Relationship between pain and depressive symptoms in middle-aged and elderly lung cancer patients undergoing chemotherapy_West China Medical Journal

Authors：

WANG Ying ¹ , ZHANG Yuejuan ² , WU Xuejuan ² ,  QU Jufen ²

1. Department of Infection Management, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P. R. China;
2. Department of Thoracic Surgery, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P. R. China;

Corresponding?author：

QU Jufen, Email: quf-123@163.com

Keywords：

Lung cancer; depression; pain; activities of daily living; chain mediation

DOI：

10.7507/1002-0179.202506188

Video：

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Objective To explore the mediating role of activities of daily living and sleep duration in the relationship between pain and depressive symptoms in lung cancer patients undergoing chemotherapy, and to provide suggestions for improving the well-being of cancer patients. Methods Using convenience sampling, middle-aged and elderly lung cancer patients receiving postoperative chemotherapy at the First Affiliated Hospital of Soochow University were selected as the study subjects between January and December 2024. Data were collected using a general information questionnaire, the Numerical Pain Rating Scale, the Center for Epidemiological Studies Depression Scale, and the activities of daily living Scale. Results A total of 252 patients were included. The depression score of lung cancer chemotherapy patients was (20.05±15.73) scores. Pain was positively correlated with activities of daily living and depression (P<0.001) and negatively correlated with sleep duration (P<0.001). The mediating effects of activities of daily living and sleep duration between pain and depression were significant, with simple mediating effects of 0.252 [95%CI (0.044, 0.494)] and 0.127 [95%CI (0.010, 0.281)], respectively. The chain mediating effect was 0.039 [95%CI (0.002, 0.105)]. The total mediating effect value was 0.418, accounting for 33.2% of the total effect. Conclusions The incidence of depression is high among middle-aged and elderly lung cancer patients undergoing chemotherapy. Activities of daily living and sleep duration play a chain mediating role between pain and depression. The mental health of lung cancer chemotherapy patients should be emphasized at different levels. Multi-faceted psychological interventions and emotional support should be implemented to effectively improve their depressive symptoms and enhance their well-being.

Citation： WANG Ying, ZHANG Yuejuan, WU Xuejuan, QU Jufen. Relationship between pain and depressive symptoms in middle-aged and elderly lung cancer patients undergoing chemotherapy. West China Medical Journal, 2026, 41(4): 569-574. doi: 10.7507/1002-0179.202506188 Copy

