Quality of Life

The personal impact of cancer-related pain is far more complex than just the somatic pain experience. Chronic cancer-related pain influences every perspective of a client�s life, including the interpersonal, family, psychological, spiritual, cultural and social realms, and may affect the ability of the client to interact with other people, to rest, and to heal. Studies show clients with poorly managed cancer pain are less able to commit to fighting their disease (25). Quality of life, a subjective and unique interpretation of what makes life meaningful for clients, is therefore subject to change over time dependent on the experiences the client undergoes (26).

Fatigue

Dealing with the often grueling recommended treatments, combined with the emotional and psychological hardships that may occur as a result of the diagnosis of cancer can be very stressful for the body and the soul, and the resulting fatigue may become overwhelming (27). As a result of experiencing pain, tiredness, weakness, nausea, and/or vomiting, or enduring painful, harmful, or invasive procedures as part of the recommended treatment, cancer clients may undergo a consequential decrease in the quality of life (28). There are three subjectively different types of fatigue: typical tiredness, treatment fatigue, and shutdown fatigue (29). Treatment fatigue is due to increased use of multi-modal therapies, as well as high-dose and often multi-drug regimens, which have a depleting effect on the client�s energy reserves. Shutdown fatigue is the result of physical, mental, spiritual, and emotional exhaustion, and may be responsible for an increase in the incidence of depression and profound, persistent lack of energy in clients with cancer (30). Issues related to fatigue, although a major impediment in pain management and quality of life, are not well represented in the literature. Depression exacerbate increased levels of anxiety, nervousness, depression and sleep disturbances leading to debilitating fatigue, changes in social functioning and depression in the cancer pain client (31). If a person�s pain is ignored or not taken seriously, that person may feel like no one understands what he or she is going through, which can cause feelings of isolation, frustration, anxiety, stress, and depression (32).

Sexuality

Surprisingly, sexuality is addressed as a measurement of quality of life when discussing cancer-related pain. As a result of prolonged treatment, invasive procedures, or feelings of loss of control, adult and child survivors of cancer may have problems with self-esteem, body image, intimacy, and sexuality (33). It is important to consider that throughout the trajectory of cancer treatment, the client�s subjective and cognitive aspects of sexuality, such as intimacy, sexual desire, and subjective feelings of sexual arousal usually remain intact (34). As healthcare professionals, it is therefore important to be aware and have valid information for those clients whom may have questions or uncertainties related to sexual functioning or intimacy issues.

Family dynamics

Although the client must independently experience the somatic component of the disease, he or she is not the only one in the family to be affected by cancer-related pain. The family of the cancer client are often the �hidden sufferers� because it is sometimes harder to watch a loved one who is experiencing pain and suffering, yet be impotent to do anything about it (35). Family dynamics play a major role in the client�s perception of quality of life, and family members are often the principal support for the client with cancer. McGrath (2001) discusses the significance of social support, familial support, and the support of the healthcare professionals caring for the individual with cancer. Development of rapport with a support person or persons, wither within or without the family, is seen as fundamental to coping with cancer-related pain.

Spirituality

Spirituality may be defined as a belief in a higher power or God, or a transcendence or connection to a higher power, comparable to a search for meaning within relationships (36). Because a healthy sense of spirituality is closely linked with quality of life, it is essential for health care professionals to recognize the spiritual aspect of the client, and to understand the importance of an adequate spiritual assessment. Spirituality as it relates to cancer-related pain is found to be under-addressed in the literature, perhaps due to the misconception of spirituality being solely about religion.

Spiritual distress may occur when a client suffers existential pain, or a discrepancy between how the person believes the world �ought� to work and the apparent unfair realities of life (37). Spiritual distress may manifest itself as anxiety, depression, anger, and withdrawal, as well as physical pain (38). The personal meaning of spirituality is exclusive to the client, and clients claiming a sense of spirituality may equate with finding a deeper meaning to life,thereby acquiring strength to cope with their pain and illness (39).