Preoperative Distress Predicts Persistent Pain After Breast Cancer Treatment: A Prospective Cohort Study

Purpose: Persistent pain after breast cancer treatment (PPBCT) affects 25% to 60% of breast cancer survivors and is recognized as a clinical problem, with 10% to 15% reporting moderate to severe pain several years after treatment. Psychological comorbidity is known to influence pain perception, and evidence links signs of depression and anxiety with development of PPBCT. The purpose of this study was to assess preoperative distress as a predictive factor for development of PPBCT. Methods: Between October 2008 and October 2009, 426 women diagnosed with primary breast cancer, undergoing surgery at the Department of Breast Surgery, Rigshospitalet, Denmark, were invited to participate in the study. Patients filled out a questionnaire preoperatively, and 4 and 8 months after surgery. Preoperative distress was measured with the Distress Thermometer (DT; 11-point scale, 0–10). We examined the association between severe preoperative distress (using DT ≥7) and moderate to severe PPBCT 8 months after diagnosis using a logistic regression model. Results: A total of 357 patients participated in this study and 291 (82%) returned all follow-up questionnaires. Preoperative distress was significantly associated with moderate to severe PPBCT at 8 months, with an adjusted odds ratio (OR) of 2.05 (95% CI, 1.18–3.59; P=.01), and at 4 months, with an OR of 2.23 (95% CI, 1.23–4.05; P=.01). Conclusions: Preoperative distress was associated with PPCBT, suggesting distress as an independent risk factor for PPBCT. Preoperative identification of patients at risk for PPBCT allows for further research in psychological and pharmacological treatment of this condition.

Target Audience

This activity has been designed to meet the educational needs of physicians and nurses involved in the management of patients with cancer.

Learning Objectives

Upon completion of this activity, participants will be able to:

  • Examine preoperative distress as a predictive factor for development of PPBCT
  • Identify psychological risk factors for PPBCT that may be targeted in preventive interventions
Additional information
Supporters: 

No commercial support was received for this article.

Course summary
Available credit: 
  • 1.00 Participation
  • 1.00 Nurse
  • 1.00 Physician
Course opens: 
08/18/2015
Course expires: 
08/18/2016
Cost:
$0.00

Mathias Kvist Mejdahl, MD
Section for Surgical Pathophysiology
Rigshospitalet, University of Copenhagen
Copenhagen, Denmark

Birgitte Goldschmidt Mertz, RN
Department of Breast Surgery
Rigshospitalet, University of Copenhagen
Copenhagen, Denmark

Pernille Envold Bidstrup, MSc, PhD
Survivorship Unit
Danish Cancer Society Research Center
Copenhagen, Denmark

Kenneth Geving Andersen, MD, PhD
Section for Surgical Pathophysiology
Rigshospitalet, University of Copenhagen
Copenhagen, Denmark

Available Credit

  • 1.00 Participation
  • 1.00 Nurse
  • 1.00 Physician

Accreditation Period

Course opens: 
08/18/2015
Course expires: 
08/18/2016

Price

Cost:
$0.00
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Required Hardware/software

To access this activity, users will need:

  • A device with an Internet connection
  • Adobe Reader or other PDF reader software for article and certificate viewing/printing