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Early postoperative psychological distress as a mediator of subsequent persistent postsurgical pain outcomes among younger breast cancer patients

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

Abstract

Purpose

Younger age is a risk factor for worse pain outcomes following breast cancer surgery, yet little is known about how younger women’s psychological state may contribute to their pain experience. Using prospectively collected longitudinal data from a surgical cohort, we examined whether early postoperative psychological distress at 2 weeks mediated the association between younger age and subsequent worse pain-related functioning 3 months after surgery.

Methods

Patients (N = 159) were recruited before breast cancer surgery into this longitudinal cohort study. Age at time of surgery, psychological distress (anxiety, depression, and sleep disturbance) assessed 2 weeks postoperatively, and impact of surgical pain on cognitive/emotional functioning and physical functioning assessed 3 months postoperatively were used for analysis.

Results

Younger age was associated with greater depression, anxiety, and sleep disturbance 2 weeks postoperatively. Younger age was also associated with greater ratings of pain impacting cognitive/emotional functioning and physical functioning 3 months postoperatively. The association between younger age and worse cognitive/emotional impact of pain was mediated by greater anxiety and sleep disturbance. Similarly, the association between younger age and worse physical impact of pain was mediated by greater sleep disturbance.

Conclusion

The degree of anxiety and sleep disturbance that occur early after breast surgery may contribute to greater chronic pain-related functional disability among younger patients. Anxiety and sleep disturbance are modifiable with behavioral interventions, making them potential perioperative targets to improve long-term outcomes in young breast cancer survivors.

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Data availability

The dataset analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request.

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Funding

This work was supported by the National Institutes of Health (Grant Nos. NIH K23 GM110540, R35GM128691).

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, 45 Francis St, Boston, MA, 02115, USA

    Jenna M. Wilson, Carin A. Colebaugh, K. Mikayla Flowers, Robert R. Edwards & Kristin L. Schreiber

  2. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA

    Ann H. Partridge

  3. Department of Surgery, Brigham and Women’s Hospital, Boston, USA

    Laura S. Dominici

  4. Breast Oncology Center, Dana-Farber Cancer Institute, Boston, USA

    Laura S. Dominici

Authors
  1. Jenna M. Wilson
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  2. Carin A. Colebaugh
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  3. K. Mikayla Flowers
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  4. Robert R. Edwards
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  5. Ann H. Partridge
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  6. Laura S. Dominici
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  7. Kristin L. Schreiber
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Corresponding author

Correspondence to Jenna M. Wilson.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board at Brigham and Women’s Hospital in Boston, MA.

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

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Wilson, J.M., Colebaugh, C.A., Flowers, K.M. et al. Early postoperative psychological distress as a mediator of subsequent persistent postsurgical pain outcomes among younger breast cancer patients. Breast Cancer Res Treat 196, 363–370 (2022). https://doi.org/10.1007/s10549-022-06720-2

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  • DOI: https://doi.org/10.1007/s10549-022-06720-2

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