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

Sex Differences in the Regulation of Interleukins in Chronic Pain: A Widely Recognized but Difficult-to-Tackle Factor

Chronic pain is an extremely prevalent healthcare issue that has a profound impact on individuals and society. Sex and sex hormones regulate the pain threshold differently in males and females in pain processing. However, the regulatory mechanisms of sex differences in response to painful stimuli are still unclear, which contributes to the difficulty of analgesic drug development. Interleukins mediate neuroinflammation and are involved in the development of chronic pain. Recent studies have found that sex and sex hormones are involved in the regulation of pain thresholds by interleukins. Most previous studies used male animals to study the analgesic effects of treatments due to the complexity of estrogen. This review summarizes studies that used only female animals or both sexes to examine the impact of sex on interleukin-regulated chronic pain, to provide a theoretical basis for the development of more targeted precision medicines for pain.

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

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 rs ≤ -0.2, p ≥ 0.05) but was associated with Pain Interference (rs = 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.

Survivorship concerns among posttreatment cancer survivors in South Korea: A secondary analysis of a cross-sectional survey

BACKGROUND

Cancer survivors may have a variety of survivorship concerns despite their cancer treatment having ended, with some negatively affecting their health-related quality of life. An in-depth understanding of survivorship concerns is essential for the development of survivorship care programs. However, previous findings have been limited to Western countries, and evidence from Asian countries is lacking.

OBJECTIVE

This study aimed to examine the prevalence of survivorship concerns among posttreatment cancer survivors in South Korea, identify factors associated with survivorship concerns, and explore their relationship with health-related quality of life.

DESIGN

Secondary analysis of a cross-sectional survey.

SETTING

Data were collected through an online survey of five online communities of cancer survivors in South Korea.

PARTICIPANTS

Overall, 1019 cancer survivors diagnosed with breast, colorectal, lung, stomach, and thyroid cancer (top five cancers in South Korea) who completed their cancer treatment.

METHODS

The survey collected data on demographic, disease- and treatment-related characteristics, survivorship concerns, and health-related quality of life. Survivorship concerns were measured using the checklist for survivorship concerns from the National Comprehensive Cancer Network Guidelines for Cancer Survivorship, which includes 12 survivorship concerns (e.g. cardiac toxicity, distress, cognitive dysfunction, fatigue, lymphoedema). Health-related quality of life was assessed using the Korean version of the 30-item European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire. Data were analysed using descriptive statistics, the Chi-square test, and multiple regression.

RESULTS

The prevalence of survivorship concerns ranged from 34.7 % to 78.4 %. Fatigue (78.4 %), unhealthy lifestyle (74.8 %), cognitive dysfunction (60.5 %), insomnia (58.9 %), and distress (52.9 %) were the five most frequent concerns. Survivors aged in their 50s, those diagnosed with stomach cancer, those with an elapsed time of ≥2 years but <5 years since diagnosis, and those who had received chemotherapy and/or radiotherapy were significantly more likely to report survivorship concerns. Regression analyses revealed that all survivorship concerns were significant predictors of one or more subscales of health-related quality of life. Distress was found to be a significant predictor of all six subscales of the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire.

CONCLUSIONS

This study revealed that posttreatment cancer survivors in South Korea had various survivorship concerns that decreased their health-related quality of life. To improve their health-related quality of life, systematic screening of survivorship concerns and timely appropriate interventions are critical. Our findings can thus contribute to the development of targeted survivorship care programs in Asia.

STUDY REGISTRATION

Not registered.

Chronic pain is a risk factor for all-cause and cancer-specific mortality in cancer survivors: a population-based cohort study

BACKGROUND

Evidence is lacking on whether chronic pain is related to the risk of cancer mortality. This study seeks to unveil the association between chronic pain and all-cause, cancer, as well as non-cancer death in cancer patients based on the National Health and Nutrition Examination Survey (NHANES) database.

METHODS

Cancer survivors aged at least 20 (n = 1369) from 3 NHANES (1999-2004) cycles were encompassed. Chronic pain and cancer were determined through self-report. We employed records from the National Death Index for the determination of death status and reason. All-cause, cancer, and non-cancer deaths were primary outcomes. We used time-dependent ROC curve assessment to evaluate the predictive value of chronic pain for death in cancer patients.

RESULTS

Over a median 141-month follow-up (interquartile range: 61-201 months), 884 (64.57%) of 1,369 cancer sufferers died, of which 259 (18.91%) died from cancer, and 625 (45.65%) from other causes. Compared with non-chronic pain survivors, chronic pain correlated with elevated all-cause mortality (Hazard Ratio (HR), 1.40; 95% CI, 1.14-1.72, p = 0.001) and cancer death (HR, 1.75; 95% CI, 1.16-2.64, p = 0.008), primarily in patients with pain lasting 3 months or more. Chronic pain was related to higher non-cancer mortality (HR, 1.38; 95% CI, 1.04-1.82, p = 0.025), and no significant results were found in pain duration. Time-dependent ROC curves showed the area under the curve (AUC) for all-cause mortality at 1, 3, 5, 10, and 20-year survival for chronic pain of 0.71, 0.78, 0.84, 0.89, and 0.96, respectively. The AUCs for cancer mortality at 1, 3, 5, 10, and 20-year for chronic pain were 0.83, 0.87, 0.91, 0.94, and 0.95, respectively, and those for non-cancer mortality at 1, 3, 5, 10, and 20-year for chronic pain were 0.82, 0.86, 0.90, 0.91, and 0.97, respectively.

CONCLUSION

Chronic pain is associated with heightened all-cause and cancer mortality in the cancer population. Clinical staff should focus on chronic pain in this patient population.

Transdermal Opioids and the Quality of Life of the Cancer Patient: A Systematic Literature Review

OBJECTIVE

This systematic literature review aims to evaluate the effectiveness of transdermal opioids in managing cancer pain and their impact on the quality of life (QoL) of patients.

DATA SOURCES

A systematic literature review conducted following the PRISMA protocol, focusing on randomized clinical trials found in the Lilacs, Embase, PubMed, and SciELO databases over the last 20 years.

STUDY SELECTION AND DATA EXTRACTION

We included randomized clinical trials, published in English, Portuguese, or Spanish, which assessed the impact of transdermal opioids on the QoL. Data extraction was facilitated using the Rayyan app.

DATA SYNTHESIS

Six articles meeting the inclusion and exclusion criteria were analyzed. These studies covered a population ranging from 24 to 422 cancer patients experiencing moderate to severe pain. The risk of bias was assessed in each study, generally being categorized as uncertain or high.

RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE

The findings indicate that the analgesic effectiveness and side effects of transdermal formulations (specifically buprenorphine and fentanyl) for managing moderate to severe cancer pain are comparable to, or in some cases superior to, those of oral opioids traditionally employed.

CONCLUSIONS

Transdermal therapy was suggested to have several advantages over oral opioid therapy in enhancing cancer patients' QoL. These benefits span various dimensions, including pain management, physical functioning, mental health, vitality, overall patient improvement, anger/aversion, strength/activity, general QoL, cognitive and emotional functions, fatigue, and insomnia.

Identification and Management of Medical Comorbidities in Patients With HR+/HER2- Metastatic Breast Cancer Treated With CDK4/6 Inhibitors: Literature Review and Recommendations From Experts in Spain Opinion

Approximately one-third of patients with breast cancer have comorbidities at the time of their diagnosis. Recommendations for managing metastatic breast cancer are usually based on the results of clinical trials, which often limit patients with comorbidities. However, comorbidities greatly influence the quality of life, patient survival rate and treatment choice, particularly in older patients. The objective of this review was to identify clinically relevant comorbidities in patients with metastatic breast cancer, analyze the clinical approach to the treatment of these comorbidities, and propose recommendations from experts. An expert panel of eight medical oncologists identified seven therapeutic areas associated with the most relevant comorbidities in metastatic breast cancer: cardiovascular, gastrointestinal, endocrine/metabolic, renal, geriatric, psychological, and pain related. A clinical specialist from each therapeutic area specific to the relevant comorbidities (n = 8) joined the panel of experts (n = 8) to provide guidance on the appropriate management of these comorbidities. The specific comorbidities analyzed were hypertension, atrial fibrillation, venous thromboembolism, obesity, diabetes mellitus, cancer cachexia, chronic kidney disease, age-related disorders, arthritis, and fibromyalgia. In most cases, patients with metastatic breast cancer and medical comorbidities are polymedicated and/or vulnerable to toxicity. The oncologists provided recommendations on initial assessment and monitoring, follow-up recommendations, and warning signs and symptoms for referral to corresponding specialists based on their experience. The panel of experts also explored clinical scenarios related to each comorbidity and recommended a preferred CDK4/6 inhibitor based on available evidence regarding drug-drug interactions and potential for toxicity.

Complex intervention including pain science education and patient-led goal setting-based self-management strategies for management of aromatase inhibitor-induced musculoskeletal symptoms: a single-arm feasibility and pilot study

PURPOSE

Up to 74% of breast cancer survivors (BCS) treated with aromatase inhibitor (AI) experience AI-induced musculoskeletal symptoms (AIMSS). AIMSS is the predominant cause of poor adherence to AI therapy, yet no definitive treatment exists. The primary research objectives of this study were (1) to develop a novel BCS-specific complex intervention to alleviate AIMSS, and to assess its feasibility. The secondary research objective was (2) to assess the preliminary efficacy of this intervention.

METHODS

A single-arm, longitudinal pilot study was conducted involving 15 BCS with AIMSS. The complex intervention, which included pain science education, patient-led goal setting, and self-management strategies, was administered over 3 months. Feasibility was assessed by measuring overall participation, treatment completion rates, and satisfaction after 3 months of intervention. Additionally, the preliminary efficacy of the intervention was evaluated using a mixed model repeated measures analysis, with the change in pain intensity (brief pain inventory [BPI] worst pain/stiffness intensity) at 3 months as the primary endpoint.

