Chronic pain and other symptoms among breast cancer survivors: prevalence, predictors, and effects on quality of life

Abstract

Purpose: To investigate prevalence and risk factors associated with self-reported chronic pain, and other symptoms related to breast cancer or its treatment among breast cancer survivors (BCS).

Methods: A cross-sectional study of a random sample of 410 female BCS, members of "Leumit" healthcare fund, diagnosed with primary nonmetastatic invasive breast cancer in the years 2002-2012. The study questionnaire included questions on health-related quality of life, pain symptoms, and was completed by all women contacted.

Results: A total of 305 BCS (74%), with a median of 7.4 years since diagnosis reported chronic pain, of whom 84% had moderate pain, and 97% experienced pain at least 1-3 days/week. Other symptoms were paresthesia (63%), allodynia (48%), and phantom sensations (15%). Report of pain symptoms, alone or combined, was significantly associated with poorer quality of life. In multivariable analyses, chronic pain was positively associated with mastectomy compared to breast-conserving surgery [Odds ratio (OR), 3.54; 95% confidence interval (CI) 1.46-8.59; P = 0.005], radiotherapy compared to non-radiotherapy (OR 2.96; 95% CI 1.43-6.12; P = 0.003), breast cancer stage at diagnosis-regional versus localized (OR 3.63; 95% CI 2.00-6.57; P < 0.001), and inversely with age (OR per one-year increment, 0.96; 95% CI 0.94-0.99; P = 0.002), and with time since diagnosis (OR per one-year increment, 0.82; 95% CI 0.75-0.90; P < 0.001).

Conclusions: With the increasing incidence of detected breast cancer and the improvements in treatment and consequently survival, knowledge about prevalence, and factors related to treatment late effects of chronic pain is highly relevant for potential prevention or management without negatively impacting quality of life.

Keywords: Breast cancer survivor; Breast-conserving surgery; Chronic pain; Mastectomy; Quality of life; Survivorship.