Abstract
Purpose
Breast cancer patients receiving radiotherapy (RT) commonly report pain, contributing to physical and emotional distress, and potentially resulting in poor quality of life. This study prospectively identified trends and risk factors in patient-reported pain associated with breast irradiation using the Edmonton Symptom Assessment Scale (ESAS) and a study-specific Skin Symptom Assessment (SSA).
Methods
Before RT and once per week during RT, patients completed the ESAS and SSA. Upon RT completion, patients were contacted via telephone to complete both assessments weekly for 6 weeks, and a final assessment was conducted 1–3 months post-RT. Only data from patients who had completed both assessments before, at least once during, and at least once after RT were included in our analysis.
Results
A total of 426 patients provided data for the analysis. Overall acute pain increased significantly at week 1–2 (p < 0.0001), week 5 (p = 0.0011), and at 1–3 months (p < 0.0001) post-RT compared with baseline, and acute breast pain increased significantly at week 1 (p < 0.001) and week 2 (p = 0.0002) post-RT compared with baseline. Previous chemotherapy (adjuvant or neoadjuvant) in mastectomy patients was associated with increased overall pain compared with mastectomy patients without previous chemotherapy (p = 0.017). Younger patients (40–49 or 50–59 years of age) reported more overall pain (p = 0.0001, p = 0.038) and breast pain (p = 0.0003, p = 0.0038) compared with patients ≥ 60 years of age.
Conclusions
Patient-reported pain associated with breast irradiation peaked 1 week after RT completion. Our findings provide support for closer monitoring of acute pain associated with breast RT in younger patients.
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Funding
We thank the generous support of Bratty Family Fund, Michael and Karyn Goldstein Cancer Research Fund, Joey and Mary Furfari Cancer Research Fund, Pulenzas Cancer Research Fund, Joseph and Silvana Melara Cancer Research Fund, and Ofelia Cancer Research Fund.
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This study was approved by the research ethics board at Sunnybrook Health Sciences Centre. Informed consent was obtained prior to the first RT treatment.
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Appendices
Appendix 1 Edmonton Symptom Assessment Scale
Appendix 2 Skin Symptom Assessment
Appendix 3 ESAS and SSA pain severities
Time point | None | Mild | Moderate | Severe | Any paina | p valueb |
|---|---|---|---|---|---|---|
n (%) | n (%) | n (%) | n (%) | n (%) | ||
ESAS pain severity | ||||||
Baseline (N = 426) | 244 (57.28%) | 110 (25.82%) | 50 (11.74%) | 22 (5.16%) | 182 (42.72%) | Ref |
During RT week 1 (N = 321) | 162 (50.47%) | 113 (35.20%) | 33 (10.28%) | 13 (4.05%) | 159 (49.53%) | 0.0232 |
During RT week 2 (N = 358) | 168 (46.93%) | 131 (36.59%) | 44 (12.29%) | 15 (4.19%) | 190 (53.07%) | 0.0004 |
During RT week 3 (N = 327) | 113 (34.56%) | 142 (43.43%) | 54 (16.51%) | 18 (5.50%) | 214 (65.44%) | < 0.0001 |
During RT week 4 (N = 189) | 54 (28.57%) | 90 (47.62%) | 28 (14.81%) | 17 (8.99%) | 135 (71.43%) | < 0.0001 |
Post-RT week 1 (N = 165) | 35 (21.21%) | 63 (38.18%) | 45 (27.27%) | 22 (13.33%) | 130 (78.79%) | < 0.0001 |
Post-RT week 2 (N = 215) | 79 (36.74%) | 80 (37.21%) | 38 (17.67%) | 18 (8.37%) | 136 (63.26%) | < 0.0001 |
Post-RT week 3 (N = 202) | 95 (47.03%) | 60 (29.70%) | 34 (16.83%) | 13 (6.44%) | 107 (52.97%) | 0.0057 |
Post-RT week 4 (N = 215) | 104 (48.37%) | 74 (34.42%) | 24 (11.16%) | 13 (6.05%) | 111 (51.63%) | 0.0139 |
Post-RT week 5 (N = 187) | 84 (44.92%) | 71 (37.97%) | 20 (10.70%) | 12 (6.42%) | 103 (55.08%) | 0.0011 |
Post-RT week 6 (N = 191) | 90 (47.12%) | 67 (35.08%) | 26 (13.61%) | 8 (4.19%) | 101 (52.88%) | 0.0080 |
FU Appt (N = 272) | 119 (43.75%) | 102 (37.50%) | 36 (13.24%) | 15 (5.51%) | 153 (56.25%) | < 0.0001 |
SSA breast pain severity | ||||||
Baseline (N = 426) | 211 (49.53%) | 185 (43.43%) | 27 (6.34%) | 3 (0.70%) | 215 (50.47%) | Ref |
During RT week 1 (N = 327) | 205 (62.69%) | 105 (32.11%) | 15 (4.59%) | 2 (0.61%) | 122 (37.31%) | <0 .0001 |
During RT week 2 (N = 353) | 172 (48.73%) | 151 (42.78%) | 29 (8.22%) | 1 (0.28%) | 181 (51.27%) | 0.7995 |
During RT week 3 (N = 330) | 133 (40.30%) | 148 (44.85%) | 41 (12.42%) | 8 (2.42%) | 197 (59.70%) | 0.0041 |
During RT week 4 (N = 178) | 50 (28.09%) | 94 (52.81%) | 24 (13.48%) | 10 (5.62%) | 128 (71.91%) | < 0.0001 |
Post-RT week 1 (N = 160) | 39 (24.38%) | 71 (44.38%) | 36 (22.50%) | 14 (8.75%) | 121 (75.63%) | < 0.0001 |
Post-RT week 2 (N = 209) | 73 (34.93%) | 85 (40.67%) | 38 (18.18%) | 13 (6.22%) | 136 (65.07%) | 0.0002 |
Post-RT week 3 (N = 198) | 91 (45.96%) | 79 (39.90%) | 22 (11.11%) | 6 (3.03%) | 107 (54.04%) | 0.3652 |
Post-RT week 4 (N = 220) | 112 (50.91%) | 88 (40.00%) | 15 (6.82%) | 5 (2.27%) | 108 (49.09%) | 0.7218 |
Post-RT week 5 (N = 186) | 99 (53.23%) | 73 (39.25%) | 11 (5.91%) | 3 (1.61%) | 87 (46.77%) | 0.3634 |
Post-RT week 6 (N = 186) | 100 (53.76%) | 75 (40.32%) | 7 (3.76%) | 4 (2.15%) | 86 (46.24%) | 0.2857 |
FU Appt (N = 290) | 137 (47.24%) | 110 (37.93%) | 38 (13.10%) | 5 (1.72%) | 153 (52.76%) | 0.5125 |
Appendix 4 ESAS pain score in all patients and in subgroups of patients over time
Radiotherapy 5000/25 | Radiotherapy 4256/16 | |||||
|---|---|---|---|---|---|---|
Time point | Alone N (mean ± SD) | Plus boost N (mean ± SD) | p valuea | Alone N (mean ± SD) | Plus boost N (mean ± SD) | p valuea |
Baseline | 45 (1.84 ± 2.06) | 19 (1.37 ± 1.86) | 0.3654 | 203 (1.45 ± 2.26) | 154 (1.36 ± 2.14) | 0.8318 |
During RT (1) | 35 (1.31 ± 1.75) | 14 (1.14 ± 1.17) | 0.9133 | 152 (1.39 ± 2.07) | 115 (1.50 ± 2.17) | 0.7183 |
