Skip to main content
Top
Published in: Journal of Cancer Survivorship 1/2014

01-03-2014

Persistent breast pain 5 years after treatment of invasive breast cancer is largely unexplained by factors associated with treatment

Authors: Robin J. Bell, Penelope J. Robinson, Fathima Nazeem, Mary Panjari, Pamela Fradkin, Max Schwarz, Susan R. Davis

Published in: Journal of Cancer Survivorship | Issue 1/2014

Login to get access

Abstract

Purpose

The aim of our study was to establish the prevalence of breast pain persisting 5 years after the initial treatment of breast cancer (BC) and the relationship between those persistent symptoms and general well-being.

Methods

The study involved women from Victoria, Australia, who had survived at least 5 years from diagnosis, remained free from recurrence or new BC and completed the fifth annual follow-up questionnaire. Analysis involved both multivariable logistic and linear regression.

Results

Of 1,205 women, 45 % reported breast pain which persisted for at least 3 months following initial treatment, and of these, 80 % reported pain persisting for at least 5 years. The factor contributing most to the likelihood of persistent breast pain was current lymphedema; however, a full multivariable model explained <10 % of the likelihood of breast pain persisting for 5 years. The presence of breast pain at 5 years was associated with only a modest reduction in general well-being.

Conclusions

Breast pain persisting for at least 5 years after treatment for BC is common. As the pain is largely unexplained by factors associated with the characteristics of the cancer or its treatment, the contribution of patient expectations to persistent breast pain may be considerable.

