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Association between chronic pain and quality of life in long-term breast cancer survivors: a prospective analysis

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Abstract

Purpose

Pain is a leading cause of disability worldwide and is highly prevalent among breast cancer survivors. Pain and quality of life (QOL) are associated in breast cancer patients undergoing active treatment, but little is known about the relationship between the two in long-term survivors.

Methods

We evaluated associations between pain information collected during a 5-year post-diagnosis follow-up survey and QOL assessed by the SF-36 during a 10-year post-diagnosis survey for 2828 participants in the Shanghai Breast Cancer Survival Study.

Results

The mean overall QOL score was 78.7 for the entire study population and decreased as pain severity and frequency measured at the 5-year timepoint increased (none: 81.9, mild: 75.9, moderate/severe: 70.4, infrequent: 76.7, frequent: 72.3; P < 0.001). Significant inverse associations were found between pain and all QOL domains, including pain at 10-years post-diagnosis after multivariate adjustments. Concurrent pain was significantly and strongly associated with QOL. Most of the associations between 5-years post-diagnosis pain and QOL at 10-years post-diagnosis persisted after further adjustment for concurrent pain.

Conclusions

Pain is associated prospectively and concurrently with poor QOL among long-term breast cancer survivors. Programs to manage pain are needed to improve QOL among breast cancer survivors.

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Data availability

All data supporting this study's findings are present in the text or Appendix.

References

  1. Pham T-M, et al. Average lifespan shortened due to breast cancer in Australia, 1990–2015. Breast Cancer. 2021;28(6):1389–91.

    Article  PubMed  Google Scholar 

  2. DeSantis C, et al. Breast cancer statistics, 2013. CA Cancer J Clin. 2014;64(1):52–62.

    Article  PubMed  Google Scholar 

  3. Myers ER, et al. Benefits and harms of breast cancer screening: a systematic review. JAMA. 2015;314(15):1615–34.

    Article  CAS  PubMed  Google Scholar 

  4. Chen Z, et al. Trends of female and male breast cancer incidence at the global, regional, and national levels, 1990–2017. Breast Cancer Res Treat. 2020;180(2):481–90.

    Article  PubMed  Google Scholar 

  5. Hurwitz EL, et al. The Global Spine Care Initiative: a summary of the global burden of low back and neck pain studies. Eur Spine J. 2018;27(6):796–801.

    Article  PubMed  Google Scholar 

  6. Smith D, et al. Chronic pain and mortality: a systematic review. PLoS ONE. 2014;9(6): e99048.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Leadley RM, et al. Healthy aging in relation to chronic pain and quality of life in Europe. Pain Pract. 2014;14(6):547–58.

    Article  PubMed  Google Scholar 

  8. Cooney MA, et al. Current knowledge of pain after breast cancer treatment: a systematic review. Pain Manag Nurs. 2013;14(2):110–23.

    Article  PubMed  Google Scholar 

  9. Hamood R, et al. Chronic pain and other symptoms among breast cancer survivors: prevalence, predictors, and effects on quality of life. Breast Cancer Res Treat. 2018;167(1):157–69.

    Article  PubMed  Google Scholar 

  10. Bredal IS, et al. Chronic pain in breast cancer survivors: comparison of psychosocial, surgical, and medical characteristics between survivors with and without pain. J Pain Sympt Manag. 2014;48(5):852–62.

    Article  Google Scholar 

  11. Jung BF, et al. Neuropathic pain associated with non-surgical treatment of breast cancer. Pain. 2005;118(2):10–4.

    Article  PubMed  Google Scholar 

  12. Farrar JT, et al. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94(2):149–58.

    Article  PubMed  Google Scholar 

  13. Jensen MP, et al. Pain in long-term breast cancer survivors: frequency, severity, and impact. Pain Med. 2010;11(7):1099–106.

    Article  PubMed  Google Scholar 

  14. Z B, et al. Reliability and validity of a Short-Form Health Survey Scale (SF-36), Chinese version used in an elderly population of Zhejiang province in China. Zhonghua liu xing bing xue za zhi= Zhonghua liuxingbingxue zazhi. 2008;29(12):1193–8.

    Google Scholar 

  15. Zhou K, et al. Reliability, validity, and sensitivity of the Chinese Short-Form 36 Health Survey version 2 (SF-36v2) in women with breast cancer. J Eval Clin Pract. 2019;25(5):864–72.

