Identification of patient subgroups and risk factors for persistent arm/shoulder pain following breast cancer surgery.
OBJECTIVE
In 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
Patients 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.


RESULTS
Using 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.


CONCLUSIONS
Findings 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.
School of Nursing, University of California, San Francisco, CA, USA. Electronic address: chris.miaskowski@nursing.ucsf.edu.
Christine
C
Miaskowski
School of Nursing, University of California, San Francisco, CA, USA.
Steven M
SM
Paul
School of Nursing, University of California, San Francisco, CA, USA.
Bruce
B
Cooper
School of Nursing, University of California, San Francisco, CA, USA.
Claudia
C
West
School of Medicine, University of California, San Francisco, CA, USA.
Jon D
JD
Levine
Redwood Regional Medical Group, Santa Rosa, CA, USA.
Charles
C
Elboim
School of Nursing, University of California, San Francisco, CA, USA.
Deborah
D
Hamolsky
School of Medicine, University of California, San Francisco, CA, USA.
Gary
G
Abrams
School of Medicine, University of California, San Francisco, CA, USA.
Judith
J
Luce
School of Medicine, University of California, San Francisco, CA, USA.
Anand
A
Dhruva
School of Nursing, University of California, San Francisco, CA, USA.
Dale J
DJ
Langford
School of Nursing, University of California, San Francisco, CA, USA.
John D
JD
Merriman
School of Nursing, University of California, San Francisco, CA, USA.
Kord
K
Kober
School of Nursing, University of California, San Francisco, CA, USA.
Christina
C
Baggott
School of Nursing, University of California, San Francisco, CA, USA.
Heather
H
Leutwyler
School of Nursing, University of California, San Francisco, CA, USA; Institute for Human Genetics, University of California, San Francisco, CA, USA.
Bradley E
BE
Aouizerat
D000203:Activities of Daily Living; D001132:Arm / Q000503:physiopathology; D001943:Breast Neoplasms / Q000601:surgery*; D002140:California / Q000453:epidemiology; D005260:Female; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008137:Longitudinal Studies; D008408:Mastectomy; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology* / Q000503:physiopathology; D015995:Prevalence; D011446:Prospective Studies; D011788:Quality of Life; D016059:Range of Motion, Articular / Q000502:physiology; D012307:Risk Factors; D020069:Shoulder Pain / Q000453:epidemiology* / Q000503:physiopathology; D011795:Surveys and Questionnaires
Arm pain; Breast cancer surgery; Chronic pain; Growth mixture modeling; Latent class analysis; Persistent postsurgical pain; Risk factors; Shoulder pain