Factors Associated with Chronic Thoracic Spine and Low Back Pain in Caregivers of Cancer Patients

Background: Caregiving for people with cancer can cause chronic back pain (CBP) in family caregivers, but little is known about the associated caregiving-related factors. The study aim was to examine relationship between pain location and the factors related to care of cancer patients by family caregivers.

Methods: A cross-sectional survey was conducted among 320 family caregivers of advanced cancer patients from 2016 to 2018 at a single-unit university hospital. CBP locations were categorized as thoracic spine and lower back, and achievement of pain improvement goals defined as pain intensity (PI) ≤ personalized pain goal (PPG). Cancer caregiving-related factors were examined using a self-report questionnaire measuring subjective psychological stresses in family caregivers: depression, anxiety, insomnia, and caregiver burden. Medical records were used to determine patients' cancer severity based on performance status and time from survey until death. Multivariate logistic regression analysis was conducted. The dependent variable was presence of thoracic spine/low back pain; the independent variables were care recipient performance status and duration from survey until death, and caregiver scores on the Hospital Anxiety and Depression ScaleDepression, Hospital Anxiety and Depression Scale-Anxiety, Pittsburgh Sleep Quality Index-J, and Zarit Caregiver Burden Interview-J.

Results: In total, 31.4% of family caregivers had chronic thoracic spine pain and 28.3% chronic lower back pain. Of these, 60.0% of those with thoracic spine pain and 46.7% of those with lower back pain achieved their pain improvement goal. Logistic regression analysis showed that depression score was associated with chronic thoracic spine pain (both PI ≤ PPGs and PI > PPGs) (P=0.001 and P=0.027) and sleep score with chronic thoracic spine pain (PI > PPGs) (P=0.018). Performance status and time from survey until death were associated with chronic lower back pain (PI > PPGs) (P=0.034 and P=0.017).

Conclusions: Our results suggest that the factors related to caregiving in cancer patients differ according to back pain location. To reduce CBP, it is important to address subjective psychological stress and physical burden with reference to back pain location.