Although racial and ethnic cancer pain disparities are well-documented, there is insufficient Asian American representation in extant literature, leading to inadequate knowledge about pain outcomes in this population. In addition, the prevalence of depression and its relationship with cancer pain in Asian American patients are poorly characterized. This study evaluated pain differences between Asian American and white patients with cancer and the role of depressive symptoms.
Methods:
Data from two randomized clinical trials investigating integrative therapies for chronic musculoskeletal cancer pain were analyzed to examine the association between race and pain interference using bivariate analyses and linear regression models. We pooled participants from both trials, which enrolled cancer patients with pain and used identical pain and depression assessments, to increase the sample size of Asian American cancer patients, a historically underrepresented population in pain and depression research.
Results:
Compared to White counterparts, Asian American patients reported greater pain interference (5.5 vs. 4.7, p = 0.016) and depressive symptoms (7.1 vs. 5.9, p = 0.047). The Asian race was associated with pain interference (coef. = 0.83, 95% CI: 0.1 to 1.5, p = 0.016) in bivariate analysis. When depressive symptoms were added to regression models, Asian race was no longer associated with pain interference (coef. = 0.51, 95% CI: −0.09 to 1.1, p = 0.097).
Conclusions:
Higher pain interference levels among Asian Americans were partly driven by greater depression severity. These findings highlight the mental health burden among the Asian American cancer population and suggest that treatment for depressive symptoms may need to be incorporated in oncology care and pain management for this population. Importantly, results suggest Asian Americans affected by cancer may be at increased risk for poorly managed pain and depressive symptoms.
SnijdersRAH, BromL, TheunissenM, et al.Update on prevalence of pain in patients with cancer 2022: A systematic literature review and meta-analysis. Cancers (Basel), 2023; 15(3):591; doi: 10.3390/cancers15030591
2.
van den Beuken-van EverdingenMH, HochstenbachLM, JoostenEA, et al.Update on prevalence of pain in patients with cancer: Systematic review and meta-analysis. J Pain Symptom Manage, 2016; 51(6):1070–1090.e9; doi: 10.1016/j.jpainsymman.2015.12.340
3.
ZyllaD, SteeleG, GuptaP. A systematic review of the impact of pain on overall survival in patients with cancer. Support Care Cancer, 2017; 25(5):1687–1698; doi: 10.1007/s00520-017-3614-y
4.
EnzingerAC, GhoshK, KeatingNL, et al.US trends in opioid access among patients with poor prognosis cancer near the end-of-life. J Clin Oncol, 2021; 39(26):2948–2958; doi: 10.1200/JCO.21.00476
5.
CoyneCJ, Reyes-GibbyCC, DurhamDD, et al.Cancer pain management in the emergency department: A multicenter prospective observational trial of the Comprehensive Oncologic Emergencies Research Network (CONCERN). Support Care Cancer, 2021; 29(8):4543–4553; doi: 10.1007/s00520-021-05987-3
6.
RobertoA, GrecoMT, UggeriS, et al.Living systematic review to assess the analgesic undertreatment in cancer patients. Pain Pract, 2022; 22(4):487–496; doi: 10.1111/papr.13098
LeeRJ, MadanRA, KimJ, et al.Disparities in cancer care and the Asian American population. Oncologist, 2021; 26(6):453–460; doi: 10.1002/onco.13748
9.
FischMJ, LeeJ-W, WeissM, et al.Prospective, observational study of pain and analgesic prescribing in medical oncology outpatients with breast, colorectal, lung, or prostate cancer. J Clin Oncol, 2012; 30(16):1980–1988; doi: 10.1200/jco.2011.39.2381
10.
CleelandCS, GoninR, BaezL, et al.Pain and treatment of pain in minority patients with cancer: The Eastern cooperative oncology group minority outpatient pain study. Ann Intern Med, 1997; 127(9):813–816; doi: 10.7326/0003-4819-127-9-199711010-00006
11.
EnzingerAC, GhoshK, KeatingNL, et al.Racial and ethnic disparities in opioid access and urine drug screening among older patients with poor-prognosis cancer near the end of life. J Clin Oncol, 2023; 41(14):2511–2522; doi: 10.1200/JCO.22.01413
12.
VitzthumLK, NalawadeV, RiviereP, et al.Racial, ethnic, and socioeconomic discrepancies in opioid prescriptions among older patients with cancer. JCO Oncol Pract, 2021; 17(6):e703–e713; doi: 10.1200/OP.20.00773
13.
ChenMS, LeeRJ, MadanRA, et al.Charting a path towards Asian American cancer health equity: A way forward. J Natl Cancer Inst, 2022; 114(6):792–799; doi: 10.1093/jnci/djac055
14.
KimJHJ, LuQ, StantonAL. Overcoming constraints of the model minority stereotype to advance Asian American health. Am Psychol, 2021; 76(4):611–626; doi: 10.1037/amp0000799
15.
HoIK, LawrenceJS. The role of social cognition in medical decision making with Asian American patients. J Racial Ethn Health Disparities, 2021; 8(5):1112–1118; doi: 10.1007/s40615-020-00867-8
16.
KhoslaN, WashingtonKT, MukherjeaA, et al.Health-Care providers’ perspectives on decision-making among seriously Ill patients of South Asian origin in the United States. J Palliat Care, 2019; 34(3):181–188; doi: 10.1177/0825859719829480
17.
