Preoperative Distress Predicts Persistent Pain After Breast Cancer Treatment: A Prospective Cohort Study.
OBJECTIVE
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.
From the Section for Surgical Pathophysiology, and Department of Breast Surgery, Rigshospitalet, University of Copenhagen; and Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark.
Mathias Kvist
MK
Mejdahl
From the Section for Surgical Pathophysiology, and Department of Breast Surgery, Rigshospitalet, University of Copenhagen; and Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark.
Birgitte Goldschmidt
BG
Mertz
From the Section for Surgical Pathophysiology, and Department of Breast Surgery, Rigshospitalet, University of Copenhagen; and Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark.
Pernille Envold
PE
Bidstrup
From the Section for Surgical Pathophysiology, and Department of Breast Surgery, Rigshospitalet, University of Copenhagen; and Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark.
Kenneth Geving
KG
Andersen
D000368:Aged; D001943:Breast Neoplasms / Q000150:complications* / Q000523:psychology* / Q000601:surgery; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D010146:Pain / Q000209:etiology*; D011183:Postoperative Complications; D057234:Preoperative Period; D011446:Prospective Studies; D012307:Risk Factors; D013315:Stress, Psychological; D011795:Surveys and Questionnaires