Background: Pain is one of the most common cancer symptoms. Individuals in pain often experience psychological distress in the form of anxiety and depression. Social support is an important resource utilized by patients to cope with cancer.

Aims: (1) Identify clinicodemographic factors influencing cancer pain; (2) examine social support as a moderator of the relation between anxiety, depression and cancer pain.

Methods: Participants included stage I-IV cancer patients (N = 11,815) who completed a routine tablet-based psychosocial distress screening at a large academic hybrid, multi-site, community-based cancer institute (Jan 2017- Jan 2019). Participants were matched to the Cancer Registry (N = 7,333); clinicodemographic factors were incorporated into lasso regression models. Models identified pain predictors from self-reported anxiety, depression and social support. Analyses examined if the effect of anxiety and depression on pain differed by levels of social support.

Results: Median age was 59 (RNG, 18-101), 61% female and 77% white. Tumor site (GI, Gyn, head/neck), advanced disease, black race, and lower income were independently associated with severe pain. Anxiety (β = 0.48, p < .001) and depression (β = 0.69, p < 0.001) were related to pain intensity after accounting for clinicodemographic factors. The effect of depression on pain differed by level of social support (p = 0.009). The effect of anxiety on pain differed in patients reporting transportation issues (p = 0.035).

Conclusions: This is the largest study to date examining cancer pain intensity, psychological factors of anxiety and depression, and social support. Our data suggests that patient characteristics of race, income, tumor site, and disease staging independently predict pain intensity. Anxiety and depression are significant factors of pain intensity; these associations remain after accounting for patient characteristics. Social support buffers the negative impact of anxiety/depression on pain. Clinicians who treat cancer pain should be attuned to modifiable psychological factors which can greatly influence a patient’s pain experience. Findings emphasize the need for interdisciplinary multimodal approaches for cancer pain.