ShengJ, LiuS, WangY, et al.The link between depression and chronic pain: Neural mechanisms in the brain. Neural Plast, 2017; 2017:9724371–9724310; doi: 10.1155/2017/9724371
18.
Farmer TehC, ZaslavskyAM, ReynoldsCF, et al.Effect of depression treatment on chronic pain outcomes. Psychosomatic Medicine, 2010; 72(1):61–67; doi: 10.1097/psy.0b013e3181c2a7a8
19.
HartungTJ, BrahlerE, FallerH, et al.The risk of being depressed is significantly higher in cancer patients than in the general population: Prevalence and severity of depressive symptoms across major cancer types. Eur J Cancer, 2017; 72:46–53; doi: 10.1016/j.ejca.2016.11.017
20.
ColesCE, EarlH, AndersonBO, et al.; Lancet Breast Cancer Commission. The lancet breast cancer commission. Lancet, 2024; 403(10439):1895–1950; doi: 10.1016/S0140-6736(24)00747-5
21.
LairdBJA, BoydAC, ColvinLA, et al.Are cancer pain and depression interdependent? A systematic review. Psychooncology, 2009; 18(5):459–464; doi: 10.1002/pon.1431
22.
LiouKT, BaserR, RomeroSAD, et al.Personalized Electro-Acupuncture versus auricular-acupuncture Comparative Effectiveness (PEACE): A protocol of a randomized controlled trial for chronic musculoskeletal pain in cancer survivors. Medicine (Baltimore), 2020; 99(21):e20085; doi: 10.1097/md.0000000000020085
23.
RomeroSAD, EmardN, BaserRE, et al.Acupuncture versus massage for pain in patients living with advanced cancer: A protocol for the IMPACT randomised clinical trial. BMJ Open, 2022; 12(9):e058281; doi: 10.1136/bmjopen-2021-058281
24.
CleelandCS, RyanKM. Pain assessment: Global use of the brief pain inventory. Ann Acad Med Singap, 1994; 23(2):129–138.
25.
ImEO, LiuY, KimYH, CheeW. Asian American cancer patients’ pain experience. Cancer Nurs, 2008; 31(3):E17–E23; doi: 10.1097/01.Ncc.0000305730.95839.83
SternAF. The hospital anxiety and depression scale. Occup Med (Lond), 2014; 64(5):393–394; doi: 10.1093/occmed/kqu024
28.
AhnH, WeaverM, LyonD, et al.Depression and pain in Asian and white Americans with knee osteoarthritis. J Pain, 2017; 18(10):1229–1236; doi: 10.1016/j.jpain.2017.05.007
29.
EdringtonJ, SunA, WongC, et al.A pilot study of relationships among pain characteristics, mood disturbances, and acculturation in a community sample of Chinese American patients with cancer. Oncol Nurs Forum, 2010; 37(2):172–181; doi: 10.1188/10.onf.172-181
30.
LakkadM, MartinB, LiC, et al.Factors associated with guideline-concordant pharmacological treatment for neuropathic pain among breast cancer survivors. Clin Breast Cancer, 2023; 23(6):598–619; doi: 10.1016/j.clbc.2023.05.002
31.
EdringtonJ, SunA, WongC, et al.Barriers to pain management in a community sample of Chinese American patients with cancer. J Pain Symptom Manage, 2009; 37(4):665–675; doi: 10.1016/j.jpainsymman.2008.04.014
32.
AhmadF, MauleC, WangJ, et al.Symptoms and experience of depression among Chinese communities in the west: A scoping review. Harv Rev Psychiatry, 2018; 26(6):340–351; doi: 10.1097/hrp.0000000000000202
33.
ZhouX, MinS, SunJ, et al.Extending a structural model of somatization to South Koreans: Cultural values, somatization tendency, and the presentation of depressive symptoms. J Affect Disord, 2015; 176:151–154; doi: 10.1016/j.jad.2015.01.040
34.
TangL, ZhongJ, ZengM, et al.Construction and verification of a predictive model for depression risk of patients with somatization symptoms. Front Psychiatry, 2025; 16:1555513; doi: 10.3389/fpsyt.2025.1555513
35.
WooB, JunJ. COVID-19 racial discrimination and depressive symptoms among Asians Americans: Does communication about the incident matter? J Immigr Minor Health, 2022; 24(1):78–85; doi: 10.1007/s10903-021-01167-x
36.
AbramsZ. The mental health impact of anti-Asian racism. Monitor on Psychology, 2021.
37.
Abe-KimJ, TakeuchiDT, HongS, et al.Use of mental health–related services among immigrant and US-Born Asian Americans: Results from the national Latino and Asian American study. Am J Public Health, 2007; 97(1):91–98; doi: 10.2105/ajph.2006.098541
38.
LeeS, JuonH-S, MartinezG, et al.Model minority at risk: Expressed needs of mental health by Asian American young adults. J Community Health, 2009; 34(2):144–152; doi: 10.1007/s10900-008-9137-1
39.
DataAAPI. State of Asian Americans, Native Hawaiians, and pacific islanders in the United States. AAPI Data: Riverside (CA); 2022. 124 p.
40.
TsaiW, LuQ. Acculturation matters in the relation between ambivalence over emotional expressions and well-being among Chinese American breast cancer survivors. Qual Life Res, 2017; 26(10):2755–2762; doi: 10.1007/s11136-017-1618-1
