Assessing the Relationship of Different Levels of Pain to the Health Status of Long-Term Breast Cancer Survivors: A Cross-Sectional Study

Abstract

Purpose: This study investigated the relationship between different pain levels in the affected arm and health status in long-term breast cancer survivors (LTBCSs) and identified predictors of pain at this stage of long-term survivorship. Methods: A cross-sectional study of 80 participants categorized LTBCSs by pain levels in the affected arm into three groups: no pain (0-0.99), mild pain (1-3.99), and moderate to severe pain (4-10). Variables assessed at least 5 years since diagnosis include pain in the non-affected arm, pain interference, cancer-related fatigue (CRF), physical activity (PA) level, fitness condition, mood state, and health-related quality of life (HRQoL). Results: A total of 36.25% of LTBCSs have no pain, 30% have mild pain, and 33.75% have moderate to severe pain. Furthermore, pain presence was associated with increased pain in the non-affected arm, pain interference, CRF, mood disturbances, and physical inactivity, as well as a decreased HRQoL (all p < 0.05). Regression analysis found "upset by hair loss", CRF "affective domain", "dyspnea", and "alcohol consumption" as significant predictors of higher levels of pain in the affected arm (r² adjusted = 0.646). Conclusions: A total of 63.75% of LTBCSs continue to experience mild to moderate to severe pain in the affected arm, negatively impacting their physical, mental, and emotional health status, with increased pain severity ≥5 years beyond cancer diagnosis. "Upset by hair loss", CRF "affective domain", "dyspnea", and alcohol consumption collectively explain 64.6% of the affected-arm pain level in LTBCSs.

Keywords: breast cancer; long-term survivorship; pain; quality of life; rehabilitation.

Figure 1

Fitness condition of LTBCSs according to the level of pain in the affected arm expressed as mean ± SD. Abbreviations: IFIS: International Fitness Scale, n: sample size, SD: standard deviation. Note: International Fitness Scale values are as follows: (1) very poor, (2) poor, (3) average, (4) good, and (5) very good. Note: The median and inter-quartile range can be found in Supplementary Material Table S1. p-values for between-group differences were calculated using the t test (Mann–Whitney U test). * p ˂ 0.05.

Figure 2

Spearman’s correlation coefficient for pain in the affected arm using the Visual Analogue Scale (VAS). Abbreviations: VAS: Visual Analogue Scale, PFS: Piper Fatigue Scale, IFIS: International Fitness Scale, EVEA: Scale for Mood Assessment, QLQC30: the EORTC Core Quality of Life Questionnaire, QLQBR23: the Breast Cancer-Specific Module, SCC: Spearman’s correlation coefficient. Note: For this analysis, the VAS data as the dependent variable were used in their non-categorized version. * p ˂ 0.05/** p < 0.01.