Implications for Cancer Survivors

Where persistent pain occurs, referral for the management of pain and, where appropriate, lymphedema is warranted.
Literature
1.
go back to reference Australian Institute of Health and Welfare. (2009) Breast cancer in Australia: an overview, 2009 Cat. no. CAN 46 Australian Institute of Health and Welfare. (2009) Breast cancer in Australia: an overview, 2009 Cat. no. CAN 46
2.
go back to reference Lundstedt D, Gustafsson M, Steineck G, Malmstrom P, Alsadius D, Sundberg A, et al. Risk factors of developing long-lasting breast pain after breast cancer radiotherapy. Int J Radiat Oncol Biol Phys. 2012;83:71–8.CrossRefPubMed Lundstedt D, Gustafsson M, Steineck G, Malmstrom P, Alsadius D, Sundberg A, et al. Risk factors of developing long-lasting breast pain after breast cancer radiotherapy. Int J Radiat Oncol Biol Phys. 2012;83:71–8.CrossRefPubMed
3.
go back to reference Steegers MA, Wolters B, Evers AW, Strobbe L, Wilder-Smith OH. Effect of axillary lymph node dissection on prevalence and intensity of chronic and phantom pain after breast cancer surgery. J Pain: Off J Am Pain Soc. 2008;9:813–22.CrossRef Steegers MA, Wolters B, Evers AW, Strobbe L, Wilder-Smith OH. Effect of axillary lymph node dissection on prevalence and intensity of chronic and phantom pain after breast cancer surgery. J Pain: Off J Am Pain Soc. 2008;9:813–22.CrossRef
4.
go back to reference Sheridan D, Foo I, O'Shea H, Gillanders D, Williams L, Fallon M, et al. Long-term follow-up of pain and emotional characteristics of women after surgery for breast cancer. J Pain Symptom Manag. 2012;44:608–14.CrossRef Sheridan D, Foo I, O'Shea H, Gillanders D, Williams L, Fallon M, et al. Long-term follow-up of pain and emotional characteristics of women after surgery for breast cancer. J Pain Symptom Manag. 2012;44:608–14.CrossRef
5.
go back to reference Miaskowski C, Cooper B, Paul SM, West C, Langford D, Levine JD, et al. Identification of patient subgroups and risk factors for persistent breast pain following breast cancer surgery. J Pain: OffJ Am Pain Soc. 2012;13:1172–87.CrossRef Miaskowski C, Cooper B, Paul SM, West C, Langford D, Levine JD, et al. Identification of patient subgroups and risk factors for persistent breast pain following breast cancer surgery. J Pain: OffJ Am Pain Soc. 2012;13:1172–87.CrossRef
6.
go back to reference Henry NL, Clauw DJ. Thinking beyond the tumor to better understand chronic symptoms in breast cancer survivors. Breast cancer Res Treat. 2012;133:413–6.CrossRefPubMed Henry NL, Clauw DJ. Thinking beyond the tumor to better understand chronic symptoms in breast cancer survivors. Breast cancer Res Treat. 2012;133:413–6.CrossRefPubMed
7.
go back to reference Hickey OT, Nugent NF, Burke SM, Hafeez P, Mudrakouski AL, Shorten GD. Persistent pain after mastectomy with reconstruction. J Clin Anesth. 2011;23:482–8.CrossRefPubMed Hickey OT, Nugent NF, Burke SM, Hafeez P, Mudrakouski AL, Shorten GD. Persistent pain after mastectomy with reconstruction. J Clin Anesth. 2011;23:482–8.CrossRefPubMed
8.
go back to reference Lijovic M, Davis SR, Fradkin P, La China M, Farrugia H, Wolfe R, et al. Use of a cancer registry is preferable to a direct-to-community approach for recruitment to a cohort study of wellbeing in women newly diagnosed with invasive breast cancer. BMC cancer. 2008;8:126.PubMedCentralCrossRefPubMed Lijovic M, Davis SR, Fradkin P, La China M, Farrugia H, Wolfe R, et al. Use of a cancer registry is preferable to a direct-to-community approach for recruitment to a cohort study of wellbeing in women newly diagnosed with invasive breast cancer. BMC cancer. 2008;8:126.PubMedCentralCrossRefPubMed
9.
go back to reference Dupuy H. The Psychological General Well-Being (PGWB) Index. In: Wenger NK, Mattson ME, Furberg C, Elinson J, editors. Assessment of quality of life in clinical trials of cardiovascular therapies. New York: Le Jacq Publishing Incorporated; 1984. p. 170–83. Dupuy H. The Psychological General Well-Being (PGWB) Index. In: Wenger NK, Mattson ME, Furberg C, Elinson J, editors. Assessment of quality of life in clinical trials of cardiovascular therapies. New York: Le Jacq Publishing Incorporated; 1984. p. 170–83.
10.
go back to reference Armitage P, Berry G. Statistical methods in medical research. Oxford: Blackwell Scientific Publications; 1994. Armitage P, Berry G. Statistical methods in medical research. Oxford: Blackwell Scientific Publications; 1994.
11.
go back to reference Gartner R, Jensen MB, Nielsen J, Ewertz M, Kroman N, Kehlet H. Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA: J Am Med Assoc. 2009;302:1985–92.CrossRef Gartner R, Jensen MB, Nielsen J, Ewertz M, Kroman N, Kehlet H. Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA: J Am Med Assoc. 2009;302:1985–92.CrossRef
12.
go back to reference Wallace MS, Wallace AM, Lee J, Dobke MK. Pain after breast surgery: a survey of 282 women. Pain. 1996;66:195–205.CrossRefPubMed Wallace MS, Wallace AM, Lee J, Dobke MK. Pain after breast surgery: a survey of 282 women. Pain. 1996;66:195–205.CrossRefPubMed