During RT (2) | 36 (1.89 ± 2.01) | 16 (1.13 ± 1.26) | 0.3358 | 169 (1.67 ± 2.37) | 133 (1.45 ± 1.90) | 0.8051 |
During RT (3) | 34 (1.47 ± 1.58) | 16 (1.44 ± 1.46) | 0.9305 | 154 (2.08 ± 2.48) | 118 (1.95 ± 2.02) | 0.8442 |
During RT (4) | 35 (2.03 ± 2.01) | 17 (2.18 ± 2.19) | 0.9574 | 36 (3.00 ± 2.95) | 96 (2.18 ± 2.27) | 0.1992 |
Post-RT (1) | 12 (3.92 ± 2.47) | 6 (3.00 ± 3.10) | 0.3260 | 72 (3.04 ± 2.81) | 70 (3.23 ± 2.59) | 0.4329 |
Post-RT (2) | 17 (2.18 ± 1.70) | 8 (2.38 ± 2.13) | 0.9746 | 103 (2.22 ± 2.58) | 82 (2.27 ± 2.47) | 0.7229 |
Post-RT (3) | 15 (2.13 ± 2.23) | 9 (1.44 ± 1.59) | 0.5180 | 95 (2.04 ± 2.42) | 80 (1.63 ± 2.44) | 0.1369 |
Post-RT (4) | 23 (2.09 ± 2.41) | 11 (1.64 ± 2.42) | 0.4989 | 105 (1.79 ± 2.43) | 71 (1.34 ± 2.03) | 0.2116 |
Post-RT (5) | 19 (2.79 ± 2.80) | 8 (1.75 ± 2.38) | 0.3475 | 92 (1.29 ± 1.99) | 64 (1.81 ± 2.22) | 0.0632 |
Post-RT (6) | 19 (1.84 ± 2.41) | 8 (1.13 ± 1.81) | 0.4207 | 89 (1.88 ± 2.59) | 71 (1.27 ± 1.64) | 0.3136 |
FU Appt | 25 (1.88 ± 2.45) | 7 (0.86 ± 1.07) | 0.3280 | 134 (1.84 ± 2.21) | 102 (1.71 ± 2.25) | 0.5171 |
Tangents technique | Locoregional technique | |||||
Time point | Alone N (mean ± SD) | Plus boost N (mean ± SD) | p valueb | Alone N (mean ± SD) | Plus boost N (mean ± SD) | p valueb |
Baseline | 153 (1.43 ± 2.30) | 122 (1.31 ± 2.19) | 0.6942 | 99 (1.61 ± 2.08) | 51 (1.49 ± 1.90) | 0.8456 |
During RT (1) | 119 (1.39 ± 2.16) | 95 (1.61 ± 2.30) | 0.4674 | 72 (1.28 ± 1.71) | 34 (1.03 ± 1.22) | 0.6956 |
During RT (2) | 125 (1.70 ± 2.42) | 105 (1.54 ± 2.03) | 0.9724 | 84 (1.65 ± 2.12) | 44 (1.11 ± 1.28) | 0.3630 |
During RT (3) | 118 (1.95 ± 2.51) | 95 (1.98 ± 2.10) | 0.4922 | 74 (1.93 ± 2.04) | 39 (1.67 ± 1.59) | 0.6842 |
During RT (4) | 33 (2.91 ± 2.74) | 75 (2.31 ± 2.38) | 0.2636 | 42 (2.02 ± 2.32) | 38 (1.92 ± 1.96) | 0.9280 |
Post-RT (1) | 53 (3.02 ± 2.69) | 55 (3.13 ± 2.70) | 0.7949 | 35 (3.14 ± 2.87) | 21 (3.43 ± 2.40) | 0.4721 |
Post-RT (2) | 78 (2.00 ± 2.43) | 60 (2.20 ± 2.55) | 0.6873 | 46 (2.52 ± 2.45) | 30 (2.43 ± 2.22) | 0.9901 |
Post-RT (3) | 73 (2.00 ± 2.35) | 62 (1.60 ± 2.25) | 0.2426 | 39 (2.13 ± 2.46) | 27 (1.63 ± 2.65) | 0.2441 |
Post-RT (4) | 77 (1.51 ± 2.11) | 51 (1.35 ± 2.05) | 0.6662 | 55 (2.29 ± 2.70) | 31 (1.42 ± 2.14) | 0.1011 |
Post-RT (5) | 64 (1.30 ± 1.95) | 46 (1.98 ± 2.32) | 0.0611 | 50 (1.88 ± 2.45) | 26 (1.50 ± 2.02) | 0.6401 |
Post-RT (6) | 66 (2.00 ± 2.69) | 59 (1.14 ± 1.54) | 0.1281 | 45 (1.62 ± 2.28) | 20 (1.60 ± 1.93) | 0.8613 |
FU Appt | 106 (1.92 ± 2.17) | 77 (1.73 ± 2.34) | 0.3515 | 56 (1.75 ± 2.41) | 32 (1.47 ± 1.83) | 0.7520 |
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Lam, E., Wong, G., Zhang, L. et al. Self-reported pain in breast cancer patients receiving adjuvant radiotherapy. Support Care Cancer 29, 155–167 (2021). https://doi.org/10.1007/s00520-020-05462-5
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DOI: https://doi.org/10.1007/s00520-020-05462-5