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2.	Wilson BE, Jacob S, Yap ML, et al. Estimates of global chemotherapy demands and corresponding physician workforce requirements for 2018 and 2040: a population-based study. Lancet Oncol, 2019, 20(6): 769-780.
3.	Zhang J, He Q, Mao D, et al. Efficacy and adverse reaction management of oncolytic viral intervention combined with chemotherapy in patients with liver metastasis of gastrointestinal malignancy. Front Oncol, 2023, 13: 1159802.
4.	Earle CC, Neville BA, Fletcher R. Mental health service utilization among long-term cancer survivors. J Cancer Surviv, 2007, 1(2): 156-160.
5.	DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med, 2000, 160(14): 2101-2107.
6.	Reiche EM, Morimoto HK, Nunes SM. Stress and depression-induced immune dysfunction: implications for the development and progression of cancer. Int Rev Psychiatry, 2005, 17(6): 515-527.
7.	Wang X, Wang N, Zhong L, et al. Prognostic value of depression and anxiety on breast cancer recurrence and mortality: a systematic review and meta-analysis of 282, 203 patients. Mol Psychiatry, 2020, 25(12): 3186-3197.
8.	Printz C. Anxiety and depression may contribute to an increased risk of death in some cancers. Cancer, 2017, 123(13): 2389.
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10.	Muhammad T, Rashid M, Zanwar PP, et al. Examining the association of pain and pain frequency with self-reported difficulty in activities of daily living and instrumental activities of daily living among community-dwelling older adults: findings from the longitudinal aging study in India. J Gerontol B Psychol Sci Soc Sci, 2023, 78(9): 1545-1554.
11.	劉彥旭, 羅莉, 付國琪, 等. 我國老年慢性病患者疼痛與睡眠的關系及日常活動能力和生活滿意度的中介作用研究. 現代預防醫學, 2025, 52(4): 703-708.
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13.	薛純純, 謝磊, 沙中瑋, 等. 神經病理性疼痛與睡眠障礙. 中國疼痛醫學雜志, 2020, 26(7): 522-525.
14.	Lin CY, Lai TF, Huang WC, et al. Sleep duration and timing are nonlinearly associated with depressive symptoms among older adults. Sleep Med, 2021, 81: 93-97.
15.	Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas, 1977, 1(3): 385-401.
16.	Yen S, Robins CJ, Lin N. A cross-cultural comparison of depressive symptom manifestation: China and the United States. J Consult Clin Psychol, 2000, 68(6): 993-999.
17.	Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum Associates, 1988.
18.	周曉燕, 魏申奧, 盧曼曼. 基于 Lasso-logistic 回歸和隨機森林模型的癌癥患者抑郁影響因素分析. 安徽醫學, 2024, 45(9): 1177-1182.
19.	劉曉菲, 張靜. 化療期癌癥病人抑郁狀況及影響因素分析. 護理研究, 2014, 28(9): 1059-1061.
20.	田英漢, 劉樂偉, 楊鋮, 等. 城市老年人抑郁與認知功能的相關性及性別差異研究. 中國全科醫學, 2025, 28(1): 47-52.
21.	王瑞琪, 趙慶華, 黃歡歡, 等. 我國 28 個省份老年人疼痛與抑郁癥狀現狀及相關性研究. 中華護理教育, 2023, 20(1): 103-108.
22.	Rogers AH, Farris SG. A meta-analysis of the associations of elements of the fear-avoidance model of chronic pain with negative affect, depression, anxiety, pain-related disability and pain intensity. Eur J Pain, 2022, 26(8): 1611-1635.
23.	Landi F, Russo A, Liperoti R, et al. Daily pain and functional decline among old-old adults living in the community: results from the ilSIRENTE Study. J Pain Symptom Manage, 2009, 38(3): 350-357.
24.	Bierman A, Statland D. Timing, social support, and the effects of physical limitations on psychological distress in late life. J Gerontol B Psychol Sci Soc Sci, 2010, 65(5): 631-639.
25.	Yang Y. How does functional disability affect depressive symptoms in late life? The role of perceived social support and psychological resources. J Health Soc Behav, 2006, 47(4): 355-372.
26.	申莉, 賈光耀, 李佳遇, 等. 基于中國健康與養老追蹤調查的老年人疼痛、睡眠與抑郁關系研究. 中國預防醫學雜志, 2023, 24(2): 156-160.
27.	Maglione JE, Ancoli-Israel S, Peters KW, et al. Depressive symptoms and subjective and objective sleep in community-dwelling older women. J Am Geriatr Soc, 2012, 60(4): 635-643.
28.	張彧, 姚崢嶸, 張麗. 老年人日常活動能力與睡眠質量及其交互作用對認知功能的影響. 現代預防醫學, 2021, 48(20): 3779-3782, 3787.
29.	廖黎敏, 林璠, 劉火妹. 基于生物-心理-社會功能全方位干預模式對肺癌術后患者疼痛、生活質量及預后的影響. 吉林醫學, 2025, 46(3): 744-747.

1. Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022. J Natl Cancer Cent, 2024, 4(1): 47-53.
2. Wilson BE, Jacob S, Yap ML, et al. Estimates of global chemotherapy demands and corresponding physician workforce requirements for 2018 and 2040: a population-based study. Lancet Oncol, 2019, 20(6): 769-780.
3. Zhang J, He Q, Mao D, et al. Efficacy and adverse reaction management of oncolytic viral intervention combined with chemotherapy in patients with liver metastasis of gastrointestinal malignancy. Front Oncol, 2023, 13: 1159802.
4. Earle CC, Neville BA, Fletcher R. Mental health service utilization among long-term cancer survivors. J Cancer Surviv, 2007, 1(2): 156-160.
5. DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med, 2000, 160(14): 2101-2107.
6. Reiche EM, Morimoto HK, Nunes SM. Stress and depression-induced immune dysfunction: implications for the development and progression of cancer. Int Rev Psychiatry, 2005, 17(6): 515-527.
7. Wang X, Wang N, Zhong L, et al. Prognostic value of depression and anxiety on breast cancer recurrence and mortality: a systematic review and meta-analysis of 282, 203 patients. Mol Psychiatry, 2020, 25(12): 3186-3197.
8. Printz C. Anxiety and depression may contribute to an increased risk of death in some cancers. Cancer, 2017, 123(13): 2389.
9. Turk DC, Fillingim RB, Ohrbach R, et al. Assessment of psychosocial and functional impact of chronic pain. J Pain, 2016, 17(Suppl 9): T21-T49.
10. Muhammad T, Rashid M, Zanwar PP, et al. Examining the association of pain and pain frequency with self-reported difficulty in activities of daily living and instrumental activities of daily living among community-dwelling older adults: findings from the longitudinal aging study in India. J Gerontol B Psychol Sci Soc Sci, 2023, 78(9): 1545-1554.
11. 劉彥旭, 羅莉, 付國琪, 等. 我國老年慢性病患者疼痛與睡眠的關系及日常活動能力和生活滿意度的中介作用研究. 現代預防醫學, 2025, 52(4): 703-708.
12. Xie LQ, Yang BX, Liao YH, et al. Sleep disturbance in older adults with or without mild cognitive impairment and its associated factors residing in rural area, China. J Geriatr Psychiatry Neurol, 2021, 34(6): 632-641.
13. 薛純純, 謝磊, 沙中瑋, 等. 神經病理性疼痛與睡眠障礙. 中國疼痛醫學雜志, 2020, 26(7): 522-525.
14. Lin CY, Lai TF, Huang WC, et al. Sleep duration and timing are nonlinearly associated with depressive symptoms among older adults. Sleep Med, 2021, 81: 93-97.
15. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas, 1977, 1(3): 385-401.
16. Yen S, Robins CJ, Lin N. A cross-cultural comparison of depressive symptom manifestation: China and the United States. J Consult Clin Psychol, 2000, 68(6): 993-999.
17. Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum Associates, 1988.
18. 周曉燕, 魏申奧, 盧曼曼. 基于 Lasso-logistic 回歸和隨機森林模型的癌癥患者抑郁影響因素分析. 安徽醫學, 2024, 45(9): 1177-1182.
19. 劉曉菲, 張靜. 化療期癌癥病人抑郁狀況及影響因素分析. 護理研究, 2014, 28(9): 1059-1061.
20. 田英漢, 劉樂偉, 楊鋮, 等. 城市老年人抑郁與認知功能的相關性及性別差異研究. 中國全科醫學, 2025, 28(1): 47-52.
21. 王瑞琪, 趙慶華, 黃歡歡, 等. 我國 28 個省份老年人疼痛與抑郁癥狀現狀及相關性研究. 中華護理教育, 2023, 20(1): 103-108.
22. Rogers AH, Farris SG. A meta-analysis of the associations of elements of the fear-avoidance model of chronic pain with negative affect, depression, anxiety, pain-related disability and pain intensity. Eur J Pain, 2022, 26(8): 1611-1635.
23. Landi F, Russo A, Liperoti R, et al. Daily pain and functional decline among old-old adults living in the community: results from the ilSIRENTE Study. J Pain Symptom Manage, 2009, 38(3): 350-357.
24. Bierman A, Statland D. Timing, social support, and the effects of physical limitations on psychological distress in late life. J Gerontol B Psychol Sci Soc Sci, 2010, 65(5): 631-639.
25. Yang Y. How does functional disability affect depressive symptoms in late life? The role of perceived social support and psychological resources. J Health Soc Behav, 2006, 47(4): 355-372.
26. 申莉, 賈光耀, 李佳遇, 等. 基于中國健康與養老追蹤調查的老年人疼痛、睡眠與抑郁關系研究. 中國預防醫學雜志, 2023, 24(2): 156-160.
27. Maglione JE, Ancoli-Israel S, Peters KW, et al. Depressive symptoms and subjective and objective sleep in community-dwelling older women. J Am Geriatr Soc, 2012, 60(4): 635-643.
28. 張彧, 姚崢嶸, 張麗. 老年人日常活動能力與睡眠質量及其交互作用對認知功能的影響. 現代預防醫學, 2021, 48(20): 3779-3782, 3787.
29. 廖黎敏, 林璠, 劉火妹. 基于生物-心理-社會功能全方位干預模式對肺癌術后患者疼痛、生活質量及預后的影響. 吉林醫學, 2025, 46(3): 744-747.

West China Medical Journal

Relationship between pain and depressive symptoms in middle-aged and elderly lung cancer patients undergoing chemotherapy

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