    Article  PubMed  Google Scholar 

  16. Cella D, Fallowfield LJ. Recognition and management of treatment-related side effects for breast cancer patients receiving adjuvant endocrine therapy. Breast Cancer Res Treat. 2008;107(2):167–80.

    Article  CAS  PubMed  Google Scholar 

  17. Schmitz KH, et al. Prospective surveillance and management of cardiac toxicity and health in breast cancer survivors. Cancer. 2012;118(S8):2270–6.

    Article  PubMed  Google Scholar 

  18. Gold M, et al. Co-occurrence of anxiety and depressive symptoms following breast cancer surgery and its impact on quality of life. Eur J Oncol Nurs. 2016;20:97–105.

    Article  PubMed  Google Scholar 

  19. So WKW, et al. Anxiety, depression and quality of life among Chinese breast cancer patients during adjuvant therapy. Eur J Oncol Nurs. 2010;14(1):17–22.

    Article  PubMed  Google Scholar 

  20. Leung J, Pachana NA, McLaughlin D. Social support and health-related quality of life in women with breast cancer: a longitudinal study. Psychooncology. 2014;23(9):1014–20.

    Article  PubMed  Google Scholar 

  21. Hewitt M, Rowland JH, Yancik R. Cancer survivors in the United States: age, health, and disability. J Gerontol A Biol Sci Med Sci. 2003;58(1):M82–91.

    Article  Google Scholar 

  22. Sun Y, Shigaki CL, Armer JM. Return to work among breast cancer survivors: a literature review. Support Care Cancer. 2017;25(3):709–18.

    Article  PubMed  Google Scholar 

  23. Bower JE, et al. Inflammation and behavioral symptoms after breast cancer treatment: do fatigue, depression, and sleep disturbance share a common underlying mechanism? J Clin Oncol. 2011;29(26):3517–22.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Miaskowski CA. Subgroups of patients with cancer with different symptom experiences and quality-of-life outcomes: a cluster analysis. Onclo Nurs Forum. 1969;33(5):E79–89.

    Article  Google Scholar 

  25. Cheng KKF, Lee DTF. Effects of pain, fatigue, insomnia, and mood disturbance on functional status and quality of life of elderly patients with cancer. Crit Rev Oncol Hematol. 2011;78(2):127–37.

    Article  PubMed  Google Scholar 

  26. McBeth J, et al. Chronic widespread pain predicts physical inactivity: results from the prospective EPIFUND study. Eur J Pain. 2010;14(9):972–9.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Grasdalsmoen M, et al. Physical exercise and chronic pain in university students. PLoS One. 2020;15(6): e0235419.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Forsythe LP, et al. Pain in long-term breast cancer survivors: the role of body mass index, physical activity, and sedentary behavior. Breast Cancer Res Treat. 2013;137(2):617–30.

    Article  PubMed  Google Scholar 

  29. Yin M, et al. Chronic pain and its correlates among long-term breast cancer survivors. J Cancer Surviv. 2022;17:460–7.

    Article  PubMed  Google Scholar 

  30. Chou C-H, Hwang C-L, Ying-Tai Wu. Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: a meta-analysis. Arch Phys Med Rehabil. 2012;93(2):237–44.

    Article  PubMed  Google Scholar 

  31. Liberman K, et al. The effects of exercise on muscle strength, body composition, physical functioning and the inflammatory profile of older adults: a systematic review. Curr Opin Clin Nutr Metab Care. 2017;20(1):30–53.

    Article  PubMed  Google Scholar 

  32. Sebba A. Pain: a review of interleukin-6 and its roles in the pain of rheumatoid arthritis. Open Access Rheumatol. 2021;13:31.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Liu L, et al. Fatigue and sleep quality are associated with changes in inflammatory markers in breast cancer patients undergoing chemotherapy. Brain Behav Immun. 2012;26(5):706–13.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Bower JE. Cancer-related fatigue: links with inflammation in cancer patients and survivors. Brain Behav Immun. 2007;21(7):863–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Hajj J, et al. Sleep quality, fatigue, and quality of life in individuals with heart failure. J Nurse Pract. 2020;16(6):461–5.