RESULTS

The feasibility assessment showed promising results, with a 70.7% participation rate, an 83.3% intervention completion rate, and a satisfaction score of 8.2 ± 1.5. The intervention significantly reduced BPI worst pain/stiffness intensity by 2.78 points after 3 months (95% CI, - 4.5 to - 0.87, p < 0.01). Secondary outcomes demonstrated significant improvements in disability, quality of life, and pain catastrophizing (p < 0.05).

CONCLUSION

The novel complex intervention appears valuable for management AIMSS in BCS. Future large-scale studies, including randomized controlled trials, are warranted.

TRIAL REGISTRATION

The study was registered in the Clinical Trials Registry of the University Hospital Medical Information Network (UMIN-CTR: UMIN 000049035) in October 2022.

IMPLICATIONS FOR CANCER SURVIVORS

The novel BCS-specific complex intervention program holds the potential to aid in managing AIMSS, improving adherence to AI therapy, and enhancing their quality of life.

Addressing Breast Cancer Disparities: A Comprehensive Approach to Health Equity

This article addresses the persistent disparities in breast cancer outcomes across different racial, ethnic, and socioeconomic groups despite advancements in diagnosis and treatment. The disparities are rooted in various factors, including access to care, socioeconomic status, and cultural barriers. The article emphasizes the need for targeted interventions, such as expanding insurance coverage, mobile mammography units, and culturally tailored outreach programs to promote health equity. Achieving this requires comprehensive strategies addressing systemic and social determinants of health.

Nurse-Led Mobile App Effect on Quality of Life in Breast Cancer Patients After Surgery: Nonrandomized Controlled Prospective Cohort Study (Step 3)

BACKGROUND

Following surgery, women with breast cancer (BC) frequently experience emotional and physiological negative consequences.

OBJECTIVE

To evaluate the effect of a nurse-led mobile app (NL-Mapp) intervention on quality of life (QoL) in patients after surgery for BC.

METHODS

This single-center, 12-month, nonrandomized controlled trial, with 2 parallel groups, represents the final stage of 3-step research. In this study, women were assigned to either the intervention (n = 45) or control (n = 45) group. The intervention group participated in the NL-Mapp, whereas participants in the control group received standard care. The main outcomes were measured using the Functional Assessment of Cancer Therapy-Breast at 3 time points (baseline and 1 and 12 months after the intervention). Clinical Trial number: NCT06505538.

RESULTS

The intervention participants reported significant improvement in physical well-being, emotional well-being, and the BC-specific subscale compared with the control group at the 1-month postsurgery mark. Equally noteworthy, at the 1-year follow-up, consistent improvements were observed across all QoL subscale scores for the intervention group, except for the BC-specific subscale for additional concerns.

CONCLUSION

Our study revealed a notable enhancement in the QoL among postoperative women with BC who utilized the NL-Mapp. This program emerges as an effective intervention for providing short-term and longer-term supportive care to women affected by BC, leading to tangible improvements in their QoL.

IMPLICATION FOR NURSING

The study's findings offer valuable evidence supporting the integration of mobile health services into clinical and transitional nursing care.

Impact of pain on functional status and quality of life in Jordanian women with breast cancer

BACKGROUND

Currently, breast cancer is the most prevalent type of cancer affecting women, and the number of newly diagnosed cases continues to increase both in Jordan and globally. Upon receiving a cancer diagnosis, the suffering experienced by patients intensifies as they grapple with the debilitating side effects that hinder their ability to carry out routine activities.

PURPOSE

This study aims to assess the impact of cancer pain on functional status and quality of life (QOL) among Jordanian women with breast cancer.

METHODS

A descriptive cross-sectional design and structured interviews were conducted in the Oncology Unit at Al-Bashir Hospital with a sample of 150 eligible Jordanian women with breast cancer who provided data on pain and functional status, and QOL using four Arabic questionnaires (brief pain inventory, functional status SF-12 questionnaire, and quality of life index) to measure pain and functional status and QOL, descriptive statistics, Pearson correlation, and regression statistical test were utilized to analyze the study data.

RESULTS

A Significant positive correlation (r = 0.342) was found between cancer pain and functional status interference, a significant negative correlation (r = -0.134) between quality of life and functional status interference, and a significant negative correlation (r = -0.211) between pain and quality of life. Patients with higher intensity of cancer pain are more likely to experience low functional status and poor QOL.

CONCLUSION

Breast cancer patients experience alterations in their quality of life as a result of cancer-related pain, which has a detrimental impact on their ability to carry out daily activities and disrupts their functional abilities. Healthcare providers must take these alterations into account and effectively handle them. Understanding the relationship between cancer pain and breast cancer can aid nurses in managing symptoms and providing holistic care, ultimately improving the quality of life.

Pain neuroscience education and therapeutic exercise for the treatment of sequelae in breast cancer survivors living with chronic pain: A pilot study

BACKGROUND

Breast cancer represents the most common type of malignant neoplasm worldwide. Advances in diagnosis and treatment have increased the life expectancy of patients. However, the sequelae associated with the treatment of the disease such as chronic pain, kinesiophobia and loss of physical function in breast cancer survivors (BCS) are a long-term health problem. Therapeutic strategies are required for the treatment of chronic sequelae in this population.

OBJECTIVES

To evaluate the effectiveness of a pain neuroscience education (PNE) and therapeutic exercise (TE) for the treatment of chronic sequelae in BCS.

METHODS

Quasi-experimental repeated measures study. The intervention lasted 9 weeks, with 3 educational and 24 exercise sessions. Pain frequency and intensity (VAS scale), neuropathic pain (DN4), kinesiophobia level (TSK-11V), central sensitization (CSI-Sp), functionality of the affected arm (ULFI-Sp) and active joint range (ROM) with goniometry were measured at baseline, 3rd, 6th and 9th week. Statistical analysis included Friedman's test and ANOVA according to normality criteria.

RESULTS

A total sample of 26 BCS participate in the study. Significant statistical changes were found from the 3rd week of treatment in the frequency and intensity of pain, kinesiophobia and neuropathic pain (p < 0.05). All variables had significant changes at the 9th week (p = 0.001).

CONCLUSION

The results of the present investigation suggest that the combination of PNE and TE are effective in treating sequelae at short term in BCS with chronic pain.

Evaluating the effect of upper-body morbidity on quality of life following primary breast cancer treatment: a systematic review and meta-analysis

PURPOSE

Improvements in breast cancer management continue to increase survival and life expectancy after treatment. Yet the adverse effects of treatment may persist long term, threatening physical, psychological, and social wellbeing, leading to impaired quality of life (QOL). Upper-body morbidity (UBM) such as pain, lymphoedema, restricted shoulder range of motion (ROM), and impaired function are widely reported after breast cancer treatment, but evidence demonstrating its impact on QOL is inconsistent. Therefore, the aim of the study was to conduct a systematic review and meta-analysis evaluating the effect of UBM on QOL following primary breast cancer treatment.

METHODS

The study was prospectively registered on PROSPERO (CRD42020203445). CINAHL, Embase, Emcare, PsycInfo, PubMed/Medline, and SPORTDiscus databases were searched for studies reporting QOL in individuals with and without UBM following primary breast cancer treatment. Primary analysis determined the standardised mean difference (SMD) in physical, psychological, and social wellbeing scores between UBM + /UBM - groups. Secondary analyses identified differences in QOL scores between groups, according to questionnaire.

RESULTS

Fifty-eight studies were included, with 39 conducive to meta-analysis. Types of UBM included pain, lymphoedema, restricted shoulder ROM, impaired upper-body function, and upper-body symptoms. UBM + groups reported poorer physical (SMD =  - 0.99; 95%CI =  - 1.26, - 0.71; p < 0.00001), psychological (SMD =  - 0.43; 95%CI =  - 0.60, - 0.27; p < 0.00001), and social wellbeing (SMD =  - 0.62; 95%CI =  - 0.83, - 0.40; p < 0.00001) than UBM - groups. Secondary analyses according to questionnaire showed that UBM + groups rated their QOL poorer or at equal to, UBM - groups across all domains.

CONCLUSIONS

Findings demonstrate the significant, negative impact of UBM on QOL, pervading physical, psychological, and social domains.

IMPLICATIONS FOR CANCER SURVIVORS

Efforts to assess and minimise the multidimensional impact of UBM are warranted to mitigate impaired QOL after breast cancer.

Resilience's impact on quality of life and post-traumatic growth in breast cancer patients during treatment

BACKGROUND

This article aims to examine how psychological resilience influences the interplay between quality of life and post-traumatic growth among breast cancer patients receiving follow-up care and treatment in Türkiye.

METHODS

The study involved 119 female individuals diagnosed with breast cancer who visited the Oncology outpatient clinic at a state hospital in Türkiye from January to September 2023. Data were gathered through the administration of a survey form and the utilization of several assessment tools, including the Adult Life Quality Scale in Cancer Survivors (QLACS), the Brief Resilience Scale (BRS), and the Post-traumatic Growth Inventory (PTGI). Data analysis was carried out using SPSS 25 software.

RESULTS

The participants demonstrated an inverse correlation between Post-Traumatic Growth (PTG) and two QLACS sub-dimensions, namely recurrence and family concern. Conversely, a positive association was identified between PTG and the advantages of dealing with cancer. Furthermore, a statistically significant positive association was established between BRS and all QLACS sub-dimensions, except for family concern and appearance. However, it was determined that psychological resilience did not act as a moderator in the relationship between PTG and QLACS.

CONCLUSION

It is important to enhance psychological resilience in women who have survived cancer at all stages of the cancer journey, including the years after treatment, to have a positive impact on post-traumatic growth and quality of life.

Active social engagement and health among older adults: assessing differences by cancer survivorship status

INTRODUCTION

The number of older adults who are cancer survivors is rapidly growing. Evidence is needed to inform interventions to support successful aging among older adults (including older adult cancer survivors). Active engagement with life, that is, spending time with family and/or close friends, may be related to health outcomes, but this concept remains understudied.

