Living with chronic pain: perceptions of breast cancer survivors
Abstract
Purpose
Breast cancer treatments may lead to chronic pain. For some breast cancer survivors (BCS), this experience can develop into the perception of living with chronic pain. The majority of BCS are postmenopausal and have hormone receptor-positive (HR+) breast cancer requiring aromatase inhibitors (AIs). Neither the prevalence nor risk factors associated with the perception of living with chronic pain among this population are well defined.
Methods
We conducted a cross-sectional survey among postmenopausal, HR+ BCS who previously took or were currently taking AIs. The primary outcome was patients’ perception of living with chronic pain over the past 6 months. We measured pain and demographic and clinical variables. Multivariable logistic regression analysis was performed to evaluate risk factors associated with the perception of chronic pain.
Results
Among 1280 participants, 167 (13%) reported having the perception of living with chronic pain before their breast cancer diagnosis; 426 (34%) reported this perception after completion of non-hormonal cancer treatment. Seventy-eight percent of BCSs reported experiencing at least one type of treatment-related pain within the past 7 days, with 23% experiencing at least three types. The most common types of pain were AI-induced musculoskeletal pain (49%) and pain at the surgery or radiation site (31%). Younger age (< 56), BMI > 25, and the perception of living with chronic pain before diagnosis were risk factors associated with the perception of living with chronic pain.
Conclusions
One in three postmenopausal, HR+ BCS considered themselves to be living with chronic pain. Effective interventions to reduce chronic pain are needed.
Keywords
Breast cancer Chronic pain Aromatase inhibitors Musculoskeletal painNotes
Acknowledgements
This study was funded in part by a National Cancer Institute R01CA158243 (Mao) and R21CA173263 (Bao), a Memorial Sloan Kettering Cancer Center P30 grant (P30-CA008748), and the Byrne Fund at Memorial Sloan Kettering Cancer Center. The funding sources had no involvement in the study design; collection, analysis and interpretation of data; writing of the report; or decision to submit the article for publication.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
References
- 1.Cancer Facts and Statistics 2017, American Cancer Society, 2017Google Scholar
- 2.Peuckmann V, Ekholm O, Rasmussen NK et al (2009) Chronic pain and other sequelae in long-term breast cancer survivors: nationwide survey in Denmark. Eur J Pain 13:478–485CrossRefPubMedGoogle Scholar
- 3.De Oliveira GS Jr, Chang R, Khan SA et al (2014) Factors associated with the development of chronic pain after surgery for breast cancer: a prospective cohort from a tertiary center in the United States. Breast J 20:9–14CrossRefPubMedGoogle Scholar
- 4.Schou Bredal I, Smeby NA, Ottesen S et al (2014) Chronic pain in breast cancer survivors: comparison of psychosocial, surgical, and medical characteristics between survivors with and without pain. J Pain Symptom Manag 48:852–862CrossRefGoogle Scholar
- 5.Gartner R, Jensen MB, Nielsen J et al (2009) Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA 302:1985–1992CrossRefPubMedGoogle Scholar
- 6.Bruce J, Thornton AJ, Powell R et al (2014) Psychological, surgical, and sociodemographic predictors of pain outcomes after breast cancer surgery: a population-based cohort study. Pain 155:232–243CrossRefPubMedGoogle Scholar
- 7.Crew KD, Greenlee H, Capodice J et al (2007) Prevalence of joint symptoms in postmenopausal women taking aromatase inhibitors for early-stage breast cancer. J Clin Oncol 25:3877–3883CrossRefPubMedGoogle Scholar
- 8.Mao JJ, Stricker C, Bruner D et al (2009) Patterns and risk factors associated with aromatase inhibitor-related arthralgia among breast cancer survivors. Cancer 115:3631–3639CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Bao T, Basal C, Seluzicki C et al (2016) Long-term chemotherapy-induced peripheral neuropathy among breast cancer survivors: prevalence, risk factors, and fall risk. Breast Cancer Res Treat 159:327–333CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Hershman DL, Till C, Wright JD et al (2016) Comorbidities and risk of chemotherapy-induced peripheral neuropathy among participants 65 years or older in southwest oncology group clinical trials. J Clin Oncol 34:3014–3022CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Amiri AH, Rafiei A (2010) Analysis of patients with post-chemotherapy arthralgia and arthritis in breast cancer. Indian J Med Sci 64:197–203CrossRefPubMedGoogle Scholar
