Predictors of Response to an Evidence-Based Behavioral Cancer Pain Management Intervention: An Exploratory Analysis From a Clinical Trial



      Interventions that teach patients cognitive and behavioral strategies for managing cancer pain have demonstrated effectiveness. Systematic reviews of such interventions call for research to inform their implementation in practice, including investigations into which patients are most likely to benefit.


      We aimed to identify predictors of response to an evidence-based behavioral intervention for cancer pain, pain coping skills training (PCST).


      We conducted an exploratory secondary analysis of a randomized noninferiority trial comparing in-person to videoconference-based PCST. Using modified Poisson regression, we estimated the adjusted associations of patient characteristics with clinically meaningful reductions (≥30%) in pain severity and pain interference.


      Of the 178 patients who were randomized, 135 completed at least one follow-up assessment and were included in this analysis. Proportions of patients experiencing reductions in pain severity and pain interference were 34% and 46%, respectively. In multivariable analysis, education level was associated with a reduction in pain severity (adjusted relative risk, some college or technical school vs. college or higher: 0.49, 95% CI: 0.26-0.93). Patients with colorectal cancer were 61% more likely to experience a reduction in pain interference than patients with breast cancer (95% CI:1.21-2.34). Marital status was also statistically significantly associated with pain interference reduction, with married patients less likely to experience a reduction in pain interference (adjusted relative risk, married vs. not: 0.69, 95% CI: 0.49-0.98).


