Many Patients Have Some Pain 12 Months After Breast Cancer Surgery
In a prospective study reported as a research letter in JAMA, Meretoja et al found that 50% of patients had mild pain and 16% moderate or severe pain at 12 months after surgery for breast cancer. Factors predictive of pain were chronic preoperative pain, preoperative pain in the area of surgery, preoperative depression, axillary lymph node dissection, receipt of chemotherapy, and receipt of radiotherapy.
Study Details
The study included 860 consecutive patients aged < 75 years with unilateral nonmetastatic breast cancer treated at the Helsinki University Central Hospital from 2006 to 2010 with either breast-conserving surgery or mastectomy with axillary surgery. Patients receiving neoadjuvant treatment or immediate or delayed breast reconstruction or who were negative for breast cancer on final histology evaluation were not included in the study. Pain in the operative area (breast, axilla, arm) was rated on a numeric scale as none (0), mild (1–3), moderate (4–6), or severe (≥ 7).
Most patients were aged > 50 years (75%), histology of the primary tumor was infiltrating ductal carcinoma in 65% and infiltrating lobular carcinoma in 17%, 24% had chronic preoperative pain with a mean worst pain score of 1.3 in the area of surgery, 54% had preoperative hormone therapy, 59% were never smokers, 62% had resection and 38% mastectomy, 48% had axillary node dissection and 52% had sentinel node biopsy, 15% had lymphovascular invasion in primary tumor, 60% were at medium and 19% at high prognostic risk, 57% received chemotherapy (86% docetaxel), 73% radiotherapy, and 68% endocrine therapy (tamoxifen in 38% and aromatase inhibitor in 31%).
Patients had a mean body mass index of 25.4 kg/m2, a mean of 2.3 prior operations (mean of 0.1 breast operations), a mean of 1.6 metastatic lymph nodes, mean tumor size of 19.3 mm, mean score of 7.1 on the Beck Depression Inventory, and mean scores of 33.0 and 34.5 on the Spielberger Anxiety Questionnaire trait scale and state scale.
Prevalence of Pain and Predictors
At 12 months after surgery, 34.5% (95% confidence interval [CI] = 31.4%–37.8%) of patients reported no pain, 49.7% (95% CI = 46.3%–53.0%) mild pain, 12.1% (95% CI = 10.0%–14.5%) moderate pain, and 3.7% (95% CI = 2.6%–5.3%) severe pain. On logistic regression analysis, factors significantly associated with pain were chronic preoperative pain (odds ratio [OR] = 0.70 for no vs yes, P = .04), preoperative pain in the area of surgery (OR = 1.40, P < .001), preoperative depression (OR = 1.04, P = .003), axillary lymph node dissection (OR = 0.40 for sentinel node biopsy vs axillary node dissection, P < .001), receipt of chemotherapy (OR = 1.47, P = .03), and receipt of radiotherapy (OR = 0.51 for no vs yes, P < .001). Factors not significantly associated with pain were receipt of preoperative hormone therapy, lymphovascular invasion in primary tumor, risk class, body mass index, number of previous operations, size of primary tumor, and anxiety rating.
The investigators concluded, “These findings may be useful in developing strategies for preventing persistent pain following breast cancer treatment.”
Tuomo J. Meretoja, MD, PhD, of Helsinki University Central Hospital, is the corresponding author for the JAMA research letter.
The study was supported by grants from the Academy of Finland and Helsinki and Uusimaa Hospital District and by funding from the Orion-Pharmos Research Foundation and the Emil Aaltonen Foundation.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
