# Global Prevalence of Chronic Pain Among Cancer Survivors: A Systematic Review and Proportional Meta‐Analysis of Observational Studies

## TL;DR

This study estimates that about 41% of cancer survivors globally experience chronic pain, highlighting the need for better pain management and further research.

## Contribution

The study provides the first global pooled prevalence estimate of chronic pain in cancer survivors using a systematic review and meta-analysis.

## Key findings

- The pooled prevalence of chronic pain among cancer survivors is 41% with high heterogeneity.
- Chronic pain prevalence varies significantly by geographic region, cancer type, and pain duration.
- More research is needed on chronic pain in underrepresented regions and cancer types.

## Abstract

Cancer survivors often receive inadequate pain management, leading to impaired quality of life. Despite their importance, evidence on the global prevalence of chronic pain in cancer survivors remains insufficiently clear.

The systematic review and proportional meta‐analysis aimed to estimate the pooled global prevalence of chronic pain among cancer survivors and to explore heterogeneity stratified by geographic region, cancer type, pain duration, and pain assessment tool.

Five databases (PubMed, Embase, Cochrane Library, CINAHL, and China National Knowledge Infrastructure) were searched up to September 2024 for studies in English or Chinese. The review followed MOOSE and PRISMA guidelines with PROSPERO registration (CRDxx). Studies were included if they reported chronic pain prevalence in cancer survivors using validated instruments or solely reported chronic pain. Two reviewers independently screened studies, extracted data, and assessed quality using the JBI Critical Appraisal Checklist for Analytical Cross‐Sectional Studies. Pooled prevalence and 95% prediction intervals were calculated using a random‐effects model with Freeman–Tukey double arcsine transformation. Subgroup analysis was used to explore heterogeneity. Leave‐one‐out analysis explored robustness. Funnel plot and Egger's test were used to examine publication bias.

In total, 36 studies involving 39,806 participants were included. The pooled prevalence of chronic pain among cancer survivors was 41% (95% CI: 34%–49%) after testing robustness, with significant heterogeneity (I

2
 = 99.32%). Subgroup analysis indicated significant group differences in prevalence rates by geographic region, cancer type, and pain duration (all p < 0.001).

These findings stress the need for more extensive and tailored chronic pain management in current clinical practice. Additional research on chronic pain outcomes among pediatric cancer survivors, cancer populations within Africa and South America, and those with cancer types other than breast cancer is needed.

PROSPERO Registration: CRD42024597090.