METHODS

We used survey data to assess active engagement among older adults (ages 50 + years) from seven mid-Atlantic US states (n = 2,914), and geocoded their residence to collect collected measures of community availability of social interaction. Outcomes were physical and mental health-related quality of life (HRQoL), assessed with the SF-12. We used multivariable, multilevel linear regression to evaluate relationships between social interactions (i.e., "active engagement with life," or visiting with family and/or friends at least once per week and having at least three close friends, and community-level availability, measured with census tract-level park land and walkability and with county-level availability of social associations) and HRQoL. Finally, we explored differences in these relationships by recent cancer survivorship.

RESULTS

Overall, 1,518 (52.3%) participants were actively engaged. Active engagement was associated with higher physical HRQoL (estimate = 0.94, standard error [SE] = 0.46, p = .04) and mental HRQoL (estimate = 2.10, SE = 0.46, p < .001). The relationship between active engagement and physical HRQoL was stronger for recent cancer survivors (estimate = 4.95, SE = 1.84, p < .01) than for the general population (estimate = 1.10, SE = 0.43, p = .01). Community-level availability of social interaction was not associated with HRQoL.

CONCLUSION

Our analysis demonstrated promising associations between active engagement with life and HRQoL among older adults, with large benefits for older cancer survivors. Additional research is needed on how active engagement is associated with better HRQoL, which can inform future policies and programs to optimize the aging process in the US.

An evidence-based breathing exercise intervention for chronic pain management in breast cancer survivors: A phase II randomized controlled trial

OBJECTIVE

Explore the preliminary effects of a breathing exercise (BE) intervention on chronic pain among breast cancer survivors.

METHODS

This two-parallel-arm, open-label pilot randomized controlled trial recruited 72 breast cancer survivors who were randomly allocated to either the control or intervention group (n = 36 each). Both groups received usual care and a pain information booklet, while the intervention group received 4 weeks of additional BE. The primary clinical outcome was measured using the Brief Pain Inventory (BPI), with secondary clinical outcomes measured by the Hospital Anxiety and Depression Scale (HADS), Quality of Life Patient/Cancer Survivor Version in Chinese (QOLCSV-C), and Functional Assessment of Cancer Therapy- Breast (FACT-B) immediately post-intervention and at 4-week follow-up. Both adjusted and unadjusted Generalized Estimating Equation models were utilized to assess the BE's potential effects, with safety assessed through participant self-report.

RESULTS

Sixty-eight participants completed the study. Statistical significance was observed in BPI in both adjusted and unadjusted models at post-intervention and follow-up (p < 0.05). BE demonstrated positive effects on anxiety, depression and quality of life improvement across all measures and timepoints in both adjusted and unadjusted models (p < 0.05). The effect sizes were smaller in the adjusted model. Three mild transient discomforts were reported associated with BE practice including dizziness, tiredness and yawning, without requirement of medical treatment. No severe adverse events occurred.

CONCLUSION

This BE intervention appears effective in alleviating chronic pain, anxiety and depression, and improving quality of life for breast cancer survivors. Fully powered large-scale studies are required to confirm its effects.

Healthcare professionals' knowledge, understanding and confidence to manage chronic pain after cancer treatment: A UK survey

INTRODUCTION

Healthcare professionals are vital in preparing people living with and beyond cancer about the risks of chronic pain after cancer treatment. To do so, healthcare professionals need to be knowledgeable and confident about chronic pain after cancer treatment, yet little is known about their understanding or confidence of this common long-term and late side effect of cancer treatment.

AIM

To identify healthcare professionals' knowledge and understanding of chronic pain after cancer treatment and consider how confident they are to inform, listen and signpost people living with and beyond cancer to appropriate information and support.

METHOD

A cross sectional online survey was distributed to healthcare professionals in the UK via cancer and primary care networks, cancer alliances and social media. The survey consisted of four domains: 1) knowledge and understanding, 2) information and support, 3) confidence and 4) barriers. Quantitative data were analysed with descriptive statistics and free text comments were analysed using qualitative content analysis.

RESULTS

Healthcare professionals reported limited knowledge and understanding of chronic pain after cancer treatment. Healthcare professionals lacked confidence to talk to people about chronic pain after cancer treatment and viewed their lack of knowledge as a barrier. Additional barriers included 'Limited service provision', 'Conflict between services', 'Not my role' and 'Challenges in diagnosing chronic pain in cancer survivors'.

CONCLUSION

Chronic pain after cancer can be a significant issue for those living with and beyond cancer, yet healthcare professionals report limited knowledge of it or understanding of the impact. More education is needed to increase healthcare professionals' knowledge and confidence in chronic pain after cancer treatment.

Neuropathic Pain Affects Quality of Life in Breast Cancer Survivors with Chemotherapy-Induced Peripheral Neuropathy

BACKGROUND

Despite the significant impact of chemotherapy-induced peripheral neuropathy on the quality of life for breast cancer survivors, there is a notable lack of comprehensive research. Therefore, a crucial need exists for further systematic investigation and inquiry into this matter.

AIMS

This study examined predictors of quality of life in breast cancer survivors with chemotherapy-induced peripheral neuropathy.

DESIGN

A cross-sectional, correlational design.

SETTINGS

This study was conducted at a medical center in northern Taiwan and a teaching hospital in northeastern Taiwan.

PARTICIPANTS/SUBJECTS

One hundred and thirty adult women with breast cancer, who have undergone chemotherapy and obtained a Total Neuropathy Scale-Clinical Version score>0, were enrolled.

METHODS

Neuropathic pain, sleep disturbances, depression, and quality of life were evaluated using multiple regression analysis to identify quality of life predictors. Clinical importance was established using the minimally important difference of Functional Assessment of Cancer Therapy-Breast.

RESULTS

The study indicated that improving depression (B = -10.87, p < .001) and neuropathic pain (B = -8.33, p = .004) may enhance the quality of life of breast cancer survivors with chemotherapy-induced peripheral neuropathy. Moreover, the individual's marital status and family history of breast cancer were identified as predictive factors.

CONCLUSIONS

This study illuminates quality of life determinants for breast cancer survivors with chemotherapy-induced peripheral neuropathy, advocating comprehensive care and addressing depression and neuropathic pain for better outcomes.

Pain in Long-Term Cancer Survivors: Prevalence and Impact in a Cohort Composed Mostly of Breast Cancer Survivors

Cancer survival is becoming more common which means that there is now a growing population of cancer survivors, in whom pain may be common. However, its prevalence has hardly been addressed systematically. We aimed to assess the prevalence and explore the pathophysiology and impact of pain on health outcomes in cancer survivors. We conducted a retrospective-prospective cohort study in cancer-free patients diagnosed with cancer at least five years before the study start date. We used multivariable regression to establish the association of patients' cancer characteristics with pain, and then the association of patients' pain features with health outcomes and related symptoms. Between March and July 2021, 278 long-term cancer survivors were evaluated. Almost half of them (130/278, 46.8%) had pain, of whom 58.9% had a probable neuropathic component, but only 18 (13.8%) were taking specific drugs for neuropathic pain. A history of surgery-related pain syndrome in breast cancer patients was more than twice as frequent in the pain cohort. Post-chemotherapy and post-radiotherapy pain syndromes were uncommon. Pain was associated with lower QoL, emotional functioning, professional performance, and disability scores. Pain is a frequent health determinant in cancer survivors. Referral to specialised pain services may be a reasonable move in some cases.

Virtual reality-guided mindfulness for chronic pain in cancer survivors: protocol for the virtual mind study-a single-group feasibility trial

Background

Chronic cancer-related pain (CRP) can have a significant negative impact on quality of life. Mindfulness is hypothesized to mitigate chronic CRP by regulating both physical and emotional resistance to pain. In recent years, there has been interest in the use of virtual reality (VR) to deliver mindfulness meditation. VR provides an immersive and engaging environment, which may enhance one's focused attention to present-moment experiences, potentially making mindfulness less effortful and more efficacious for individuals with chronic pain. There has been little research in this area for people with a history of cancer.

Objective

The aim of this mixed methods study is to evaluate the feasibility of a VR-guided mindfulness (VRGM) intervention offered to adult cancer survivors with chronic CRP.

Methods

This mixed methods feasibility study will employ a single-arm, pretest-posttest design with semistructured interviews. In total, 15 cancer survivors will be enrolled in a 6-week home-based intervention that consists of 10-15 min of daily VRGM practice. The primary outcome is feasibility as assessed by accrual rates, retention in the study, intervention adherence, questionnaire completion, and side effect rates. Participants will be assessed on psychosocial outcome measures (i.e., pain, sleep, depressive and anxiety symptoms, fatigue, quality of life, and mindfulness) before and after the intervention, and 6 weeks post intervention (follow-up). Changes in pain will be described in relation to levels of immersion and presence in the virtual environment, trait mindfulness, and amount of VRGM practice. Qualitative information will provide subjective detail on participants' experience with VRGM to complement quantitative data. This study has been approved by the Health Research Ethics Board of Alberta Cancer Committee (HREBA.CC-20-0411).

Conclusions

This novel intervention provides a potential alternative treatment to pharmacological pain management. Results from this study may inform future larger VGRM trials for chronic CRP to help reduce suffering in people with cancer. Study findings will be disseminated through open access publications, traditional conference presentations, professional cancer organizations, and social media platforms.

Pain in the Context of Sensory Deafferentation

Pain that accompanies deafferentation is one of the most mysterious and misunderstood medical conditions. Prevalence rates for the assorted conditions vary considerably but the most reliable estimates are greater than 50% for strokes involving the somatosensory system, brachial plexus avulsions, spinal cord injury, and limb amputation, with controversy surrounding the mechanistic contributions of deafferentation to ensuing neuropathic pain syndromes. Deafferentation pain has also been described for loss of other body parts (e.g., eyes and breasts) and may contribute to between 10% and upwards of 30% of neuropathic symptoms in peripheral neuropathies. There is no pathognomonic test or sign to identify deafferentation pain, and part of the controversy surrounding it stems from the prodigious challenges in differentiating cause and effect. For example, it is unknown whether cortical reorganization causes pain or is a byproduct of pathoanatomical changes accompanying injury, including pain. Similarly, ascertaining whether deafferentation contributes to neuropathic pain, or whether concomitant injury to nerve fibers transmitting pain and touch sensation leads to a deafferentation-like phenotype can be clinically difficult, although a detailed neurologic examination, functional imaging, and psychophysical tests may provide clues. Due in part to the concurrent morbidities, the physical, psychologic, and by extension socioeconomic costs of disorders associated with deafferentation are higher than for other chronic pain conditions. Treatment is symptom-based, with evidence supporting first-line antineuropathic medications such as gabapentinoids and antidepressants. Studies examining noninvasive neuromodulation and virtual reality have yielded mixed results.

Synthesis, and In-silico Studies of Indole-chalcone Derivatives Targeting Estrogen Receptor Alpha (ER-α) for Breast Cancer

BACKGROUND

Breast cancer is the prominent reason of death in women worldwide, and the cases are increasing day by day. There are many FDA-approved drugs for treating breast cancer. Due to drug resistance, and problems in selectivity, there is a need to develop more effective agents with few side effects. Indole derivatives have demonstrated significant pharmacological potential as anti-breast cancer agents. Further, chalcone derivatives incorporating heterocyclic scaffolds play a significant role in medicine. Indole-chalcone-based compounds offer the potential for improved biological activity and enhanced drug-like properties. It prompted us to explore the synthesis of Indole-Chalcone derivatives targeting estrogen receptor alpha (ER-α) to discover potent anti-breast cancer agents.

OBJECTIVES

To synthesize indole-chalcone derivatives and study their binding interactions for ER-α protein by molecular docking for breast cancer treatment.

METHODS

In this study, indole-chalcone derivatives have been synthesized using conventional heating. With the help of Schrodinger software, molecular interaction as well as ADME (Adsorption, Distribution, Metabolism, and Excretion) studies of the compounds were conducted.

RESULTS

Among all the synthesized compounds, four compounds (1, 2, 3, and 4) showed better docking scores (-10.24 kcal/mol, -10.15 kcal/mol, -9.40 kcal/mol, -9.29 kcal/mol, respectively) than the standard tamoxifen (-8.43 kcal/mol).

CONCLUSION

From In-silico studies, we can conclude that four compounds from the synthesized series fit into the active site of ER-α. ADME properties of synthesized derivatives were found in the acceptable range. In the future, these compounds can be further explored for biological activity.

Regional Blocks Benefit Patients Undergoing Bilateral Mastectomy with Immediate Implant-Based Reconstruction, Even After Discharge

BACKGROUND

There is limited evidence that regional anesthesia reduces pain in patients undergoing mastectomy with immediate implant-based reconstruction. We sought to determine whether regional blocks reduce opioid consumption and improve post-discharge patient-reported pain in this population.

METHODS

We retrospectively reviewed patients who underwent bilateral mastectomy with immediate implant-based reconstruction with and without a regional block. We tested for differences in opioid consumption by block receipt using multivariable ordinal regression, and also assessed routinely collected patient-reported outcomes (PROs) for 10 days postoperatively and tested the association between block receipt and moderate or greater pain.

RESULTS

Of 754 patients, 89% received a block. Non-block patients had an increase in the odds of requiring a higher quartile of postoperative opioids. Among block patients, the estimated probability of being in the lowest quartile of opioids required was 25%, compared with 15% for non-block patients. Odds of patient-reported moderate or greater pain after discharge was 0.54 times lower in block patients than non-block patients (p = 0.025). Block patients had a 49% risk of moderate or greater pain compared with 64% in non-block patients on postoperative day 5. There was no indication of any reason for these differences other than a causal effect of the block.

CONCLUSION

Receipt of a regional block resulted in reduced opioid use and lower risk of self-reported moderate and higher pain after discharge in bilateral mastectomy with immediate implant-based reconstruction patients. Our use of PROs suggests that the analgesic effects of blocks persist after discharge, beyond the expected duration of a 'single shot' block.

Treating persistent pain after breast cancer: practice gaps and future directions

This paper discusses the growing problem of persisting pain after successful treatment of breast cancer and presents recommendations for improving pain-related outcomes for this group. We discuss the dominant treatment approach for persisting pain post-breast cancer treatment and draw contrasts with contemporary treatment approaches to persistent pain in non-cancer-related populations. We discuss modern application of the biopsychosocial model of pain and the notion of variable sensitivity within the pain system, moment by moment and over time. We present the implications of increasing sensitivity over time for treatment selection and implementation. By drawing on transformative changes in treatment approaches to persistent non-cancer-related pain, we describe the potentially powerful role that an intervention called pain science education, which is now recommended in clinical guidelines for musculoskeletal pain, may play in improving pain and disability outcomes after successful breast cancer treatment. Finally, we present several research recommendations that centre around adaptation of the content and delivery models of contemporary pain science education, to the post-breast cancer context.

Risk factors for long-term arm morbidities following breast cancer treatments: A systematic review

PURPOSE

To examine the risk factors for arm morbidity following breast cancer treatments, taking a broad view of all types of physical morbidity, including prolonged pain, lymphedema, decreased range of motion, and functional limitations.

METHODS

A systematic literature review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. Studies exploring the risk factors for prolonged arm morbidity following breast cancer surgery and treatments were included. The studies were assessed independently according to pre-eligibility criteria, following data extraction and methodological quality assessment.

RESULTS

1,242 articles were identified. After removing duplicates, the full texts of 1,153 articles were examined. Sixty-nine of these articles met the criteria and were included in the review. These 69 articles identified 29 risk factors for arm morbidity following treatments for breast cancer. The risk of bias was evaluated using NIH study quality assessment tools. The studies reviewed were published between 2001 and 2021 and included a total of 22,886 patients who were followed up for between three months and 10 years.

CONCLUSIONS

The main risk factors for long-term morbidity are removal of lymph nodes from the axilla, body mass index >30, having undergone a mastectomy, the stage of the disease, radiation therapy, chemotherapy, infection and trauma to the affected arm after surgery. An understanding of the risk factors for prolonged arm morbidity after surgery can help doctors and therapists in making personalized decisions about the need and timing of rehabilitation treatments.

Chronic pain in female breast cancer survivors - prevalence, characteristics and contributing factors: a cross-sectional pilot study

BACKGROUND

While the global incidence of breast cancer is increasing, there is also an increase in the numbers of breast cancer survivors and in survival duration, as early detection programs are implemented, and treatments are optimized. Breast cancer survivors in several countries commonly struggle with a range of symptoms (fatigue, insomnia, depression) with 25-80% of survivors suffering from chronic pain. There is a paucity of literature reporting on breast cancer survivors in South Africa. In this pilot study we aimed to determine the prevalence of chronic pain in female breast cancer survivors attending the breast oncology clinic.

METHODS

A cross-sectional survey was conducted of all breast cancer survivors attending the Groote Schuur Hospital Breast Unit during one month in 2019. 44 female breast cancer survivors (median age 60.5y) completed a sociodemographic questionnaire, the Brief Pain Inventory, Pain Catastrophizing Scale and measures for neuropathic pain (DN4), health related quality of life (HRQoL; EQ-5d-3 L), physical activity (IPAQ), depression and anxiety (PHQ4), and screening questions to evaluate sleep, happiness and perceived discrimination in the language of their choice.

RESULTS

The prevalence of chronic pain (pain on most days for more than three months) was 59% (95%CI 44-72), a significantly higher number than the 18,3% prevalence of chronic pain reported by South African adults. 39% of the women were classified as having neuropathic pain. The median pain severity score was 3.75 (IQR = 2.75-5) and the median pain interference with function score was 4 (IQR = 2.9-5.4). The women were experiencing pain in a median of 2 different body sites (IQR = 1-3). The women with pain were more likely to be unemployed or receiving a disability grant, had significantly worse HRQoL, and significantly worse scores for risk of depression and anxiety.

CONCLUSION

The results of this pilot study suggest that chronic pain may be a significant burden for South African breast cancer survivors. Routine screening for chronic pain in breast cancer survivors is recommended with a larger study indicated to explore this issue further.

Home-Based Treatment for Chronic Pain Combining Neuromodulation, Computer-Assisted Training, and Telemonitoring in Patients With Breast Cancer: Protocol for a Rehabilitative Study

BACKGROUND

Chronic pain is a disabling symptom frequently reported in patients with breast cancer with a prevalence ranging from 25% to 60%, representing a major health issue. It has negative consequences on health status, causing psychological distress and affecting quality of life. Furthermore, the clinical management of chronic pain is often inadequate, and many patients do not benefit from the administration of pharmacological treatments. Alternative therapeutic options have been implemented to improve the psychophysical well-being of patients, including neuromodulation and complementary interventions.

OBJECTIVE

We aimed to investigate the effectiveness of a home care strategy combining computerized rehabilitation, transcranial direct current stimulation (tDCS), and remote telemonitoring via a web-based platform in patients with breast cancer suffering for chronic pain.

METHODS

A web-based structured survey aimed at monitoring chronic pain and its effect on psychological functions will be delivered to patients with breast cancer through social media and email. In total, 42 patients with breast cancer affected by chronic pain will be recruited during the medical screening visit. The patients will be randomly divided into 3 treatment groups that will carry out either tDCS only, exercise therapy only, or a combination of both over a 3-week period. All the treatments will be delivered at the patients' home through the use of a system including a tablet, wearable inertial sensors, and a tDCS programmable medical device. Using web-based questionnaires, the perception of pain (based on the pain self-efficacy questionnaire, visual analogue scale, pain catastrophizing scale, and brief pain inventory) and psychological variables (based on the hospital and anxiety depression scale and 12-item short form survey) will be assessed at the beginning of treatment, 1 week after the start of treatment, at the end of treatment, 1 month after the start of treatment, and 3 months after the start of treatment. The system's usability (based on the mobile app rating scale and system usability scale) and its involvement in the decision-making process (based on the 9-item shared decision-making questionnaire) will be also evaluated. Finally, at the end of the treatment, a digital focus group will be conducted with the 42 patients to explore their unexpressed needs and preferences concerning treatment.