    Article  Google Scholar 

  36. Sherry HY, et al. Burden of sleep and fatigue in US adults with atopic dermatitis. Dermatitis®. 2016;27(2):50–8.

    Article  Google Scholar 

  37. Veauthier C, Paul F. Sleep disorders in multiple sclerosis and their relationship to fatigue. Sleep Med. 2014;15(1):5–14.

    Article  PubMed  Google Scholar 

  38. Ancoli-Israel S, et al. Sleep, fatigue, depression, and circadian activity rhythms in women with breast cancer before and after treatment: a 1-year longitudinal study. Support Care Cancer. 2014;22(9):2535–45.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Fortner BV, et al. Sleep and quality of life in breast cancer patients. J Pain Sympt Manag. 2002;24(5):471–80.

    Article  Google Scholar 

  40. Choy EHS. The role of sleep in pain and fibromyalgia. Nat Rev Rheumatol. 2015;11(9):513–20.

    Article  PubMed  Google Scholar 

  41. Chen P, et al. Sleep deprivation worsened oral ulcers and delayed healing process in an experimental rat model. Life Sci. 2019;232: 116594.

    Article  CAS  PubMed  Google Scholar 

  42. Pilevarzadeh M, et al. Global prevalence of depression among breast cancer patients: a systematic review and meta-analysis. Breast Cancer Res Treat. 2019;176(3):519–33.

    Article  PubMed  Google Scholar 

  43. Reyes-Gibby CC, et al. Depressive symptoms and health-related quality of life in breast cancer survivors. J Womens Health. 2012;21(3):311–8.

    Article  Google Scholar 

  44. Chen X, et al. Exercise, tea consumption, and depression among breast cancer survivors. J Clin Oncol. 2010;28(6):991.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Berna C, et al. Induction of depressed mood disrupts emotion regulation neurocircuitry and enhances pain unpleasantness. Biol Psychiatry. 2010;67(11):1083–90.

    Article  PubMed  Google Scholar 

  46. Hughes S, et al. Social support predicts inflammation, pain, and depressive symptoms: longitudinal relationships among breast cancer survivors. Psychoneuroendocrinology. 2014;42:38–44.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Green CR, Hart-Johnson T, Loeffler DR. Cancer-related chronic pain: examining quality of life in diverse cancer survivors. Cancer. 2011;117(9):1994–2003.

    Article  PubMed  Google Scholar 

  48. Rodriguez C, et al. Cancer pain and quality of life. J Hosp Palliat Nurs. 2019;21(2):116–23.

    Article  PubMed  Google Scholar 

  49. Cramer JD, Johnson JT, Nilsen ML. Pain in head and neck cancer survivors: prevalence, predictors, and quality-of-life impact. Otolaryngol Head Neck Surg. 2018;159(5):853–8.

    Article  PubMed  Google Scholar 

  50. Esnaola NF, et al. Pain and quality of life after treatment in patients with locally recurrent rectal cancer. J Clin Oncol. 2002;20(21):4361–7.

    Article  PubMed  Google Scholar 

  51. Mystakidou K, et al. The relationship of subjective sleep quality, pain, and quality of life in advanced cancer patients. Sleep. 2007;30(6):737–42.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Berg T, Maarten J, et al. Quality of life of patients with irritable bowel syndrome is low compared to others with chronic diseases. Eur J Gastroenterol Hepatol. 2006;18(5):475–81.

    Article  PubMed  Google Scholar 

  53. Dobrota D, Vesna, et al. The impact of neuropathic pain and other comorbidities on the quality of life in patients with diabetes. Health Qual Life Outcomes. 2014;12:1–8.

    Google Scholar 

  54. Wahl AK, et al. The complexity of the relationship between chronic pain and quality of life: a study of the general Norwegian population. Qual Life Res. 2009;18:971–80.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Gärtner R, et al. Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA. 2009;302(18):1985–92.

    Article  PubMed  Google Scholar 

  56. Bruce J, et al. Chronic preoperative pain and psychological robustness predict acute postoperative pain outcomes after surgery for breast cancer. Br J Cancer. 2012;107(6):937–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Peuckmann V, et al. Chronic pain and other sequelae in long-term breast cancer survivors: nationwide survey in Denmark. Eur J Pain. 2009;13(5):478–85.

