Pain Self-Management Behaviors in Breast Cancer Survivors Six Months Post-Primary Treatment: A Mixed-Methods, Descriptive Study

doi:10.3390/cancers17071087

. 2025 Mar 24;17(7):1087.

doi: 10.3390/cancers17071087.

Pain Self-Management Behaviors in Breast Cancer Survivors Six Months Post-Primary Treatment: A Mixed-Methods, Descriptive Study

Kaitlin M McGarragle^{1

2}, Sunny Zheng¹, Lucia Gagliese^{3

4

5

6

7}, Doris Howell¹, Elizabeth Edwards¹, Cheryl Pritlove^{1

8

9}, David McCready^{10

11}, Christine Elser^{12

13

14}, Jennifer M Jones^{1

6}, Lynn R Gauthier^{15

16

17}

Affiliations

¹ Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G 2M9, Canada.
² Institute of Medical Science, University of Toronto, Toronto, ON M5S 3H2, Canada.
³ School of Kinesiology and Health Science, York University, Toronto, ON M3J 1P3, Canada.
⁴ Department of Anesthesia and Pain Management, University Health Network, Toronto, ON M5G 2C4, Canada.
⁵ Department of Anesthesia, University of Toronto, Toronto, ON M5T 2S8, Canada.
⁶ Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada.
⁷ Department of Anesthesia and Pain Management, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5, Canada.
⁸ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada.
⁹ Division of Social and Behavioral Science, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada.
¹⁰ Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G 2M9, Canada.
¹¹ Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON M5T 1P5, Canada.
¹² Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G 2M9, Canada.
¹³ Division of Medical Oncology, Faculty of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada.
¹⁴ Marvelle Koffler Breast Center, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5, Canada.
¹⁵ Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada.
¹⁶ Michel-Sarrazin Research Team in Psychosocial Oncology and Palliative Care, CHU de Québec-Laval University Research Center, Oncology Division, Quebec, QC G1J 1Z4, Canada.
¹⁷ Cancer Research Center, Laval University, Quebec, QC G1R 3S3, Canada.

PMID: 40227575
PMCID: PMC11987997
DOI: 10.3390/cancers17071087

Pain Self-Management Behaviors in Breast Cancer Survivors Six Months Post-Primary Treatment: A Mixed-Methods, Descriptive Study

Kaitlin M McGarragle et al. Cancers (Basel). 2025.

. 2025 Mar 24;17(7):1087.

doi: 10.3390/cancers17071087.

Authors

Affiliations

¹ Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G 2M9, Canada.
² Institute of Medical Science, University of Toronto, Toronto, ON M5S 3H2, Canada.
³ School of Kinesiology and Health Science, York University, Toronto, ON M3J 1P3, Canada.
⁴ Department of Anesthesia and Pain Management, University Health Network, Toronto, ON M5G 2C4, Canada.
⁵ Department of Anesthesia, University of Toronto, Toronto, ON M5T 2S8, Canada.
⁶ Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada.
⁷ Department of Anesthesia and Pain Management, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5, Canada.
⁸ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada.
⁹ Division of Social and Behavioral Science, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada.
¹⁰ Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G 2M9, Canada.
¹¹ Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON M5T 1P5, Canada.
¹² Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G 2M9, Canada.
¹³ Division of Medical Oncology, Faculty of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada.
¹⁴ Marvelle Koffler Breast Center, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5, Canada.
¹⁵ Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada.
¹⁶ Michel-Sarrazin Research Team in Psychosocial Oncology and Palliative Care, CHU de Québec-Laval University Research Center, Oncology Division, Quebec, QC G1J 1Z4, Canada.
¹⁷ Cancer Research Center, Laval University, Quebec, QC G1R 3S3, Canada.

PMID: 40227575
PMCID: PMC11987997
DOI: 10.3390/cancers17071087

Abstract

Background/Objectives: One-third of breast cancer (BC) survivors experience chronic treatment-related pain (CTP) that requires multimodal management strategies, which may include pain self-management behaviors (PSMBs). Most studies exploring PSMBs focus on patients with advanced cancer, who may differ from survivors in their pain management needs and access to resources. This mixed-methods study explored PSMBs of survivors of BC, referral sources, and goals for pain relief, and examined the relationship between PSMB engagement and pain intensity/interference. Methods: Survivors of BC who were six months post-treatment completed measures assessing their pain intensity/interference and PSMB engagement. Purposive sampling identified a subset of participants who completed interviews, which were analyzed using thematic analysis. Results: Participants (n = 60) were 60 ± 10 years old. Worst Pain Intensity and Pain Interference were 3.93 ± 2.36 and 2.09 ± 2.11, respectively. Participants engaged in 7 ± 3.5 PSMBs. The most common were walking (76%) and distraction (76%). PSMBs described in the interviews (n = 10) were arm stretching and strengthening exercises, seeking specialized pain management services, and avoidance. Most PSMBs were self-directed or suggested by friends. All pain relief goals were to minimize pain interference. PSMB engagement was not associated with Worst, Least, or Average Pain Intensity (all r_s ≤ -0.2, p ≥ 0.05) but was associated with Pain Interference (r_s = 0.3, p ≤ 0.01). Conclusions: The survivors of BC engaged in many PSMBs, with varying levels of effectiveness and a varying quality of supporting evidence. Most PSMBs were self-directed and some required intervention from healthcare providers or other people, while others required access to limited specialized pain management services.

