Pain and cancer survival: a cognitive-affective model of symptom appraisal and the uncertain threat of disease recurrence
Forty years ago, three quarters of adults and children diagnosed with cancer died. Today, almost half of adults77 and three quarters of children survive.17,70 Survival, however, is rarely psychologically simple. Life after cancer can be characterised by an altered relationship with bodily perception: in particular an anxious uncertainty about the meaning of new or recurrent sensations such as pain.87 Cancer survival is an altered context in which pain can make one fear the worst.25 To date, research on the experience of pain in cancer survival has existed largely within a biological frame. That is, pain is studied as the result of tissue damage from the cancer itself or from surgery, chemotherapy, or radiotherapy.13,43 Yet, if there is one inescapable fact of pain science it is that tissue damage cannot alone explain pain and pain-related behaviour. In this review, we discuss the threat associated with pain in cancer survival specifically how one manages the inherent uncertainty of pain as a potential symptom of cancer recurrence. We recognise that the word “survivor” is contentious82; and here, we principally use “survival” to identify the post-treatment disease-free stage that individuals experience. We introduce a cognitive-affective model of pain appraisal and experience applied to a survival context, stressing both the clinical and research opportunities it provides.