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Chronic pain and other symptoms among breast cancer survivors: prevalence, predictors, and effects on quality of life

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

To investigate prevalence and risk factors associated with self-reported chronic pain, and other symptoms related to breast cancer or its treatment among breast cancer survivors (BCS).

Methods

A cross-sectional study of a random sample of 410 female BCS, members of “Leumit” healthcare fund, diagnosed with primary nonmetastatic invasive breast cancer in the years 2002–2012. The study questionnaire included questions on health-related quality of life, pain symptoms, and was completed by all women contacted.

Results

A total of 305 BCS (74%), with a median of 7.4 years since diagnosis reported chronic pain, of whom 84% had moderate pain, and 97% experienced pain at least 1–3 days/week. Other symptoms were paresthesia (63%), allodynia (48%), and phantom sensations (15%). Report of pain symptoms, alone or combined, was significantly associated with poorer quality of life. In multivariable analyses, chronic pain was positively associated with mastectomy compared to breast-conserving surgery [Odds ratio (OR), 3.54; 95% confidence interval (CI) 1.46–8.59; P = 0.005], radiotherapy compared to non-radiotherapy (OR 2.96; 95% CI 1.43–6.12; P = 0.003), breast cancer stage at diagnosis—regional versus localized (OR 3.63; 95% CI 2.00–6.57; P < 0.001), and inversely with age (OR per one-year increment, 0.96; 95% CI 0.94–0.99; P = 0.002), and with time since diagnosis (OR per one-year increment, 0.82; 95% CI 0.75–0.90; P < 0.001).

Conclusions

With the increasing incidence of detected breast cancer and the improvements in treatment and consequently survival, knowledge about prevalence, and factors related to treatment late effects of chronic pain is highly relevant for potential prevention or management without negatively impacting quality of life.

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Abbreviations

BCS:

Breast cancer survivor/s

CI:

Confidence interval

CP:

Chronic pain

INCR:

Israel National Cancer Registry

LHS:

Leumit Health Services

OR:

Odds ratio

P :

P value

QOL:

Quality of life

SD:

Standard deviation

SF-36:

36-Item Short-Form Health Survey

χ 2 :

Chi square

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Acknowledgements

We wish to thank the Ph.D. advisory committee and all participating BCS. We are grateful to Dr. Natan Kahan for his help and support with data acquisition and study approval. Funding of this study was in part provided by a grant from the Council for Higher Education in collaboration with the Graduate Studies Authority at the University of Haifa.

Disclaimer

The results, conclusions, view, and opinions contained herein are those of the authors and not to be construed as the official policy of Israel’s Ministry of Health, or of Leumit Health Organization.

Author information

Authors and Affiliations

  1. Leumit Health Services, Haharoshet 13, Karmiel, Israel

    Hatem Hamood

  2. School of Public Health, University of Haifa, Haifa, Israel

    Rola Hamood & Lital Keinan-Boker

  3. Leumit Health Services, Netanya, Israel

    Ilya Merhasin

  4. Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel

    Lital Keinan-Boker

Authors
  1. Rola Hamood
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  2. Hatem Hamood
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  4. Lital Keinan-Boker
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Contributions

R.H. had full access to all of the data in the study, performed statistical analysis, interpreted the data, and drafted the manuscript. H.H. participated in the study concept and design, helped in data acquisition, evaluated the manuscript, and acted as the corresponding author. I.M. was responsible for data acquisition, participated in the statistical analysis, and helped to evaluate and edit the manuscript. L.K.B. had substantial contribution to the study concept, its formalization and development, interpreted the data, and assisted in the drafting and refinement of the manuscript. All authors took responsibility for the integrity of the data and the accuracy of the data analysis, and have read and approved the final manuscript.

This work has been done in partial fulfillment of the requirements for a Ph.D. degree of R.H. (supervised by L.K.B.) in the School of Public health, in the University of Haifa.

Corresponding author

Correspondence to Hatem Hamood.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional review boards of LHS and University of Haifa and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Research Involving Human and Animal Rights

All procedures performed in this study comply with the current laws of Israel.

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Hamood, R., Hamood, H., Merhasin, I. et al. Chronic pain and other symptoms among breast cancer survivors: prevalence, predictors, and effects on quality of life. Breast Cancer Res Treat 167, 157–169 (2018). https://doi.org/10.1007/s10549-017-4485-0

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  • DOI: https://doi.org/10.1007/s10549-017-4485-0

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