    Article  CAS  PubMed  Google Scholar 

  58. Grisold W, Cavaletti G, Windebank AJ. Peripheral neuropathies from chemotherapeutics and targeted agents: diagnosis, treatment, and prevention. Neuro Oncol. 2012;14(suppl_4):iv45–54.

    CAS  PubMed  PubMed Central  Google Scholar 

  59. Andersen KG, et al. Predictive factors for the development of persistent pain after breast cancer surgery. Pain. 2015;156(12):2413–22.

    Article  PubMed  Google Scholar 

  60. Leysen L, et al. Risk factors of pain in breast cancer survivors: a systematic review and meta-analysis. Support Care Cancer. 2017;25:3607–43.

    Article  PubMed  Google Scholar 

  61. Juhl AA, Christiansen P, Damsgaard TE. Persistent pain after breast cancer treatment: a questionnaire-based study on the prevalence, associated treatment variables, and pain type. J Breast Cancer. 2016;19(4):447–54.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Hylands-White N, Duarte RV, Raphael JH. An overview of treatment approaches for chronic pain management. Rheumatol Int. 2017;37:29–42.

    Article  CAS  PubMed  Google Scholar 

  63. Syrjala KL, et al. Psychological and behavioral approaches to cancer pain management. J Clin Oncol. 2014;32(16):1703.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Eccleston C, Morley SJ, Williams ACDC. Psychological approaches to chronic pain management: evidence and challenges. Br J Anaesth. 2013;111(1):59–63.

    Article  CAS  PubMed  Google Scholar 

  65. Van Dartel SAA, et al. Association between fatigue and pain in rheumatoid arthritis: does pain precede fatigue or does fatigue precede pain? Arthritis Care Res. 2013;65(6):862–9.

    Article  Google Scholar 

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Acknowledgements

Research reported in this publication was supported by the U.S. Department of Defense Breast Cancer Research Program (DAMD 17-02-1-0607 to Xiao-Ou Shu) and the National Cancer Institute of the National Institutes of Health under Award Number (R01 CA118229 to Xiao-Ou Shu). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. The authors want to thank the study participants and research team members for their dedication to the study.

Funding

Research reported in this publication was supported by the U.S. Department of Defense Breast Cancer Research Program (DAMD 17-02-1-0607 to Xiao-Ou Shu) and the National Cancer Institute of the National Institutes of Health under Award Number (R01 CA118229 to Xiao-Ou Shu).

Author information

Authors and Affiliations

  1. Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Vanderbilt University Institute of Medicine and Public Health, 2525 West End Avenue, Suite 600, Nashville, TN, 37203-1738, USA

    Michelle Yin, Hui Cai & Xiao-Ou Shu

  2. Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People’s Republic of China

    Kai Gu

Authors
  1. Michelle Yin
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  2. Kai Gu
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  3. Hui Cai
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  4. Xiao-Ou Shu
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Contributions

All authors contributed to study design and conception. Data collection and assembly were performed by KG and XS. Data analysis was performed by MY and HC. The first draft of the manuscript was written by MY. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Xiao-Ou Shu.

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Conflict of interest

The authors declare no conflicts of interest.

Institutional review board

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board of Vanderbilt University Medical Center.

Informed consent

Patient consent was waived. This study exclusively utilized de-identified information extracted from medical records.

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Appendix

Appendix

See Tables 5, 6, 7 and 8.

Table 5 Associations between pain assessed at 5-year survey and QOL scores assessed at 10-year survey excluding patients with severe pain
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Table 6 Associations between quality of life and pain severity assessed at 5-year and 10-year surveys excluding patients with severe pain
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Table 7 Associations between pain assessed at 5-year survey and QOL scores assessed at 10-year survey excluding patients with metastasis or recurrence between the 5- and 10-year surveys
Full size table
Table 8 Associations between quality of life and pain severity assessed at 5-year and 10-year surveys excluding patients with metastasis or recurrence between the 5- and 10-year surveys
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Yin, M., Gu, K., Cai, H. et al. Association between chronic pain and quality of life in long-term breast cancer survivors: a prospective analysis. Breast Cancer 30, 785–795 (2023). https://doi.org/10.1007/s12282-023-01472-3

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  • DOI: https://doi.org/10.1007/s12282-023-01472-3

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