Identification of patient subgroups and risk factors for persistent arm/shoulder pain following breast cancer surgery |
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| Affiliation: | 1. School of Nursing, University of California, San Francisco, CA, USA;2. School of Medicine, University of California, San Francisco, CA, USA;3. Institute for Human Genetics, University of California, San Francisco, CA, USA;4. Redwood Regional Medical Group, Santa Rosa, CA, USA;1. School of Nursing, University of California, San Francisco, San Francisco, California;2. School of Medicine, University of California, San Francisco, San Francisco, California;3. Department of Oral Maxillofacial Surgery, New York University College of Dentistry, New York, New York;4. Redwood Regional Medical Group, Santa Rosa, California;5. Institute for Human Genetics, University of California, San Francisco, San Francisco, California;1. Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, UK;2. Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK;3. School of Psychological Sciences, University of Manchester, Manchester, UK;4. Aberdeen Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK;5. Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, UK;6. Division of Applied Medicine, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK;7. Surgical Oncology, Dundee Cancer Centre, Ninewells Hospital and Medical School, Dundee, UK;8. Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK;9. Anaesthesia and Pain Medicine, Aberdeen Royal Infirmary, Aberdeen, UK;10. Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK;1. Department of Cancer Treatment, The Norwegian Research Center for Active Rehabilitation, Oslo University Hospital, Oslo, Norway;2. Department of Breast and Endocrine Surgery, The Norwegian Research Center for Active Rehabilitation, Oslo University Hospital, Oslo, Norway;3. Center of Epidemiology and Biostatistics, The Norwegian Research Center for Active Rehabilitation, Oslo University Hospital, Oslo, Norway;4. Faculty of Health Sciences, Department of Community Medicine, University of Tromsø, Tromsø, Norway;5. Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway;1. Portuguese Institute of Oncology of Porto, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal;2. EPIUnit – Institute of Public Health, University of Porto (ISPUP), Rua das Taipas, nº135, 4050-600 Porto, Portugal;3. Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal;4. Department of Experimental Biology, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal;5. Institute for Molecular and Cell Biology (IBMC), University of Porto, Rua do Campo Alegre, nº 823, 4150-180 Porto, Portugal;1. Oslo University Hospital, Oslo, Norway;2. University of Oslo, Oslo, Norway |
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| Abstract: | PurposeIn this prospective, longitudinal study, we extend our findings on persistent breast pain in patients (n = 398) following breast cancer surgery and evaluate the prevalence and characteristics of persistent pain in the arm/shoulder. In addition, differences in the severity of common symptoms and quality of life outcomes measured prior to surgery, among the arm pain classes, were evaluated.Methods and samplePatients were recruited from Breast Care Centers located in a Comprehensive Cancer Center, two public hospitals, and four community practices. Patients were assessed prior to and monthly for six months following breast cancer surgery.ResultsUsing growth mixture modeling, patients were classified into no (41.6%), mild (23.6%), and moderate (34.8%) arm pain classes based on ratings of worst arm/shoulder pain. Compared to the no pain class, patients in the moderate pain class were significantly younger, had a higher body mass index, and were more likely to report preoperative breast pain and swelling in the affected breast. In addition, patients in the moderate pain class reported higher levels of depression, anxiety, and sleep disturbance than the no pain class.ConclusionsFindings suggest that approximately 35% of women experience persistent levels of moderate arm/shoulder pain in the first six months following breast cancer surgery. Moderate arm/shoulder pain is associated with clinically meaningful decrements in functional status and quality of life. |
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| Keywords: | Arm pain Shoulder pain Persistent postsurgical pain Risk factors Breast cancer surgery Growth mixture modeling Latent class analysis Chronic pain |
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