Keywords: breast cancer; pain; self-management; survivorship.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

**Figure 2**
Distribution of qualitative participants based on purposive sampling. Note: pain intensity was measured using BPI Worst Pain and engagement in PSMBs was measured using the PSCBQ subscale ‘Total Number of PSMB’.

See this image and copyright information in PMC

References

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[1] Ferlay J., Soerjomataram I., Dikshit R., Eser S., Mathers C., Rebelo M., Parkin D.M., Forman D., Bray F. Cancer Incidence and Mortality Worldwide: Sources, Methods and Major Patterns in GLOBOCAN 2012. Int. J. Cancer. 2015;136:E359–E386. doi: 10.1002/ijc.29210. - DOI - PubMed

[2] Ferlay J., Soerjomataram I., Dikshit R., Eser S., Mathers C., Rebelo M., Parkin D.M., Forman D., Bray F. Cancer Incidence and Mortality Worldwide: Sources, Methods and Major Patterns in GLOBOCAN 2012. Int. J. Cancer. 2015;136:E359–E386. doi: 10.1002/ijc.29210. - DOI - PubMed

[3] Canadian Cancer Society. Canadian Cancer Society’s. Advisory Committee on Cancer Statistics . Canadian Cancer Statistics 2017. Cancer Society; Toronto, ON, Canada: 2017.

[4] Canadian Cancer Society. Canadian Cancer Society’s. Advisory Committee on Cancer Statistics . Canadian Cancer Statistics 2017. Cancer Society; Toronto, ON, Canada: 2017.

[5] Paice J.A., Portenoy R., Lacchetti C., Campbell T., Cheville A., Citron M., Constine L.S., Cooper A., Glare P., Keefe F., et al. Management of Chronic Pain in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. J. Clin. Oncol. 2016;34:3325–3345. doi: 10.1200/JCO.2016.68.5206. - DOI - PubMed

[6] Paice J.A., Portenoy R., Lacchetti C., Campbell T., Cheville A., Citron M., Constine L.S., Cooper A., Glare P., Keefe F., et al. Management of Chronic Pain in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. J. Clin. Oncol. 2016;34:3325–3345. doi: 10.1200/JCO.2016.68.5206. - DOI - PubMed

[7] van den Beuken-van Everdingen M.H., de Rijke J.M., Kessels A.G., Schouten H.C., van Kleef M., Patijn J. Prevalence of Pain in Patients with Cancer: A Systematic Review of the Past 40 Years. Ann. Oncol. 2007;18:1437–1449. - PubMed

[8] van den Beuken-van Everdingen M.H., de Rijke J.M., Kessels A.G., Schouten H.C., van Kleef M., Patijn J. Prevalence of Pain in Patients with Cancer: A Systematic Review of the Past 40 Years. Ann. Oncol. 2007;18:1437–1449. - PubMed

[9] Van Den Beuken-Van Everdingen M.H.J., Hochstenbach L.M.J., Joosten E.A.J., Tjan-Heijnen V.C.G., Janssen D.J.A. Update on Prevalence of Pain in Patients with Cancer: Systematic Review and Meta-Analysis. J. Pain. Symptom Manag. 2016;51:1070–1090.e9. doi: 10.1016/j.jpainsymman.2015.12.340. - DOI - PubMed

[10] Van Den Beuken-Van Everdingen M.H.J., Hochstenbach L.M.J., Joosten E.A.J., Tjan-Heijnen V.C.G., Janssen D.J.A. Update on Prevalence of Pain in Patients with Cancer: Systematic Review and Meta-Analysis. J. Pain. Symptom Manag. 2016;51:1070–1090.e9. doi: 10.1016/j.jpainsymman.2015.12.340. - DOI - PubMed

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Pain Self-Management Behaviors in Breast Cancer Survivors Six Months Post-Primary Treatment: A Mixed-Methods, Descriptive Study

Affiliations

Pain Self-Management Behaviors in Breast Cancer Survivors Six Months Post-Primary Treatment: A Mixed-Methods, Descriptive Study

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Abstract

Conflict of interest statement

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