RESULTS

The study project is scheduled to start in June 2023, and it is expected to be completed by August 2025.

CONCLUSIONS

We expect that the combination of tDCS and telemedicine programs will reduce pain perceived by patients with breast cancer and improve their mental well-being more effectively than single interventions. Furthermore, we assume that this home-based approach will also improve patients' participation in routine clinical care, reducing disparities in accessing health care processes. This integrated home care strategy could be useful for patients with breast cancer who cannot find relief from chronic pain with pharmacological treatments or for those who have limited access to care due to poor mobility or geographical barriers, thus increasing the patients' empowerment and reducing health care costs.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/49508.

The prevalence and risk factors for physical impairments in Chinese post-cancer treated breast cancer survivors: a 4 years' cross-sectional study at a single center

The incidence of breast cancer in China was 19.2% in 2018, with a five-year survival rate of up to 80%. The impairments that may result from breast cancer treatment, such as lymphedema, pain, and symptoms related to nerve damage, could have long-term side effects. Its prevalence and symptom profile have been commonly reported in various countries, but such data are rarely available for China. Physical function was assessed in 138 breast cancer survivors (BCSs) in the study. The prevalence of lymphedema (65.9%) was higher than that of pain (31.2%), shoulder range of motion (ROM) restriction (20.3%), grip strength restriction (GSR) (21.7%) and paresthesia (11.6%). These impairments mainly appeared within 28 months after breast cancer diagnosis, but could happen in 10 years. Carcinoma in situ and radiotherapy (RT) were related to the occurrence of lymphedema (respectively B = -1.8, p = 0.003; B = 1.3, p = 0.001). RT and delayed rehabilitation time (DRT) may increase the severity of lymphedema (respectively p = 0.003, p = 0.010). Breast conserving surgery (B = -2.1, p = 0.002) and the occurrence of AWS (B = 3.1, p = 0.006) were related to the occurrence of pain. The occurrence of brachial plexus injury (BPI) (B = 3.1, p < 0.001) and pain (B = 1.9, p = 0.002) improved the occurrence of shoulder ROM restriction. The occurrence of BPI (B = 3.6, p < 0.001) improved the occurrence of GSR. The occurrence of pain (B = 2.1, p = 0.001) improved the occurrence of paresthesia. These findings prompt us to further investigate the actual rehabilitation needs of survivors and the specific barriers to rehabilitation in the following research.

Non-Surgical Site Pain in Women following Breast Cancer Surgery: A Systematic Review and Meta-Analysis

Background

Chronic pain after breast cancer surgery affects up to 60% of patients. Evidence supports the fact that pain outwith the surgical site is a significant issue. This systematic review and meta-analysis sought to evaluate the prevalence of non-surgical site pain (NSSP) in women after breast cancer surgery at 6 months post-operatively.

Methods

Adult women with a confirmed breast cancer diagnosis who had undergone breast cancer surgery were identified. The outcome pursued was pain outwith the surgical site measured on either NRS/VRS or VAS rating scale. CENTRAL, Embase, PubMed, MEDLINE, CINAHL, PsycInfo, Web of Science, and Scopus were searched to identify studies that examined NSSP after breast cancer surgery at 6 months. Data were gathered via pre-piloted Excel forms and analysed both quantitively and qualitatively. Meta-analysis was carried out using a random-effects model to assess risk difference with 95% confidence interval (CI).

Results

A total of sixteen studies were identified for inclusion. Eleven studies failed to provide sufficient data and consequently were analysed qualitatively. Five studies were adequate for quantitative analysis, including a total of 995 patients. Meta-analysis identified a risk difference of 18% (95% CI: 5-31%) between patients who had breast cancer surgery and a reference, however, this is low-quality evidence.

Conclusion

This review has highlighted that breast cancer surgery increases the risk of pain outwith the surgical site postoperatively. It was additionally identified that NSSP data are often gathered in research yet rarely presented in results or highlighted as a primary outcome. As the quality of evidence was low, research specifying NSSP as a primary outcome is required to provide more certainty.

The Efficacy of Virtual Reality-Based Interventions in Breast Cancer-Related Symptom Management: A Systematic Review and Meta-analysis

BACKGROUND

Breast cancer patients experience a range of disease- and treatment-related symptoms that seriously threaten their quality of life. Virtual reality (VR), an emerging complementary and integrative therapy, has been increasingly applied in clinical practice. However, there is insufficient evidence to support the effectiveness of VR-based interventions on symptom management in breast cancer patients.

OBJECTIVE

This article aimed to systematically examine the effects of VR on breast cancer-related symptom management.

METHODS

The PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, CNKI, Wan Fang, and VIP databases were comprehensively searched for randomized controlled trials (RCTs) and quasi-RCTs published up to April 10, 2021. Studies using VR-based interventions to manage breast cancer-related symptoms were included. Two investigators independently reviewed and extracted data and evaluated methodological quality. RevMan 5.3 was used for meta-analysis, and heterogeneity was evaluated using Higgins' I2 (%) statistic.

RESULTS

Eight RCTs and 6 quasi-RCTs with 797 participants were included. Virtual reality-based interventions significantly improved symptoms of anxiety, depression, pain, cognitive function, and shoulder range of motion in breast cancer patients, but no significant improvements in grip and upper extremity function were observed.

CONCLUSION

Virtual reality-based interventions had a positive effect on symptom management for breast cancer patients.

IMPLICATIONS FOR PRACTICE

Health professionals, especially nurses, can apply VR in clinical practice to reduce symptoms and improve the quality of life of breast cancer patients. More studies are needed to draw higher quality conclusions and explore the best interventions and cost-effectiveness of VR.

Association of psychological distress with arm morbidity symptoms in breast cancer survivors: outcomes from the use of PHQ-9 and GAD-7 questionnaires

BACKGROUND

Although higher survival rates of breast cancer are achieved these days, breast cancer survivors are challenged with unwanted side effects from treatment or management that affect physical, functional, and psychological well-being of an individual. This study aimed to assess psychological distress status in Malaysian breast cancer survivors and factors that affected the condition.

METHODS

A cross-sectional study design was conducted on 162 breast cancer survivors from various breast cancer support groups in Malaysia. Psychological distress status was assessed based on depression and anxiety scores by applying the Malay version of Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder (GAD-7). Both instruments were self-administered along with a set of questionnaires comprising demographic, medical history, quality of life, and upper extremity function assessment. Outcomes from the PHQ-9 and GAD-7 were analyzed for severity level of psychological distress, and its association with relevant variables, arm morbidity symptoms, as well as the duration of cancer survivorship.

RESULTS

The univariate analysis showed that breast cancer survivors with arm morbidities after breast surgery had a higher score of depression (5.0 vs 4.0, p = 0.011) and anxiety (3.0 vs 1.0, p = 0.026) than those who did not. Besides that, receiving fewer post-rehabilitation treatments (p = 0.049) and having a family history of cancer (p = 0.022) were correlated with higher anxiety level. The level of depression and anxiety was inversely proportionate with quality of life and positively correlated with greater disability of the arm function (p < 0.05). Subsequent analysis showed that arm morbidity symptoms including difficulties in finding a t-shirt that fits and pain in the arm area after breast cancer surgery were positively associated with a higher level of psychological distress.

CONCLUSION

Our study demonstrated the association between psychological distress with arm morbidities in breast cancer survivors. Given that arm morbidities can affect not only physical, but psychological well-being, continuous or serial assessment on both aspects during cancer treatment may effectively help to address mental health issue experienced by this cancer population.

Association between chronic pain and quality of life in long-term breast cancer survivors: a prospective analysis

PURPOSE

Pain is a leading cause of disability worldwide and is highly prevalent among breast cancer survivors. Pain and quality of life (QOL) are associated in breast cancer patients undergoing active treatment, but little is known about the relationship between the two in long-term survivors.

METHODS

We evaluated associations between pain information collected during a 5-year post-diagnosis follow-up survey and QOL assessed by the SF-36 during a 10-year post-diagnosis survey for 2828 participants in the Shanghai Breast Cancer Survival Study.

RESULTS

The mean overall QOL score was 78.7 for the entire study population and decreased as pain severity and frequency measured at the 5-year timepoint increased (none: 81.9, mild: 75.9, moderate/severe: 70.4, infrequent: 76.7, frequent: 72.3; P < 0.001). Significant inverse associations were found between pain and all QOL domains, including pain at 10-years post-diagnosis after multivariate adjustments. Concurrent pain was significantly and strongly associated with QOL. Most of the associations between 5-years post-diagnosis pain and QOL at 10-years post-diagnosis persisted after further adjustment for concurrent pain.

CONCLUSIONS

Pain is associated prospectively and concurrently with poor QOL among long-term breast cancer survivors. Programs to manage pain are needed to improve QOL among breast cancer survivors.

Exploring the Unmet Supportive Care Needs of Breast Cancer Survivors Experiencing Psychological Distress: Qualitative Study

OBJECTIVES

This study aimed to explore the unmet supportive care needs of breast cancer survivors who experience psychological distress.

DATA SOURCES

A qualitative study design with inductive content analysis was used. Semistructured interviews were conducted with 18 Turkish breast cancer survivors who experienced psychological distress. The Consolidated Criteria for Reporting Qualitative Research checklist was used to report the study.

CONCLUSION

Three key themes emerged from data analysis: sources of psychological distress, unmet supportive care needs, and barriers to support. The survivors who experienced psychological distress defined a variety of unmet supportive care needs, in the areas of information support, psychological/emotional support, social support, and individualized health care support. They also described personal and health professional-related factors as barriers.

