Abstract P2-14-06: Clinical and Health Behavioral Factors as Predictors of Treatment Related Pain 15 Months Post-Surgery in a Nationwide Cohort of Danish Women Treated for Primary Breast Cancer
Authors: Jensen AB , Christensen S , Moeller S , Zachariae R. 
Published: April 2011

Chronic pain related to surgery, radiotherapy and adjuvant medical therapy is an issue of growing interest in breast cancer rehabilitation. Recent studies have shown high prevalence of pain, and type of treatment has been shown to be influential on pain problems but little is known about other potential predictors such as the role of different health behaviors. AIM: To explore the prevalence of treatment related pain problems and the possible role of clinical and health behavioral factors as predictors for frequency and severity of pain in a nationwide prospective study. METHODS: The study cohort consisted of 3343 Danish women (aged 26-70) treated for primary breast cancer according to standardized guidelines. A questionnaire was mailed out 3-and 15-months post-surgery (follow-up). Response rate at follow-up was 94%. The Danish Breast Cancer Cooperative Group (DBCG) and the surgical departments provided data on eligibility and clinical variables. Data on demographic factors were obtained from national registries. Frequency and severity of treatment related pain in breast, arm and shoulder was assessed by questionnaire at follow-up (range: “no pain” to “all the time” and “no strain” to “extreme strain”). Data on health behaviors was obtained at baseline. RESULTS: At follow-up 73% of the women reported pain during the recent month and 33% experienced pain “almost every day” or more frequently. Twenty-eight percent were affected by pain at least “somewhat” and 11% were “very” or “extremely” affected. Age-adjusted binary logistic regression analyses showed that clinical predictors of frequent pain problems were: Lymph node positive disease (OR=1.45 (95% CI, 1.22-1.72)), endocrine therapy (OR=1.27, (95% CI, 1.08-1.50)), and radiotherapy (OR=1.25, (95% CI, 1.03-1.52)). No significant differences were found for adjuvant chemotherapy and type of surgery. Perceived severity of pain problems was only predicted by positive nodal status (OR=1.36(95% CI, 1.14-1.63)) and mastectomy (OR=1.26, (95% CI, 1.07-1.49)). Concerning health behaviors it was found that women smoking 10-19 cigarettes per day experienced pain more frequently compared to never-smokers (OR=1.47, (95% CI, 1.16-1.87)). Women never drinking alcohol had a higher risk of developing pain than moderate drinkers (&gt;=1 and &lt;2units per day) (OR=1.52, (95%CI, 1.14-2.03)). Finally the influence of physical activity were analyzed, showing the risk of experiencing pain increased significantly with impaired physical activity. Similar results were found for perceived severity of pain.

CONCLUSION: Treatment related pain problems were frequent and substantial. Nearly 3 out of 4 women experienced pain 15 months post-surgery, and 11% of the women were very or extremely affected by pain problems. Endocrine therapy, radiotherapy, and node positive disease showed to be predictors of the frequency of treatment related pain problems. Perceived severity of pain was predicted by positive nodal status and mastectomy. Smoking, low levels of physical activity, and abstaining from alcohol were predictive of more frequent and more severe pain problems.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-14-06.