Abstract
The impact of psychosocial vulnerability on pain in the year following breast cancer diagnosis has been little studied. To identify a score of psychosocial vulnerability (cognitive, emotional, quality of life and precariousness parameters) as a predictor of a pain trajectory, we conducted an observational prospective study and included women with newly diagnosed breast cancer. One year follow-up with 3 visits (day of breast cancer diagnosis; 6 and 12 months) aimed to identify distinct pain-time trajectories. Baseline psychosocial vulnerability was characterized by z-score transformation, a higher score representing a more vulnerable patient. A total of 89 patients were included (59.3 ± 10.7 years). Two trajectories of pain were identified—“Transient Pain trajectory” (TP) (39/89 patients) and “Persistent Pain trajectory” (PP) (50/89). A significant difference of pain over time between trajectories (PP vs. TP at 6 months: 2.23 ± 0.23 vs. 0.27 ± 0.09, p < 0.001) was observed. Psychosocial vulnerability showed a large effect size (d, −0.82; 95% CI, −1.25 to −0.38; p < 0.001) and a higher score in “Persistent pain trajectory” (PP vs. TP: 0.12 ± 0.36 vs. −0.14 ± 0.26, p < 0.001). A predictive vulnerability marker of pain development is proposed and could be used at cancer diagnosis to orientate the care pathway of patients experiencing breast cancer.
Highlights
Breast cancer is the leading type of female cancer in developed countries [1]
The aim of this study was to describe pain trajectories starting from breast cancer diagnosis and for one year, taking into account all interventions, identifying associated factors and proposing a psychosocial vulnerability predictive score for the development of chronic pain
Our study followed a cohort of patients from their diagnosis of breast cancer and along successive therapeutic interventions, with the aim to identify pain trajectories and a predictive marker of pain development
Summary
Breast cancer is the leading type of female cancer in developed countries [1]. The burden of disease is significant, with 279,100 new breast cancer cases estimated in 2020 in the United States [2] and cancer treatment is associated with pain, cognition, emotion and quality of life impairment. Surgery is the main cause for pain development, patients undergo other interventions including chemotherapy or radiotherapy in a succession that depends on the clinical situation. These interventions do generate pain, neuropathic pain occurring in 58% patients with cancer chemotherapy [13,14] and moderate-to-severe symptoms of anxiety, sleep disturbances, depressed mood or fatigue co-occurring during cancer treatment [15]. Several studies on cognitive and emotional factors such as anxiety, catastrophism, memory and flexibility may characterize the psychological vulnerability of a patient and may predict pain [24,25,26,27]. According to the literature and the biopsychosocial aspects of pain, we chose these specific dimensions of psychosocial vulnerability, namely cognitive and emotional function, quality of life and precariousness in this study
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