- 12.Almoallim H, Abdulaziz S, Fallatah E et al (2017) Clinical characteristics and outcomes of cancer patients with post-chemotherapy arthritis: a retrospective case series report. Open Access Rheumatol 9:111–116CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Loprinzi CL, Duffy J, Ingle JN (1993) Postchemotherapy rheumatism. J Clin Oncol 11:768–770CrossRefPubMedGoogle Scholar
- 14.Ebaugh D, Spinelli B, Schmitz KH (2011) Shoulder impairments and their association with symptomatic rotator cuff disease in breast cancer survivors. Med Hypotheses 77:481–487CrossRefPubMedGoogle Scholar
- 15.DiSipio T, Rye S, Newman B et al (2013) Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol 14:500–515CrossRefPubMedGoogle Scholar
- 16.Kaptein AA, Schoones JW, Fischer MJ et al (2015) Illness perceptions in women with breast cancer—a systematic literature review. Curr Breast Cancer Rep 7:117–126CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Mickeviciene A, Vanagas G, Jievaltas M et al (2013) Does illness perception explain quality of life of patients with prostate cancer? Medicina (Kaunas) 49:235–241Google Scholar
- 18.Mao JJ, Su HI, Feng R et al (2011) Association of functional polymorphisms in CYP19A1 with aromatase inhibitor associated arthralgia in breast cancer survivors. Breast Cancer Res 13:R8CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Cleeland CS, Ryan KM (1994) Pain assessment: global use of the brief pain inventory. Ann Acad Med Singap 23:129–138PubMedGoogle Scholar
- 20.Rief W, Bardwell WA, Dimsdale JE et al (2011) Long-term course of pain in breast cancer survivors: a 4-year longitudinal study. Breast Cancer Res Treat 130:579–586CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Paice JA, Portenoy R, Lacchetti C et al (2016) Management of chronic pain in survivors of adult cancers: American society of clinical oncology clinical practice guideline. J Clin Oncol 34:3325–3345CrossRefPubMedGoogle Scholar
- 22.Tasmuth T, Kataja M, Blomqvist C et al (1997) Treatment-related factors predisposing to chronic pain in patients with breast cancer—a multivariate approach. Acta Oncol 36:625–630CrossRefPubMedGoogle Scholar
- 23.Sipila R, Estlander AM, Tasmuth T et al (2012) Development of a screening instrument for risk factors of persistent pain after breast cancer surgery. Br J Cancer 107:1459–1466CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Belfer I, Schreiber KL, Shaffer JR et al (2013) Persistent postmastectomy pain in breast cancer survivors: analysis of clinical, demographic, and psychosocial factors. J Pain 14:1185–1195CrossRefPubMedGoogle Scholar
- 25.Poleshuck EL, Katz J, Andrus CH et al (2006) Risk factors for chronic pain following breast cancer surgery: a prospective study. J Pain 7:626–634CrossRefPubMedGoogle Scholar
- 26.Wright LJ, Schur E, Noonan C et al (2010) Chronic pain, overweight, and obesity: findings from a community-based twin registry. J Pain 11:628–635CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Okifuji A, Hare BD (2015) The association between chronic pain and obesity. J Pain Res 8:399–408CrossRefPubMedPubMedCentralGoogle Scholar
- 28.Windebank AJ, Grisold W (2008) Chemotherapy-induced neuropathy. J Peripher Nerv Syst 13:27–46CrossRefPubMedGoogle Scholar
- 29.Wang XM, Hamza M, Wu TX et al (2009) Upregulation of IL-6, IL-8 and CCL2 gene expression after acute inflammation: correlation to clinical pain. Pain 142:275–283CrossRefPubMedPubMedCentralGoogle Scholar
- 30.Paley CA, Johnson MI (2016) Physical activity to reduce systemic inflammation associated with chronic pain and obesity: a narrative review. Clin J Pain 32:365–370CrossRefPubMedGoogle Scholar
- 31.Schmidt FM, Weschenfelder J, Sander C et al (2015) Inflammatory cytokines in general and central obesity and modulating effects of physical activity. PLoS ONE 10:e0121971CrossRefPubMedPubMedCentralGoogle Scholar
- 32.Fisch MJ, Lee JW, Weiss M et al (2012) Prospective, observational study of pain and analgesic prescribing in medical oncology outpatients with breast, colorectal, lung, or prostate cancer. J Clin Oncol 30:1980–1988CrossRefPubMedPubMedCentralGoogle Scholar