IMPLICATIONS FOR NURSING PRACTICE

Nurses should assess psychosocial well-being and supportive care needs of breast cancer survivors. Survivors should be supported to discuss their experiences of symptoms in the early survival phase, and they should be referred to an appropriate supportive care resource. A multidisciplinary survivorship services model is needed to offer posttreatment psychological support routinely in Turkey. Early, effective psychological care integrated into follow-up services for survivors can be protective against psychological morbidity.

Mobile Apps and Quality of Life in Patients With Breast Cancer and Survivors: Systematic Literature Review

BACKGROUND

Side effects of breast cancer treatment may persist long into survivorship, reducing quality of life (QOL) in patients with breast cancer and survivors. There is growing evidence for the use of digital health technologies, such as mobile apps, to support self-management, decrease symptom burden, and improve QOL in patients with cancer. However, an updated overview of the effects of mobile apps on QOL and well-being in patients with breast cancer and survivors is needed.

OBJECTIVE

The aim of this review was to provide an overview of breast cancer-specific, mobile app-driven lifestyle or behavioral interventions in patient care through to survivorship and their impact on QOL and mental well-being.

METHODS

A systematic search of PubMed, Scopus, and Web of Science was conducted to identify relevant studies. The inclusion criteria were limited to original studies involving a trial of a mobile app-driven lifestyle or behavioral intervention for patients with breast cancer or survivors and using QOL or well-being measures. The results of the studies that met the inclusion criterion were then synthesized in text and table format. The quality of the evidence was assessed with the Cochrane risk-of-bias tool.

RESULTS

A total of 17 studies with the number of participants ranging from 23 to 356 met the inclusion criterion. Of the 17 reviewed studies, 7 (41%) delivered an app-only intervention, and 10 (59%) combined an app with additional supporting materials, such as SMS text messaging, telecoaching, wearables, or printed materials. Among the 17 reviewed studies, 6 (35%) focused on aiding patients with breast cancer during the active treatment phase (excluding ongoing hormone therapy), whereas the remaining 11 (65%) focused on survivorship. The majority of the studies (14/17, 82%) observed some positive effects on QOL or well-being measures.

CONCLUSIONS

The results of the review indicate that mobile apps are a promising avenue for improving QOL and well-being in breast cancer care. Positive effects were observed in patients undergoing active treatment in all reviewed studies, but effects were less clear after chemotherapy and in long-term survivors. Although lifestyle and behavioral digital interventions are still being developed, and further research should still be pursued, the available data suggest that current mobile health apps aid patients with breast cancer and survivors.

Emotional Processing, Coping, and Cancer-Related Sickness Symptoms in Breast Cancer Survivors: Cross- Sectional Secondary Analysis of the REPAT Study

Purpose

The study aims to provide a better understanding of the relationship between emotional processing, coping, and cancer-related sickness symptoms.

Methods

The study used a cross-sectional, secondary analysis of data from 179 Israeli Jewish women who were breast cancer survivors (BCS) 3 to 18 months after completing primary treatment and who participated in a larger randomized controlled trial (REPAT study). Data were collected at baseline. Participants completed questionnaires measuring emotion acceptance, situational approach, avoidance coping, and cancer-related sickness symptoms (depression, fatigue, and pain) and a performance measure of emotional awareness. Hierarchical linear regressions were performed, controlling for background variables.

Results

Participants experienced significant clinical depression (51.7%), cancer-related fatigue (CRF, 78.8%), pain interference (78%), and pain intensity (66%) levels. There were strong correlations between cancer-related symptoms. After controlling for confounders, emotional processing (acceptance) was negatively associated with depression, and avoidance coping was positively associated with depression, CRF, and pain interference (i.e., higher use of avoidance related to higher cancer-related symptoms; higher acceptance was associated with lower depression). Emotional awareness and coping by approaching emotions were not related to cancer-related symptoms.

Conclusions

The BCS posttreatment period presents the challenge of dealing with elevated cancer-related symptoms. Regardless, BCS who used high emotional processing levels-especially acceptance of emotion and lower reliance on avoidance to cope-experienced fewer cancer-related symptoms.

Implications for Cancer Survivors

Professionals should recognize the potential role of emotional processing and avoidant coping relative to cancer-related symptoms and recognize their patterns in posttreatment patients.

Effect of pain neuroscience education after breast cancer surgery on pain, physical, and emotional functioning: a double-blinded randomized controlled trial (EduCan trial)

ABSTRACT

Pain is one of the most common and long-lasting side effects reported by women surgically treated for breast cancer. Educational interventions may optimize the current physical therapy modalities for pain prevention or relief in this population. Pain neuroscience education (PNE) is an educational intervention that explains the pain experience not only from a biomedical perspective but also the psychological and social factors that contribute to it. Through a double-blinded randomized controlled trial (EduCan trial) it was investigated if PNE, in addition to the standard physiotherapy program immediately after breast cancer surgery, was more effective over the course of 18 months postoperatively than providing a biomedical explanation for pain. Primary outcome was the change in pain-related disability (Pain Disability Index, 0-70) over 12 months. Secondary outcomes included change in pain intensity, upper limb function, physical activity level, and emotional functioning over 4, 6, 8, 12, and 18 months postoperatively. Multivariate linear models for repeated (longitudinal) measures were used to compare changes. Preoperative and postoperative moderators of the change in pain-related disability were also explored. Of 184 participants randomized, the mean (SD) age in the PNE and biomedical education group was 55.4 (11.5) and 55.2 (11.4) years, respectively. The change in pain-related disability from baseline to 12 months postoperatively did not differ between the 2 groups (PNE 4.22 [95% confidence interval [CI]: 1.40-7.03], biomedical 5.53 [95% CI: 2.74-8.32], difference in change -1.31 [95% CI: -5.28 to 2.65], P = 0.516). Similar results were observed for all secondary outcomes. Future research should explore whether a more patient-tailored intervention would yield better results.

Quality of life and wellbeing among breast cancer patients in Lahore, Pakistan

Background

Breast cancer has a high incidence rate, emphasizing the necessity of enhanced information on health-related quality of life (HrQOL) in this population of patients. The aim of this study was to identify the factors influencing the QOL experienced by patients in Pakistan.

Methods

A cross-sectional study was conducted on women with breast cancer, and four instruments were used on a random sample of 130 Pakistani women: FACIT-B Version 4 questionnaire,WHO causality assessment scale, Naranjo's algorithm, and a demographic/clinical characteristics section. Data analysis included descriptive analysis, independent sample t-test, and analysis of variance (ANOVA) test.

Results

The patients' mean age was 49.10 (standard deviation (SD) 10.89); 98.5% were married. The mean score was 18.34 for physical wellbeing (SD 5.92; interquartile range (IQR) 11), 16.33 for social/family wellbeing (SD 6.3; IQR 11.25), 13.6 for emotional wellbeing (SD 3.55; IQR 6), 17.13 for functional wellbeing (SD 3.73; IQR 6), and 24.86 for breast cancer subscale (SD 3.64; IQR 4). The study found that the age, entitlement, recurrence, marital status, salary, number of doses, duration of cancer treatment, and chemotherapy sessions were significantly related to QOL terms in the assessment of the FACIT-B scale. The WHO causality evaluation scale determined that 78.1% of the responses were "probable" and 20.1% were "possible". According to Naranjo's algorithm assessment scale, 80% of adverse drug reactions (ADRs) were "probable", whereas 18.4% were declared "possible". Chemotherapy-induced anemia was the most often reported ADR in 64.6% of patients, followed by chemotherapy-induced nausea and vomiting (61.5%).

Conclusion

Healthcare practitioners must acknowledge and take into account the significance of QOL in addition to therapy for breast cancer patients in order to enhance their health. The findings of this study will aid in filling gaps in current unknown knowledge and identifying sites where patients require additional assistance. Because cancer and chemotherapy clearly have a negative impact on individuals' QOL, oncologists must concentrate on strategies that help cancer patients during their sickness and treatment while also enhancing self-care and QOL. Those with cancer will benefit from emotional wellbeing and adaptation to their disease.

Perioperative intravenous lidocaine for postoperative pain in patients undergoing breast surgery: a meta-analysis with trial sequential analysis of randomized controlled trials

Background

The effectiveness of intravenous lidocaine infusion in managing acute and chronic pain following breast surgery has been a topic of debate. This meta-analysis aims to assess the impact of perioperative intravenous lidocaine on the relief of postoperative pain among patients undergoing breast surgery.

Methods

A systematic search of databases was conducted to identify randomized controlled trials (RCTs) that compared the effects of intravenous lidocaine infusion with placebo or routine care in patients undergoing breast surgery. The primary outcome of interest was the occurrence of chronic post-surgical pain (CPSP) at the longest follow-up. Meta-analyses, incorporating trial sequential analysis, were performed using a random-effects model to assess the overall effect.

Results

A total of twelve trials, involving 879 patients, were included in the analysis. Perioperative intravenous lidocaine demonstrated a significant reduction in the incidence of CPSP at the longest follow-up (risk ratio [RR] 0.62, 95% confidence interval [CI] 0.48-0.81; P = 0.0005; I2 = 6%). Trial sequential analysis (TSA) indicated that the cumulative z curve crossed the trial sequential monitoring boundary for benefit, providing sufficient and conclusive evidence. Furthermore, intravenous lidocaine was associated with decreased opioid consumption and a shorter length of hospital stay.

Conclusion

Perioperative intravenous lidocaine is effective in relieving acute and CPSP in patients undergoing breast surgery.

Systematic review registration

https://inplasy.com/, identifier INPLASY2022100033.

Racial and Ethnic Disparities in Synchronous and Metachronous Bilateral Breast Cancer

INTRODUCTION

Significant racial and ethnic disparities exist in breast cancer treatment and survival. However, studies characterizing these disparities among patients developing bilateral breast cancers (BBC) are lacking. The purpose of this study is to understand the association between race and ethnicity, sociodemographic factors, clinical variables, treatment, and mortality in patients with BBC--synchronous bilateral breast cancer (sBBC) or metachronous bilateral breast cancer (mBBC).

METHODS

Patients diagnosed with mBBC or sBBC in the Surveillance, Epidemiology, and End Results program between 2010 and 2016 were examined. sBBC was defined as contralateral breast cancer <1 year after the initial cancer diagnosis, and mBBC was contralateral cancer ≥1 year. Univariable analysis examined sociodemographic, clinical, and treatment variables. Kaplan-Meier curves and Cox regression models evaluated disease-specific mortality.

RESULTS

Of the 11,493 patients that met inclusion criteria, 9575 (83.3%) had sBBC, and 1918 (16.7%) had mBBC. There were significant racial and ethnic differences in stage, tumor subtype, surgical management, and chemotherapy within sBBC and mBBC groups. On adjusted multivariate analysis of all BBC patients, Black race (HR 1.42; 95%CI 1.11-1.80; p<0.005; Ref White) was associated with a higher disease-specific mortality. Conversely, patients with mBBC had a 25% relative risk reduction in disease-specific mortality (HR 0.75; 95%CI 0.61-0.92; p<0.01) compared to sBBC. Subset analysis suggested Black Race modified the effect of sBBC on mortality (p<0.0001).

CONCLUSIONS

Among patients with BBC, there are racial and ethnic disparities in clinical characteristics, treatment, and mortality. Future studies should focus on strategies to reduce these disparities.

Chronic pain and its correlates among long-term breast cancer survivors

PURPOSE

Chronic pain is a common symptom affecting quality of life for breast cancer survivors. However, its prevalence and correlate factors in long-term breast cancer survivors, particularly Asian women, are understudied. The reported study is to address these knowledge gaps.

METHODS

We evaluated pain severity and frequency, and their associations with clinical features and lifestyle factors among 3640 5-year breast cancer survivors who participated in the Shanghai Breast Cancer Survival Study. Demographic, clinical, and lifestyle information was collected at study enrollment, which occurred 6 months post-diagnosis, and pain was assessed at the 5-year post-diagnosis follow-up survey.

RESULTS

In total, 42% of participants reported experiencing pain. Pain is more prevalent among survivors with low educational attainment or low income. Multivariable polytomous regression analyses showed that pain was positively associated with metastasis or recurrence (moderate pain OR: 2.17, 95% CI: 1.45, 3.26, frequent pain OR: 1.92, 95% CI: 1.37, 2.70), triple negative status (infrequent pain OR: 1.36, 95% CI: 1.04, 1.78), obesity (frequent pain OR: 1.80, 95% CI: 1.41, 2.31), and multiple comorbidities. Exercise (OR: 0.65, 95%: 0.49, 0.88), chemotherapy (OR: 0.59, 95% CI: 0.41, 0.849), and HER2-positive and ER/PR-negative status (OR: 0.64, 95% CI: 0.43, 0.97) were inversely associated with moderate pain.

CONCLUSIONS

Chronic pain is highly prevalent among long-term breast cancer survivors in China and was associated with obesity, physical inactivity, and several clinical factors.

IMPLICATIONS FOR CANCER SURVIVORS

This study highlights the importance of promoting weight control and exercise to alleviate chronic pain.

Kinin B1 and B2 receptors mediate cancer pain associated with both the tumor and oncology therapy using aromatase inhibitors

Pain caused by the tumor or aromatase inhibitors (AIs) is a disabling symptom in breast cancer survivors. Their mechanisms are unclear, but pro-algesic and inflammatory mediators seem to be involved. Kinins are endogenous algogenic mediators associated with various painful conditions via B1 and B2 receptor activation, including chemotherapy-induced pain and breast cancer proliferation. We investigate the involvement of the kinin B1 and B2 receptors in metastatic breast tumor (4T1 breast cancer cells)-caused pain and in aromatase inhibitors (anastrozole or letrozole) therapy-associated pain. A protocol associating the tumor and antineoplastic therapy was also performed. Kinin receptors' role was investigated via pharmacological antagonism, receptors protein expression, and kinin levels. Mechanical and cold allodynia and muscle strength were evaluated. AIs and breast tumor increased kinin receptors expression, and tumor also increased kinin levels. AIs caused mechanical allodynia and reduced the muscle strength of mice. Kinin B1 (DALBk) and B2 (Icatibant) receptor antagonists attenuated these effects and reduced breast tumor-induced mechanical and cold allodynia. AIs or paclitaxel enhanced breast tumor-induced mechanical hypersensitivity, while DALBk and Icatibant prevented this increase. Antagonists did not interfere with paclitaxel's cytotoxic action in vitro. Thus, kinin B1 or B2 receptors can be a potential target for treating the pain caused by metastatic breast tumor and their antineoplastic therapy.

Prospective Study of Pain Outcomes Associated With Breast Surgery in Women With Nonhereditary Breast Cancer

OBJECTIVE

To assess pain severity and interference with life in women after different types of breast cancer surgery and the demographic, treatment-related, and psychosocial variables associated with these pain outcomes.

SUMMARY OF BACKGROUND DATA

Data are conflicting regarding pain outcomes and quality of life (QOL) among women who undergo different types of breast surgery.

METHODS

Women with nonhereditary breast cancer completed the brief pain inventory before surgery and at 1, 6, 12, and 18 months postsurgery. We assessed associations between pain outcomes and CPM status and mastectomy status using multivariable repeated measures models. We assessed associations between pain outcome and QOL and decision satisfaction.

RESULTS

Of 288 women (mean age 56 years, 58% non-Hispanic White), 50 had CPM, 75 had unilateral mastectomy, and 163 had BCS. Mean pain severity scores were higher at one (2.78 vs 1.9, P = 0.016) and 6 months (2.79 vs 1.96, P = 0.031) postsurgery in women who had CPM versus those who did not, but there was no difference at 12 and 18 months. Comparing mastectomy versus BCS, pain severity was higher at 1 and 12 months. There was a significant interaction between pain severity and time point for CPM ( P = 0.006), but not mastectomy status ( P = 0.069). Regardless of surgery type, Black women had higher pain severity ( P = 0.004) than White women. Higher pain interference was associated with lower QOL ( P < 0.001) and lower decision satisfaction ( P = 0.034).

CONCLUSIONS

Providers should counsel women considering mastectomy about the potential for greater acute pain and its impact on overall well-being. Racial/ethnic disparities in pain exist and influence pain management in breast surgical patients.

Psychosocial Interventions for Pain Management in Breast Cancer Survivors: A RE-AIM Evaluation

Psychosocial interventions for breast-cancer-related pain are effective, yet over 45% of survivors continue to struggle with this often-chronic side effect. This study evaluated multilevel indicators that can influence successful translation of interventions into clinical practice. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was applied to evaluate reporting of individual and setting/staff-level intervention indicators. A systematic search and multi-step screening process identified 31 randomized controlled trials for psychosocial interventions for breast cancer-related pain. Average reporting of indicators for individual-level dimensions (Reach and Effectiveness) were 65.2% and 62.3%, respectively. Comparatively, indicators for setting/staff-level dimensions were reported at a lower average frequency (Implementation, 46.8%; Adoption, 15.2%; Maintenance, 7.7%). Low reporting of setting/staff-level dimensions suggests gaps in the sustained implementation of psychosocial interventions. Implementation science methods and frameworks could improve trial design and accelerate the translation of psychosocial interventions for breast cancer-related pain into clinical practice.

Development of a keyword library for capturing PRO-CTCAE-focused "symptom talk" in oncology conversations

Objectives

As computational methods for detecting symptoms can help us better attend to patient suffering, the objectives of this study were to develop and evaluate the performance of a natural language processing keyword library for detecting symptom talk, and to describe symptom communication within our dataset to generate insights for future model building.

Materials and Methods

This was a secondary analysis of 121 transcribed outpatient oncology conversations from the Communication in Oncologist-Patient Encounters trial. Through an iterative process of identifying symptom expressions via inductive and deductive techniques, we generated a library of keywords relevant to the Patient-Reported Outcome version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) framework from 90 conversations, and tested the library on 31 additional transcripts. To contextualize symptom expressions and the nature of misclassifications, we qualitatively analyzed 450 mislabeled and properly labeled symptom-positive turns.

Results

The final library, comprising 1320 terms, identified symptom talk among conversation turns with an F1 of 0.82 against a PRO-CTCAE-focused gold standard, and an F1 of 0.61 against a broad gold standard. Qualitative observations suggest that physical symptoms are more easily detected than psychological symptoms (eg, anxiety), and ambiguity persists throughout symptom communication.

Discussion

This rudimentary keyword library captures most PRO-CTCAE-focused symptom talk, but the ambiguity of symptom speech limits the utility of rule-based methods alone, and limits to generalizability must be considered.

Conclusion

Our findings highlight opportunities for more advanced computational models to detect symptom expressions from transcribed clinical conversations. Future improvements in speech-to-text could enable real-time detection at scale.

Feasibility of Investigational Procedures and Efficacy of a Personalized Omega-3 Dietary Intervention in Alleviating Pain and Psychoneurological Symptoms in Breast Cancer Survivors

BACKGROUND

Breast cancer survivors (BCS) are at risk for psychoneurological symptoms (PNS) and inflammation for years following cancer treatment. Fish, particularly salmon, provides a rich source of omega-3 long chain fatty acids (omega-3LC), which has an anti-inflammatory effect. However, the benefit of omega-3LC on PNS is not well-known.

AIMS

This study evaluated the feasibility and the initial efficacy of a personalized meal plan with dietary omega-3LC in reducing PNS.

METHODS

A prospective, randomized controlled trial design (n = 46) was used to evaluate the feasibility of a personalized meal plan using two omega-3LC dose levels (high and low omega-3LC) in reducing PNS including pain, depression, fatigue, sleep, and stress.

