What is the experience of chronic pain in adult cancer survivors? J. Armoogum1 Prof. C. McCabe1,3 Prof. D. Harcourt1 Prof. C. Foster2 Dr. A. Llewellyn1,3 1 University of the West of England 2 The University of Southampton 3 Royal United Hospitals Bath NHS Foundation Trust Figure 1: Process of study selection Aim: To identify, review and synthesise qualitative literature surrounding the experience of chronic pain in adult cancer survivors. Method: A comprehensive literature search was conducted to locate all available studies (Figure 1). Studies were included if they explored cancer survivors’ experience of chronic pain and adopted a qualitative methodology. A systematic qualitative evidence synthesis was conducted following Thomas and Harden’s (2008)1 method of thematic synthesis of qualitative research. Results: Four main themes were identified. Figures 2-5 show themes with examples of participant quotes. Furthermore, the data indicated a temporal nature to chronic pain and cancer survivors’ experience of it. Figure 2: Pain not in isolation/related to the cancer experience In transition, not ill, not well Pain not in isolation/related to cancer experience Pain reminds of mortality Indicator of cancer status Pain = treatment working What does pain represent? ‘The pain triggers my thoughts, it makes me worried’3 ‘There is always someone worse off than yourself. There are those who do not have the chance to live’5 Now I’ve finished my treatment but am stuck in a period where I sit and think ‘am I healthy or am I not?’ It’s like something in between’3 ‘(pain) was proof that everything was… being renewed’5 Figure 3: Multimodal ways of coping/adopt variety of ways of coping Multimodal ways of coping/Adopt variety of ways of coping Social comparison Adaption Expectations of normalisation They (doctor) told me it was normal…. If I am told that’s it normal, I believe what I’m told’5 ‘There are some who are more unfortunate than me’5 ‘I have to make plans, to be careful when moving’4 Figure 5: Pain is an emotional experience Figure 4: Physical impact of pain Emotional experience Disappointment Irritation Anger/ injustice Learn to live with it ‘I have to learn how to live with the pain’4 ‘They said in a year you’ll be back to your regular everyday life, and I’m not. It’s a disappointment’3 ‘I was irritated by the pain’3 ‘Sometimes when I wake up I think ‘Will the pain be like this everyday, always, always… that’s hard to manage sometimes’3 ‘ Frustration ‘(I feel) frustrated that I can’t use the body as I wish to’3 Regret ‘When you were back to your old self you thought ‘oh God, you shouldn’t be so grumpy’3 Fears for the future Physical impact of pain Physical limitations ‘When I want to peel something, I drop it’3 ‘I can’t ride a scooter, I can’t raise my arms… I can’t lift a pack of milk, it’s too painful’5 Bodily sensation/ ever present ‘It’s a pain that doesn’t go away!...... I feel pain, it’s that simple’5 ‘An intense, shooting pain from the chest up towards the armpit’4 ‘I was so angry for a while’3 Conclusions: Chronic pain in cancer survivorship has physical and emotional consequences that are unique to this population. There is limited qualitative research into this area, and what is available is exclusively in the breast cancer population. Implications: More research is needed to understand the experience of survivors from different tumour types at various stages of survivorship. Thank you to Macmillan Cancer Support and UWE Bristol for supporting this work 1. Thomas, J. and Harden, A. (2008) Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodology. doi:10.1186/1471-2288-8-45 2. Björkman, B., Arnér, S. and Hydén, L.-C. (2008) Phantom breast and other syndromes after mastectomy: Eight breast cancer patients describe their experiences over time: A 2-year follow-up. The Journal of Pain. 9 (11) 1018–1025 3. Hellerstedt-Börjesson, S., Nordin, K., Fjällskog, M.-L., Holmström, I.K. and Arving, C. (2016) Women Treated for Breast Cancer Experiences of Chemotherapy Induced Pain Memories, Any Present Pain, and Future Reflections. 39 (6) 464-472 4. Hovind, I.L., Bredal, I.S. and Dihle, A. (2013) Women’s experience of acute and chronic pain following breast cancer surgery. Journal of Clinical Nursing 22 1044-1052 5. Peretti-Watel, P., Bendiane, M.K., Spica, L. and Rey, D. (2012) Pain narratives in breast cancer survivors. Pain Research and Treatment. 2012 153060 Date of poster preparation: 08.11.18