      Our findings elucidate several subgroups of patients who may be especially likely to benefit from PCST, informing both targeted implementation efforts and opportunities to improve delivery for diverse patients.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pain and Symptom Management
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Shi Q.
        • Smith T.G.
        • Michonski J.D.
        • Stein K.D.
        • Kaw C.
        • Cleeland C.S.
        Symptom burden in cancer survivors 1 year after diagnosis: a report from the American Cancer Society's Studies of Cancer Survivors.
        Cancer. 2011; 117: 2779-2790
        • Wells N.
        • Murphy B.
        • Wujcik D.
        • Johnson R.
        Pain-related distress and interference with daily life of ambulatory patients with cancer with pain.
        Oncol Nurs Forum. 2003; 30: 977-986
        • van den Beuken-van Everdingen M.H.
        • Hochstenbach L.M.
        • Joosten E.A.
        • Tjan-Heijnen V.C.
        • Janssen D.J.
        Update on prevalence of pain in patients with cancer: systematic review and meta-analysis.
        J Pain Symptom Manage. 2016; 51: 1070-1090.e1079
        • Katz N.
        The impact of pain management on quality of life.
        J Pain Symptom Manage. 2002; 24: S38-S47
        • Syrjala K.L.
        • Jensen M.P.
        • Mendoza M.E.
        • Yi J.C.
        • Fisher H.M.
        • Keefe F.J.
        Psychological and behavioral approaches to cancer pain management.
        J Clin Oncol. 2014; 32: 1703-1711
        • Sheinfeld Gorin S.
        • Krebs P.
        • Badr H.
        • et al.
        Meta-analysis of psychosocial interventions to reduce pain in patients with cancer.
        J Clin Oncol. 2012; 30: 539-547
        • Keefe F.J.
        • Abernethy A.P.
        • L C.C.
        Psychological approaches to understanding and treating disease-related pain.
        Annu Rev Psychol. 2005; 56: 601-630
        • Williams A.C.
        • Eccleston C.
        • Morley S.
        Psychological therapies for the management of chronic pain (excluding headache) in adults.
        Cochrane Database Syst Rev. 2012; 11: CD007407
        • Broderick J.E.
        • Keefe F.J.
        • Schneider S.
        • et al.
        Cognitive behavioral therapy for chronic pain is effective, but for whom?.
        Pain. 2016; 157: 2115-2123
        • Kwekkeboom K.L.
        • Kneip J.
        • Pearson L.
        A pilot study to predict success with guided imagery for cancer pain.
        Pain Manag Nurs. 2003; 4: 112-123
        • Kwekkeboom K.L.
        • Wanta B.
        • Bumpus M.
        Individual difference variables and the effects of progressive muscle relaxation and analgesic imagery interventions on cancer pain.
        J Pain Symptom Manage. 2008; 36: 604-615
        • Sikorskii A.
        • Given C.W.
        • You M.
        • Jeon S.
        • Given B.A.
        Response analysis for multiple symptoms revealed differences between arms of a symptom management trial.
        J Clin Epidemiol. 2009; 62: 716-724
        • Miaskowski C.
        • Dodd M.
        • West C.
        • et al.
        The use of a responder analysis to identify differences in patient outcomes following a self-care intervention to improve cancer pain management.
        Pain. 2007; 129: 55-63
        • Johannsen M.
        • O'Toole M.S.
        • O'Connor M.
        • Jensen A.B.
        • Zachariae R.
        Clinical and psychological moderators of the effect of mindfulness-based cognitive therapy on persistent pain in women treated for primary breast cancer - explorative analyses from a randomized controlled trial.
        Acta Oncol. 2017; 56: 321-328
        • Kelleher S.A.
        • Winger J.G.
        • Dorfman C.S.
        • et al.
        A behavioral cancer pain intervention: a randomized noninferiority trial comparing in-person with videoconference delivery.
        Psychooncology. 2019; 28: 1671-1678
        • Dobkin R.D.
        • Rubino J.T.
        • Allen L.A.
        • et al.
        Predictors of treatment response to cognitive-behavioral therapy for depression in Parkinson's disease.
        J Consult Clin Psychol. 2012; 80: 694-699
        • Troxel W.M.
        • Conrad T.S.
        • Germain A.
        • Buysse D.J.
        Predictors of treatment response to brief behavioral treatment of insomnia (BBTI) in older adults.
        J Clin Sleep Med. 2013; 9: 1281-1289
        • Wessels H.
        • Wagner M.
        • Kuhr K.
        • et al.
        Predictors of treatment response to psychological interventions in people at clinical high risk of first-episode psychosis.
        Early Interv Psychiatry. 2019; 13: 120-127
        • Cleeland C.S.
        • Ryan K.M.
        Pain assessment: global use of the brief pain Inventory.
        Ann Acad Med Singapore. 1994; 23: 129-138
        • Farrar J.T.
        What is clinically meaningful: outcome measures in pain clinical trials.
        Clin J Pain. 2000; 16: S106-S112
        • Farrar J.T.
        • Portenoy R.K.
        • Berlin J.A.
        • Kinman J.L.
        • Strom B.L.
        Defining the clinically important difference in pain outcome measures.
        Pain. 2000; 88: 287-294
        • Farrar J.T.
        • Pritchett Y.L.
        • Robinson M.
        • Prakash A.
        • Chappell A.
        The clinical importance of changes in the 0 to 10 numeric rating scale for worst, least, and average pain intensity: analyses of data from clinical trials of duloxetine in pain disorders.
        J Pain. 2010; 11: 109-118
        • McQuay H.J.
        • Barden J.
        • Moore R.A.
        Clinically important changes-what's important and whose change is it anyway?.
        J Pain Symptom Manage. 2003; 25: 395-396
        • Anderson K.O.
        • Dowds B.N.
        • Pelletz R.E.
        • Edwards W.T.
        • Peeters-Asdourian C.
        Development and initial validation of a scale to measure self-efficacy beliefs in patients with chronic pain.
        Pain. 1995; 63: 77-84
        • Zou G.
        A modified Poisson regression approach to prospective studies with binary data.
        Am J Epidemiol. 2004; 159: 702-706
        • Farrar J.T.
        • Young Jr., J.P.
        • LaMoreaux L.
        • Werth J.L.
        • Poole R.M.
        Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale.
        Pain. 2001; 94: 149-158
        • Mosher C.E.
        • Winger J.G.
        • Given B.A.
        • Helft P.R.
        • O'Neil B.H.
        Mental health outcomes during colorectal cancer survivorship: a review of the literature.
        Psychooncology. 2016; 25: 1261-1270
        • Mosher C.E.
        • Winger J.G.
        • Given B.A.
        • Shahda S.
        • Helft P.R.
        A systematic review of psychosocial interventions for colorectal cancer patients.
        Support Care Cancer. 2017; 25: 2349-2362
        • Dorfman C.S.
        • Kelleher S.A.
        • Winger J.G.
        • et al.
        Development and pilot testing of an mHealth behavioral cancer pain protocol for medically underserved communities.
        J Psychosoc Oncol. 2019; 37: 335-349
        • Jones K.F.
        • Fu M.R.
        • Merlin J.
        • et al.
        Exploring factors associated with long-term opioid therapy in cancer survivors:an integrative review.
        J Pain Symptom Manage. 2021; 61: 395-415
        • Miaskowski C.
        • Penko J.M.
        • Guzman D.
        • Mattson J.E.
        • Bangsberg D.R.
        • Kushel M.B.
        Occurrence and characteristics of chronic pain in a community-based cohort of indigent adults living with HIV infection.
        J Pain. 2011; 12: 1004-1016
        • Serota D.P.
        • Capozzi C.
        • Lodi S.
        • et al.
        Predictors of pain-related functional impairment among people living with HIV on long-term opioid therapy.
        AIDS Care. 2020; : 1-9
        • Fournier J.C.
        • DeRubeis R.J.
        • Shelton R.C.
        • Hollon S.D.
        • Amsterdam J.D.
        • Gallop R.
        Prediction of response to medication and cognitive therapy in the treatment of moderate to severe depression.
        J Consult Clin Psychol. 2009; 77: 775-787
        • Button K.S.
        • Wiles N.J.
        • Lewis G.
        • Peters T.J.
        • Kessler D.
        Factors associated with differential response to online cognitive behavioural therapy.
        Soc Psychiatry Psychiatr Epidemiol. 2012; 47: 827-833