13.
go back to reference Poleshuck EL, Katz J, Andrus CH, Hogan LA, Jung BF, Kulick DI, et al. Risk factors for chronic pain following breast cancer surgery: a prospective study. J Pain: Off J Am Pain Soc. 2006;7:626–34.CrossRef Poleshuck EL, Katz J, Andrus CH, Hogan LA, Jung BF, Kulick DI, et al. Risk factors for chronic pain following breast cancer surgery: a prospective study. J Pain: Off J Am Pain Soc. 2006;7:626–34.CrossRef
14.
go back to reference Rief W, Bardwell WA, Dimsdale JE, Natarajan L, Flatt SW, Pierce JP. Long-term course of pain in breast cancer survivors: a 4-year longitudinal study. Breast Cancer Res Treat. 2011;130:579–86.PubMedCentralCrossRefPubMed Rief W, Bardwell WA, Dimsdale JE, Natarajan L, Flatt SW, Pierce JP. Long-term course of pain in breast cancer survivors: a 4-year longitudinal study. Breast Cancer Res Treat. 2011;130:579–86.PubMedCentralCrossRefPubMed
15.
go back to reference Bell RJ, Robinson PJ, Barallon R, Fradkin P, Schwarz M, Davis SR. Lymphedema: experience of a cohort of women with breast cancer followed for 4 years after diagnosis in Victoria. Aust Support Care Cancer: Off J Multinatl Assoc Support Care Cancer. 2013;21:2017–24.CrossRef Bell RJ, Robinson PJ, Barallon R, Fradkin P, Schwarz M, Davis SR. Lymphedema: experience of a cohort of women with breast cancer followed for 4 years after diagnosis in Victoria. Aust Support Care Cancer: Off J Multinatl Assoc Support Care Cancer. 2013;21:2017–24.CrossRef
16.
go back to reference Bell RJ, Fradkin P, Schwarz M, Davis SR. Understanding discontinuation of oral adjuvant endocrine therapy by women with hormone receptor-positive invasive breast cancer nearly 4 years from diagnosis. Menopause. 2013;20:15–21.CrossRefPubMed Bell RJ, Fradkin P, Schwarz M, Davis SR. Understanding discontinuation of oral adjuvant endocrine therapy by women with hormone receptor-positive invasive breast cancer nearly 4 years from diagnosis. Menopause. 2013;20:15–21.CrossRefPubMed
17.
go back to reference Bruce J, Thornton AJ, Scott NW, Marfizo S, Powell R, Johnston M, et al. Chronic preoperative pain and psychological robustness predict acute postoperative pain outcomes after surgery for breast cancer. British J Cancer. 2012;107:937–46.CrossRef Bruce J, Thornton AJ, Scott NW, Marfizo S, Powell R, Johnston M, et al. Chronic preoperative pain and psychological robustness predict acute postoperative pain outcomes after surgery for breast cancer. British J Cancer. 2012;107:937–46.CrossRef
18.
go back to reference Katz J, Poleshuck EL, Andrus CH, Hogan LA, Jung BF, Kulick DI, et al. Risk factors for acute pain and its persistence following breast cancer surgery. Pain. 2005;119:16–25.CrossRefPubMed Katz J, Poleshuck EL, Andrus CH, Hogan LA, Jung BF, Kulick DI, et al. Risk factors for acute pain and its persistence following breast cancer surgery. Pain. 2005;119:16–25.CrossRefPubMed
19.
go back to reference Montgomery GH, Schnur JB, Erblich J, Diefenbach MA, Bovbjerg DH. Presurgery psychological factors predict pain, nausea, and fatigue one week after breast cancer surgery. J Pain Symptom Manag. 2010;39:1043–52.CrossRef Montgomery GH, Schnur JB, Erblich J, Diefenbach MA, Bovbjerg DH. Presurgery psychological factors predict pain, nausea, and fatigue one week after breast cancer surgery. J Pain Symptom Manag. 2010;39:1043–52.CrossRef
20.
go back to reference Janz NK, Mujahid M, Chung LK, Lantz PM, Hawley ST, Morrow M, et al. Symptom experience and quality of life of women following breast cancer treatment. J Womens Health (Larchmt). 2007;16:1348–61.CrossRef Janz NK, Mujahid M, Chung LK, Lantz PM, Hawley ST, Morrow M, et al. Symptom experience and quality of life of women following breast cancer treatment. J Womens Health (Larchmt). 2007;16:1348–61.CrossRef
21.
go back to reference Bell RJ, Lijovic M, La China M, Schwarz M, Fradkin P, Bradbury J, et al. Psychological well-being in a cohort of women with invasive breast cancer nearly 2 years after diagnosis. Support Care Cancer: Off J Multinatl Assoc Support Care Cancer. 2010;18:921–9.CrossRef Bell RJ, Lijovic M, La China M, Schwarz M, Fradkin P, Bradbury J, et al. Psychological well-being in a cohort of women with invasive breast cancer nearly 2 years after diagnosis. Support Care Cancer: Off J Multinatl Assoc Support Care Cancer. 2010;18:921–9.CrossRef
Metadata
Title
Persistent breast pain 5 years after treatment of invasive breast cancer is largely unexplained by factors associated with treatment
Authors
Robin J. Bell
Penelope J. Robinson
Fathima Nazeem
Mary Panjari
Pamela Fradkin
Max Schwarz
Susan R. Davis
Publication date
01-03-2014
Publisher
Springer US
Published in
Journal of Cancer Survivorship / Issue 1/2014
Print ISSN: 1932-2259
Electronic ISSN: 1932-2267
DOI
https://doi.org/10.1007/s11764-013-0306-6

Other articles of this Issue 1/2014

Journal of Cancer Survivorship 1/2014 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine