The impact of adverse childhood experiences on pain and subjective cognitive decline in patients treated for localized breast cancer: The mediating role of sense of coherence, sense of danger and psychosocial distress and danger

Abstract

Background: Pain and subjective cognitive decline (SCD) are common sequala of breast cancer (BC) treatment. Adverse childhood experiences (ACEs) are associated with pain and adverse health outcomes in noncancer population. Sense of coherence (SOC) reflects the disposition that life is manageable and predictable. Sense of danger (SOD) is the extent of perceived danger to oneself and family from a specific stressor. We aimed to assess if ACEs are associated with pain and SCD in patients treated for localized BC, and whether decreased SOC, increased SOD from BC, and increased psychological distress mediate these links.

Methods: This study is a primary analysis of an on-going prospective trial, recruiting patients with localized BC before (neo) adjuvant oncological therapy. Patients completed validated questionnaires on ACEs, pain, SCD, SOC, SOD, and psychosocial distress. Demographic and clinical data were also collected.

Results: We performed an analysis of baseline assessments in 127 patients. After controlling for demographic and clinical factors that correlated with study variables, serial mediation analyses confirmed that ACEs were associated with increased pain and SCD. These links were mediated by decreased SOC, followed by increased SOD, followed by increased psychosocial distress (all p's < 0.001). The models explained 50.14 % of the variance in pain and 43.37 % of the variance in SCD.

Conclusion: Our study suggests that ACEs increase the risk of pain and SCD in patients with localized BC, mediated by SOC, SOD, and psychosocial distress. These factors should be addressed when aiming to reduce symptom burden in BC patients.

Keywords: Adverse childhood events; Childhood adversity; Cognitive decline; Pain; Sense of coherence; Sense of danger; Survivorship.

Fig. 1

ACEs prevalence in the sample (N = 127).

Fig. 2

Path diagram for the association between the number of adverse experiences and pain through SOC, SOC, and psychosocial distress (N = 115). Note. Analyses were conducted while controlling for the number of comorbidities, BC stage, planned chemotherapy, educational level, and living with a partner status. Statistics are standardized regression coefficients. Solid lines indicate significant paths. Dashed lines represent non-significant paths. a Standardized regression coefficient of the effect of adverse events on pain when the mediators (i.e., SOC, SOD, and psychosocial distress) are not considered. b Standardized regression coefficient of the effect of adverse events on pain when the mediators when the effects of the mediators (i.e., SOC, SOD, and psychosocial distress) are considered. ∗p < .05. ∗∗p < .01. ∗∗∗p < .001.

Fig. 3

Path Diagram for the Association between the Number of Adverse Experiences and SCD through SOC, SOD and psychosocial distress (N = 114). Note. Analyses were conducted while controlling for the number of comorbidities, BC stage, planned chemotherapy, educational level, and living with a partner status. Statistics are standardized regression coefficients. Solid lines indicate significant paths. Dashed lines represent non-significant paths. ^a Standardized regression coefficient of the effect of adverse events on cognitive impairment when the mediators (i.e., SOC, SOD, and psychosocial distress) are not considered. ^b Standardized regression coefficient of the effect of adverse events on cognitive impairment when the mediators when the effects of the mediators (i.e., SOc, SOD, and psychosocial distress) are considered. ∗p < .05. ∗∗p < .01. ∗∗∗p < .001.