, or ethnicity. Older black patients (unadjusted Odds Ratio [OR] =1.9, 95% CI 1.3-2.8, reference White) and older patients with pancreatic (unadjusted OR=1.8, 95% CI 1.1-2.8, and colorectal cancer (unadjusted [OR] = 1.80, 95% CI 1.15-2.83 were more likely to experience moderate to severe pain. (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable border=\"1\" id=\"Tab1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eUnadjusted Odds Ratios of demographics and clinical variables to pain\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDemographics \u0026amp; clinical variables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUnadjusted OR\u003c/p\u003e\n \u003cp\u003e(95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e60-64\u003c/p\u003e\n \u003cp\u003e65-69\u003c/p\u003e\n \u003cp\u003e70-74\u003c/p\u003e\n \u003cp\u003e75-74\u003c/p\u003e\n \u003cp\u003e80+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eREF\u003c/p\u003e\n \u003cp\u003e0.90 (0.60-1.35)\u003c/p\u003e\n \u003cp\u003e0.73 (0.480-1.11)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.60 (0.37-0.97)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.85 (0.49-1.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eREF\u003c/p\u003e\n \u003cp\u003e1.02 (0.75-1.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRace\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003cp\u003eBlack\u003c/p\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eREF\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e1.89 (1.29-2.75)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1.28 (0.42-3.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthnicity, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNon-Hispanic\u003c/p\u003e\n \u003cp\u003eHispanic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eREF\u003c/p\u003e\n \u003cp\u003e1.32 (0.42-4.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation Level\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eLess than high school\u003c/p\u003e\n \u003cp\u003eHigh school graduate\u003c/p\u003e\n \u003cp\u003eSome college\u003c/p\u003e\n \u003cp\u003eAssociate/Bachelors\u003c/p\u003e\n \u003cp\u003eAdvance Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eREF\u003c/p\u003e\n \u003cp\u003e0.60 (0.36-1.00)\u003c/p\u003e\n \u003cp\u003e0.70 (0.41-1.20)\u003c/p\u003e\n \u003cp\u003e0.32 (0.19-0.53)\u003c/p\u003e\n \u003cp\u003e0.19 (0.10-0.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003cp\u003eSeparated/Divorced\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eREF\u003c/p\u003e\n \u003cp\u003e0.92 (0.47-1.81)\u003c/p\u003e\n \u003cp\u003e0.69 (0.36-1.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmployment\u003c/p\u003e\n \u003cp\u003eFull-time (\u0026gt;32hr/wk)\u003c/p\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003cp\u003eDisabled\u003c/p\u003e\n \u003cp\u003ePart-time (\u0026lt;32hr/wk)\u003c/p\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eREF\u003c/p\u003e\n \u003cp\u003e2.11 (1.28- 3.49)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e6.25 (3.26- 11.98)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1.04 (0.37- 2.95)\u003c/p\u003e\n \u003cp\u003e3.17 (1.70- 5.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCancer Type\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eColorectal\u003c/p\u003e\n \u003cp\u003ePancreatic\u003c/p\u003e\n \u003cp\u003eHepatobiliary\u003c/p\u003e\n \u003cp\u003eGastroesophageal\u003c/p\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eREF\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e1.80 (1.15-2.83)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1.64 (0.97-2.75)\u003c/p\u003e\n \u003cp\u003e0.87 (0.44-1.72)\u003c/p\u003e\n \u003cp\u003e1.56 (1.07-2.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCancer Stage\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eI/II\u003c/p\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003cp\u003eIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eREF\u003c/p\u003e\n \u003cp\u003e1.14 (0.76-1.71)\u003c/p\u003e\n \u003cp\u003e1.19 (0.83-1.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment Phase\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePre-treatment\u003c/p\u003e\n \u003cp\u003eDuring-treatment\u003c/p\u003e\n \u003cp\u003ePost-treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eREF\u003c/p\u003e\n \u003cp\u003e0.92 (0.61-1.38)\u003c/p\u003e\n \u003cp\u003e0.60 (0.38-0.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec11\"\u003e\n \u003ch2\u003eAssociation of pain with functional status limitations, mental health, and other geriatric assessment impairments\u003c/h2\u003e\n \u003cp\u003ePain was associated with all GA impairments included in this study (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Participants with moderate to severe pain were more likely to report IADL dependence (70.6% vs 33.3%; \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), ADL dependence (25.2% vs 8.6%; \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), falls (30.1% vs 15.1%; \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), and limitations in walking one block (72.0% vs 31.1%; \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001). They were also more likely to have impaired self-reported ECOG performance status (48.5% vs 13.8%; \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), take \u0026ge; 9 medications per day (33.3% vs 15.6%; \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), report \u0026ge;3 comorbidities (59.2% vs 42.7%; \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), and have malnutrition (46.9% vs 36.3%; \u003cem\u003ep\u003c/em\u003e=0.004). Those with moderate to severe pain reported more cognitive complaints (10.0% vs 3.0%; \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), limitations in social activities (42.7% vs 16.3%; \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), anxiety (24.6% vs 12.4%; \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), and depression (19.7% vs 5.7%; \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable border=\"1\" id=\"Tab2\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eGeriatric assessment impairments in those with and without moderate/severe pain.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOverall\u003c/p\u003e\n \u003cp\u003e(n=714)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNone / Mild pain\u003c/p\u003e\n \u003cp\u003e(n=405)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eModerate / Severe pain\u003c/p\u003e\n \u003cp\u003e(n=309)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep*\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eGeriatric Assessment Domain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAny IADL dependence\u003c/strong\u003e, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e353, (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e135, (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e218, (70.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAny ADL dependence\u003c/strong\u003e, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e113, (16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35, (8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78, (25.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFalls\u003c/strong\u003e (\u0026ge;1), n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e154, (21.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61, (15.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93, (30.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eReported limitations in walking on block\u003c/strong\u003e, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e348, (49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e126, (31.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e222, (72.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eImpaired ecog\u003c/strong\u003e ps (\u0026ge;2), n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e206, (29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56, (13.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e150, (48.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedications\u003c/strong\u003e (\u0026ge;9 daily), n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e166, (23.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63, (15.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e103, (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e (\u0026ge;3), n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e356, (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e173, (42.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e183, (59.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMalnutrition\u003c/strong\u003e, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e292, (41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e147, (36.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e145, (46.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCognitive complaints\u003c/strong\u003e (mod/sev.), n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43, (6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12, (3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31, (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLimitations in social activities\u003c/strong\u003e, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e198, (28.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66, (16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e132, (42.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety\u003c/strong\u003e (mod/sev.), n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e126, (18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50, (12.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76, (24.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression\u003c/strong\u003e (mod/sev.), n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e84, (12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23, (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61, (19.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e*\u003cem\u003ep\u003c/em\u003e-value from the bivariate comparison of those with moderate/severe versus none/mild pain\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eLogistic regression analyses adjusting for demographic and cancer-related variables showed an association between moderate to severe pain and IADL dependence (adjusted Odds Ratio [aOR]=4.3, 95% CI 3.0-6.1, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), ADL dependence (aOR=3.2, 95% CI 2.0-5.1, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), falls (aOR=2.4, 95% CI 1.6-3.6, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), cognitive complaints (aOR=2.9, 95% CI 1.4-6.0, \u003cem\u003ep\u003c/em\u003e=0.004), anxiety (aOR=2.2, 95% CI 1.4-3.4, \u003cem\u003ep\u003c/em\u003e=0.004), and depression (aOR=3.7, 95% CI 2.2-6.5, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001) .(Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable border=\"1\" id=\"Tab3\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMultivariable model of associations of moderate/severe pain with impairments in instrumental activities of daily living and activities of daily living, falls, and psycho-neurological disorders.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUnadjusted OR\u003c/p\u003e\n \u003cp\u003e(95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAdjusted OR\u003c/p\u003e\n \u003cp\u003e(95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep*\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eIADL dependence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.79 (3.48-6.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.28 (3.01- 6.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eADL dependence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.57 (2.32-5.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.15 (1.96-5.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFalls\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.43 (1.67-3.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.41 (1.61-3.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCognition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.65 (1.84-7.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.91 (1.41-6.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.32 (1.56-3.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.18 (1.42-3.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.09 (2.46-6.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.74 (2.16-6.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eAbbreviations: IADL, Instrumental Activities of Daily Living; ADL, Activities of Daily Living; OR (Odds Ratio).\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e*\u003cem\u003ep\u003c/em\u003e-values for individual regression models adjusted for age, sex, race, ethnicity, education level, marital status, employment, cancer type, cancer stage, and treatment phase\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study found that 43% of older adults with primarily gastrointestinal malignancies report moderate to severe pain, and the presence of moderate-severe pain is associated with functional status limitations, cognitive complaints, anxiety, and depression. the prevalence of pain among older adults and the association of pain with Regression models found IADL dependence, ADL dependence, falls, cognitive complaints, anxiety, and depression were associated with pain after adjusting for demographic and cancer-related clinical factors.\u003c/p\u003e \u003cp\u003eThe prevalence of moderate to severe pain in our study population was 43%, which is consistent with previous findings. Notably, a 2016 meta-analysis examined 122 studies published between 2005-2014, on the prevalence of pain in patients of all ages with cancer and found that overall, 38% of participants reported moderate to severe pain [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Similarly, a 2007 meta-analysis including 52 studies looked at pain prevalence grouped by cancer stage and type and found overall rates of moderate to severe pain reported in 31%- 45% of participants [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile previous literature has found that female patients with cancer report higher levels of pain compared to male cancer patients, our analyses did not find any differences in pain by sex [32 34]. These inconsistencies may be explained by discrepancies in proportions of cancer type between study populations. For instance, previous studies have found that patients with breast cancer are more likely to report pain than patients with other cancer types [33 34]. Importantly, studies which found that females report more pain also had large proportions of patients with breast cancer in their study. In contrast, patients with breast cancer were not included in our study population, which could explain the inconsistency of this finding [32 34].\u003c/p\u003e \u003cp\u003eOur study found that respondents aged 75-79 were less likely to report moderate to severe pain compared to patients between 60-64 years. No other differences were found between age categories. These results are not surprising as previous research on age and cancer pain has produced inconsistent findings [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Also congruent with previous literature, our study found that patients on disability reported significantly more pain than those working full-time [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. It is important to note that the measurement of pain in our study does not specify pain related to cancer. Consequently, when considering the relationship between pain and functional impartments in patients with cancer, it is unclear whether cancer-related pain increases the likelihood of being functionally impaired, or if people with functional impairments simply tend to report greater pain in general.\u003c/p\u003e \u003cp\u003eBlack participants were significantly more likely to report moderate to severe pain compared to White participants. Previous research suggests several possible explanations for this discrepancy including that Black patients are less likely to be prescribed pain relieving medication and that pain medication adherence is poorer among Black patients [36 37]. Black patients also may have an increased difficulty in obtaining pain medications given pharmacies in many predominantly Black neighborhoods often inadequately stock opioids as well as potential financial barriers in obtaining pain medications[38 39]. These findings highlight the need to ensure that Black patients with cancer are thoroughly assessed for pain and provided assistance in accessing pain medications if a pain prescription is warranted.\u003c/p\u003e \u003cp\u003eBivariate and multivariate analyses revealed significant association between IADL and ADL dependence and moderate to severe pain. While there is a robust literature examining pain and IADL dependence in non-cancer populations, limited research has evaluated the relationship between the presence of pain and IADL/ADLs dependence in older adults with cancer [\u003cspan additionalcitationids=\"CR41\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Patients in our cohort with moderate to severe pain experienced more cognitive complaints and anxiety.\u003c/p\u003e \u003cp\u003eOur study is not without limitations. Perhaps most importantly, we employed a cross-sectional study design and therefore we cannot establish causality between pain and outcome variables. Participants were recruited from a single center. This solitary source of collection exists in primarily underserved areas in Alabama, which is located in the \u0026ldquo;Deep South\u0026rdquo; region of the Southeastern United States (a historically underserved and disadvantaged region). Therefore, the results of this study may not be generalizable to other populations. Our study did not account for pain medications, or other analgesics, prescriptions or administration among participants, which could have theoretically impacted the levels of pain perceived by study subjects. Furthermore, while we did control for treatment phase with regard to chemotherapy in our regression model, we did not include consideration of patients who received surgical vs non-surgical treatments.\u003c/p\u003e \u003cp\u003eModerate to severe pain was frequently reported in our study population. Pain was more frequently reported in patients who were Black, had lower levels of education, had pancreatic cancer, and were on disability. Additionally, moderate to severe pain was associated with several important GA impairments that are known predictors of adverse outcomes. Notably, our findings suggest that pain is associated with IADL and ADL dependence in older adults with malignancies. Given functional independence is a recognized priority of older adults, these results highlight the potential importance of screening for and managing pain in older patients with cancer [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Future longitudinal research is necessary to better understand the relationship between pain and GA impairments with a specific focus on the source(s) of pain and the impact of pain management.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: Supported in part by the National Institutes of Health (K08CA234225 \u0026ndash; GW). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest statement:\u0026nbsp;\u003c/strong\u003eThe authors have no conflicts to disclose relevant to the content of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e: All data is available per written individual request to University of Alabama at Birmingham (UAB). Code availability: Any software programming code is available per written individual request to UAB.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode availability\u003c/strong\u003e: Any software programming code is available per written individual request to University of Alabama at Birmingham (UAB).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e: All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [Grant R. Williams], [Mustafa AL-Obaidi], and [Sarah Kosmicki], and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e: Ethical considerations were presented to and approved by the UAB IRB per review. Study subjects were determined to be exposed to minimal risk.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e: All enrolled participants have been consented by IRB-approved study personnel, according to UAB IRB rules and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eAll authors reviewed and agreed to submission with an intent for publication.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSmith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA (2009) Future of cancer incidence in the United States: burdens upon an aging, changing nation. 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N Engl J Med 346(14):1061\u0026ndash;1066 : 10.1056/NEJMsa012528[published Online First: Epub Date]|\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"pain, cancer, aging, geriatric assessment, geriatric oncology, mental health, functional status, depression, anxiety","lastPublishedDoi":"10.21203/rs.3.rs-1307446/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1307446/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e The impact of pain on functional status and mental health among older adults with cancer is a relevant, yet understudied. We sought to identify the prevalence of pain at diagnosis in older adults with cancer and evaluate the association of pain with functional status limitations, cognition, and mental health. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis study included older adults (age ≥60) with cancer enrolled in the CARE Registry. Pain measured in numeric rating scale from 0-10. We utilized the literature based cut off for moderate-severe as ≥4. Logistic regression used to assess differences in functional status, falls, cognitive complaints, and depression/anxiety associated with moderate/severe pain, adjusted for sex, race, education, ethnicity, marital status, cancer type/stage, and treatment phase. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u0026nbsp;Our cohort included 714 older adults with an average mean age of 70 years and 59% male. Common diagnoses included colorectal (27.9%) and pancreatic (18%). 43.3% reported moderate/severe pain. After multivariate adjusting for covariates, participants with self-reported moderate/severe pain were more likely to report limitations in instrumental activities of daily living (adjusted Odds Ratio [aOR] 4.3 95% confidence interval [CI] 3.1-6.1, \u003cem\u003ep\u003c/em\u003e\u0026lt;.001), limitation in activities of daily living (aOR 3.2 95% CI 2.0-5.1,\u0026nbsp;\u003cem\u003ep\u003c/em\u003e\u0026lt;.001), cognitive complaints (aOR 2.9 95% CI 1.4-6.0, \u003cem\u003ep\u003c/em\u003e\u0026lt;.004), anxiety (aOR 2.2 95% CI 1.4-3.4, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.01), and depression (aOR 3.7 95% CI 2.2-6.5, \u003cem\u003ep\u003c/em\u003e\u0026lt;.001).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Pain is common amongst older adults with cancer and is associated with functional status limitations, cognitive complaints, and depression/anxiety. Strategies to reduce pain and minimize its potential impact on function and mental health warrant future research.\u003c/p\u003e","manuscriptTitle":"Pain among Older Adults with Cancer - Results from the Cancer and Aging Resilience Evaluation (CARE) Registry","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-04-13 18:35:59","doi":"10.21203/rs.3.rs-1307446/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2022-04-11T14:25:25+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-04-11T14:17:15+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"Supportive Care in Cancer","date":"2022-02-26T21:27:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-01-31T09:57:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2022-01-28T13:09:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"a6c1a8f7-388a-4cb9-9362-d10b1567cc3f","owner":[],"postedDate":"April 13th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2022-08-02T19:06:35+00:00","versionOfRecord":[],"versionCreatedAt":"2022-04-13 18:35:59","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1307446","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1307446","identity":"rs-1307446","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}