RESULTS

The recruitment rate was 4.9% with overall retention rate of 74% and 67.1% adherence to personalized meal plan and dietary procedures. Of participants who completed the investigation, 94% completed fish adherence logs and consumed ≥70% of the assigned quantity of fish. Saliva collection was 97.8% at baseline and 100% at follow-up. BCS in the high omega-3LC group had a significant decrease in pain (p < .01), perceived stress (p < .05), sleep (p < .001), depression (p < .001), and fatigue (p < .01) over the course of intervention. There were trends of PNS improvement in the low omega-3LC group but the differences did not reach statistical significance.

CONCLUSION

Our results support the feasibility of our investigational design, procedures, and intervention. The outcomes provide preliminary support for an expanded research effort using fish as a source of omega-3LC and personalized dietary planning as a vehicle for symptom self-management in BCS.

Perioperative Sleep Disturbance Following Mastectomy: A Longitudinal Investigation of the Relationship to Pain, Opioid Use, Treatment, and Psychosocial Symptoms

OBJECTIVES

Sleep disturbance negatively impacts the quality of life and recovery. Our objective was to evaluate the relationship between the individual patient and surgical factors with greater sleep disturbance following breast surgery.

METHODS

In this prospective longitudinal study, patients completed validated measures regarding sleep disturbance, pain, opioid use, and psychological symptoms preoperatively and then 2 weeks, 6 and 12 months postoperatively. Univariable and multivariable generalized estimating equations evaluated demographic, surgical, pain, and psychological predictors of sleep disturbance during the first year after breast surgery.

RESULTS

Female patients (n=259) reported varying degrees of sleep disturbance, which were longitudinally associated with pain and psychosocial factors (eg, anxiety, depression, and affect). Independent preoperative predictors of worse sleep disturbance included younger age (B=-0.09, P =0.006), opioid use (B=3.09, P =0.02), and higher pain (B=0.19, P =<0.001) and anxiety (B=0.45, P =<0.001) at baseline. In addition, higher baseline positive affect (B=-0.14, P =<0.012) and the surgical category total mastectomy without reconstruction (B=-2.81, P =<0.006) were independently associated with lower sleep disturbance. Those with worse baseline sleep required more opioid analgesics during surgical recovery, and continued use of opioids at 2 weeks postsurgery was associated with disturbed sleep.

DISCUSSION

Certain patient characteristics, including younger age and baseline anxiety, positive affect, pain, and opioid use, were associated with greater sleep disturbance in the first year after breast surgery. Sleep disturbance was also associated with the greater perioperative and postoperative opioid requirements. Preoperative interventions (eg, anxiety management, cultivating positive affect, and multimodal pain management) in high-risk individuals may enhance sleep and recovery postoperatively, and allow more moderate and less prolonged opioid use.

Update on Prevalence of Pain in Patients with Cancer 2022: A Systematic Literature Review and Meta-Analysis

Experiencing pain and insufficient relief can be devastating and negatively affect a patient's quality of life. Developments in oncology such as new treatments and adjusted pain management guidelines may have influenced the prevalence of cancer pain and severity in patients. This review aims to provide an overview of the prevalence and severity of pain in cancer patients in the 2014-2021 literature period. A systematic literature search was performed using the databases PubMed, Embase, CINAHL, and Cochrane. Titles and abstracts were screened, and full texts were evaluated and assessed on methodological quality. A meta-analysis was performed on the pooled prevalence and severity rates. A meta-regression analysis was used to explore differences between treatment groups. We identified 10,637 studies, of which 444 studies were included. The overall prevalence of pain was 44.5%. Moderate to severe pain was experienced by 30.6% of the patients, a lower proportion compared to previous research. Pain experienced by cancer survivors was significantly lower compared to most treatment groups. Our results imply that both the prevalence of pain and pain severity declined in the past decade. Increased attention to the assessment and management of pain might have fostered the decline in the prevalence and severity of pain.

Prediction models for chronic postsurgical pain in patients with breast cancer based on machine learning approaches

Purpose

This study aimed to develop prediction models for chronic postsurgical pain (CPSP) after breast cancer surgery using machine learning approaches and evaluate their performance.

Methods

The study was a secondary analysis based on a high-quality dataset from a randomized controlled trial (NCT00418457), including patients with primary breast cancer undergoing mastectomy. The primary outcome was CPSP at 12 months after surgery, defined as modified Brief Pain Inventory > 0. The dataset was randomly split into a training dataset (90%) and a testing dataset (10%). Variables were selected using recursive feature elimination combined with clinical experience, and potential predictors were then incorporated into three machine learning models, including random forest, gradient boosting decision tree and extreme gradient boosting models for outcome prediction, as well as logistic regression. The performances of these four models were tested and compared.

Results

1152 patients were finally included, of which 22.1% developed CPSP at 12 months after breast cancer surgery. The 6 leading predictors were higher numerical rating scale within 2 days after surgery, post-menopausal status, urban medical insurance, history of at least one operation, under fentanyl with sevoflurane general anesthesia, and received axillary lymph node dissection. Compared with the multivariable logistic regression model, machine learning models showed better specificity, positive likelihood ratio and positive predictive value, helping to identify high-risk patients more accurately and create opportunities for early clinical intervention.

Conclusions

Our study developed prediction models for CPSP after breast cancer surgery based on machine learning approaches, which may help to identify high-risk patients and improve patients' management after breast cancer.

Effects of esters' cetylated fatty acids taping for chronic neck pain with mobility deficit in patients with breast cancer

PURPOSE

To evaluate the effects of a protocol treatment based on inelastic adhesive tape with cetylated fatty acids (CFAs) esters in breast cancer survivors with chronic neck pain.

METHODS

In this observational study, patients have been visited for chronic neck pain using numeric rating scale (NRS) for pain assessment, Neck Disability Index (NDI) for disability caused by neck pain, and range of movement (ROM) measures for cervical mobility. Scales have been performed at T0, after 15 days of treatment (T1) and successively after 15 days of stop treatment (T2). Patients have been treated with an inelastic adhesive tape with CFA esters (Cetilar® Tape, Pharmanutra Spa, Italy) positioned, 8 h/day for 15 days, on specific anatomic sites (upper trapezius, paravertebral cervical muscles, sub-occipitals, and/or levator scapulae muscles).

RESULTS

Forty-five patients were included in the study. A statistically significant reduction in pain has been reported from T0 to T1 and maintained at T2 (p < 0.05); a statistically significant improvement in the mobility of the cervical spine, as evidenced by ROMs, and in disability, as resulted by Neck Disability Index, have been reported from T0 to T1 and maintained at T2; moreover, ROM at T0 correlates inversely and statistically significantly with NRS and all NDI variables at T0, similarly at T1 and T2 (p < 0.001).

CONCLUSIONS

CFA ester taping is a simple, effective, and side-effect-free treatment in order to reduce pain and improve cervical mobility in breast cancer survivors with chronic neck pain.

Role of self-efficacy for pain management and pain catastrophizing in the relationship between pain severity and depressive symptoms in women with breast cancer and pain

PURPOSE

This study evaluated the relationship between pain and depressive symptoms through pain self-efficacy and pain catastrophizing in breast cancer patients with pain.

DESIGN

Secondary analysis of a randomized trial investigating a cognitive-behavioral pain management protocol.

SAMPLE

Females (N = 327) with stage I-III breast cancer and report of at least moderate pain.

METHODS

Pain severity, pain self-efficacy, pain catastrophizing, and depressive symptoms were measured. The proposed model was assessed using structural equation modeling.

RESULTS

Higher pain severity was significantly related to lower pain self-efficacy and higher pain catastrophizing. Lower pain self-efficacy and higher pain catastrophizing were significantly related to more depressive symptoms. Higher pain severity was significantly associated with more depressive symptoms through lower pain self-efficacy and higher pain catastrophizing. The association between pain severity and depressive symptoms was not significant when specified as a direct effect.

CONCLUSION

Pain severity related to depressive symptoms in breast cancer patients via pain self-efficacy and pain catastrophizing.

IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS

Measurement of pain self-efficacy and pain catastrophizing should be incorporated into comprehensive pain assessments for women with breast cancer, as these variables may be relevant therapeutic targets. Psychosocial symptom management interventions should include strategies that increase pain self-efficacy and decrease pain catastrophizing because these pain-related cognitive variables appear to drive the relationship between pain severity and depressive symptoms.

Pain prevalence and characteristics in survivors of solid cancers: a systematic review and meta-analysis

PURPOSE

The latest systematic review on the prevalence of pain in cancer survivors was published 5 years ago. The current review aims to provide an extended overview on the prevalence of pain, pain mechanisms, pain characteristics, and assessment methods in cancer survivors.

METHODS

A systematic research was conducted on 17th of April 2020 using MEDLINE, Embase, Scopus, Web of Science, and Cochrane looking at studies from 2014 to 2020. Studies had to report pain prevalence rates in cancer survivors with a solid tumor who finished curative treatment at least 3 months ago. Methodological quality was assessed by two independent reviewers using the Joanna Briggs Institute quality appraisal tool. Characteristics of the included studies, participants and reported pain prevalence rates were extracted. The reported prevalence rates of the individual studies were pooled within a meta-analysis. Meta-regressions were performed to identify possible determinants of the pooled pain prevalence.

RESULTS

After deduplication, 7300 articles were screened, after which 38 were included in the meta-analysis. Risk of bias was rated low in 26 articles and moderate in 12 articles. The pooled pain prevalence was 47% (95%CI 39-55), with a heterogeneity of 98.99%.

CONCLUSION

This meta-analysis suggests that nearly half of cancer survivors report pain after completing curative treatment at least 3 months ago. However, substantial unexplained heterogeneity warrants cautious interpretation of these results. Meta-regression using cancer type, treatment location, pain measurement, and follow-up time as a covariate could not explain influencing factors explaining the high heterogeneity.