TOPLINE:

Pain interfering with daily activities was associated with frailty in adult survivors of childhood cancer. Persistent or worsening pain over time, along with sedentary behavior, was associated with frailty progression, whereas physical activity appeared protective.

METHODOLOGY:

• Researchers analyzed data from 1261 adult survivors of childhood cancer (mean age at baseline, 30.7 years; 50.4% male) treated at St. Jude Children’s Research Hospital in the US to assess the associations between pain and frailty.
• Participants were at least 10 years from their childhood cancer diagnosis and completed baseline assessments between 2008 and 2013 and follow-up assessments between 2014 and 2018.
• Bodily pain and pain interference were assessed separately. Pain interference measured how much pain interfered with normal work over the previous 4 weeks. Pain outcomes were classified as no pain, pain with interference, and pain without interference, and changes in pain from baseline to follow-up were categorized as no or decreasing pain, persistent pain, or increasing pain.
• Frailty was assessed using the Fried criteria, which included low muscle mass, exhaustion, low energy expenditure, slowness, and weakness. Pre-frailty was defined as meeting two criteria and frailty as meeting three or more criteria. Frailty progression was categorized as stable healthy, improved, persistent frail, or progressed.
• The primary outcomes were frailty status and progression. Survivors reported their health behaviors, such as smoking, alcohol use, sedentary behavior, and physical activity.

TAKEAWAY:

• At baseline, 37.4% of participants reported pain, with 15.4% reporting pain with interference. Pain with interference at baseline was associated with pre-frail (adjusted odds ratio [aOR], 1.85; 95% CI, 1.19-2.88) and frail (aOR, 5.66; 95% CI, 2.75-11.68) status.
• Survivors reporting pain with interference at baseline had higher odds of persistent frailty (aOR, 3.44; 95% CI, 1.88-6.31) and progressed frailty (aOR, 2.09; 95% CI, 1.25-3.49) at follow-up than survivors who were never frail.
• Persistent pain (aOR, 1.70; 95% CI, 1.11-2.61) and increasing pain (aOR, 1.69; 95% CI, 1.09-2.61) from baseline to follow-up were associated with progressed frailty.
• Each 30-minute increase in moderate-to-vigorous physical activity was associated with reduced risks for persistent frailty (aOR, 0.58; 95% CI, 0.48-0.69) and progressed frailty (aOR, 0.68; 95% CI, 0.61-0.75); sedentary behavior of 4 hours or more per day was associated with higher odds of both persistent frailty (aOR, 1.92; 95% CI, 1.12-3.28) and progressed frailty (aOR, 1.78; 95% CI, 1.21-2.61).

IN PRACTICE:

“[The study] findings suggest that pain might independently contribute to frailty in survivors, highlighting the need for pain management and lifestyle interventions to potentially slow frailty progression,” the authors of the study wrote. “[The] results highlight physical activity and sedentary behavior as key targets for slowing frailty progression and improving quality of life in pain-affected survivors,” they added.

SOURCE:

The study was led by Cassie M. Argenbright, PhD, St. Jude Children’s Research Hospital, Memphis, Tennessee. It was published online on May 28, 2026, in The Lancet Healthy Longevity.

LIMITATIONS:

The survivors included in the study were slightly older and had higher cranial radiation and platinum exposure than those with missing follow-up data for pain. The absence of longitudinal data for the control groups affected the ability to compare pain and frailty trajectories between cancer survivors and people without cancer.

DISCLOSURES:

The study received support from the US National Cancer Institute, Cancer Center Support Grant, and the American Lebanese Syrian Associated Charities. One author disclosed receiving funding from Pfizer, Seagen, and the Children’s Oncology Group Foundation, along with honoraria and travel reimbursement from Amgen.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.