Li Wang1, Gordon H Guyatt1, Sean A Kennedy1, Beatriz Romerosa1, Henry Y Kwon1, Alka Kaushal1, Yaping Chang1, Samantha Craigie1, Carlos P B de Almeida1, Rachel J Couban1, Shawn R Parascandalo1, Zain Izhar1, Susan Reid1, James S Khan1, Michael McGillion1, Jason W Busse2. 1. Michael G. DeGroote Institute for Pain Research and Care (Wang, Craigie, Couban, Busse), Department of Anesthesia (Wang, Busse), Department of Clinical Epidemiology and Biostatistics (Guyatt, Kaushal, Chang, Izhar, Busse), Michael G. DeGroote School of Business (Izhar), Department of Surgery (Reid) and School of Nursing (McGillion), McMaster University, Hamilton, Ont.; Chinese Cochrane Centre (Wang), West China Hospital, Sichuan University, Chengdu, China; Department of Diagnostic Radiology (Kennedy) and Department of Anesthesiology (Khan), University of Toronto, Toronto, Ont.; Department of Anesthesia and Critical Care (Romerosa), University Hospital of Toledo, Toledo, Spain; Wayne State University School of Medicine (Kwon), Detroit, Mich.; Respiratory Sciences Program (de Almeida), Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; School of Medicine (Parascandalo), University College Cork, Cork, Ireland. 2. Michael G. DeGroote Institute for Pain Research and Care (Wang, Craigie, Couban, Busse), Department of Anesthesia (Wang, Busse), Department of Clinical Epidemiology and Biostatistics (Guyatt, Kaushal, Chang, Izhar, Busse), Michael G. DeGroote School of Business (Izhar), Department of Surgery (Reid) and School of Nursing (McGillion), McMaster University, Hamilton, Ont.; Chinese Cochrane Centre (Wang), West China Hospital, Sichuan University, Chengdu, China; Department of Diagnostic Radiology (Kennedy) and Department of Anesthesiology (Khan), University of Toronto, Toronto, Ont.; Department of Anesthesia and Critical Care (Romerosa), University Hospital of Toledo, Toledo, Spain; Wayne State University School of Medicine (Kwon), Detroit, Mich.; Respiratory Sciences Program (de Almeida), Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; School of Medicine (Parascandalo), University College Cork, Cork, Ireland bussejw@mcmaster.ca.
Abstract
BACKGROUND: Persistent pain after breast cancer surgery affects up to 60% of patients. Early identification of those at higher risk could help inform optimal management. We conducted a systematic review and meta-analysis of observational studies to explore factors associated with persistent pain among women who have undergone surgery for breast cancer. METHODS: We searched the MEDLINE, Embase, CINAHL and PsycINFO databases from inception to Mar. 12, 2015, to identify cohort or case-control studies that explored the association between risk factors and persistent pain (lasting ≥ 2 mo) after breast cancer surgery. We pooled estimates of association using random-effects models, when possible, for all independent variables reported by more than 1 study. We reported relative measures of association as pooled odds ratios (ORs) and absolute measures of association as the absolute risk increase. RESULTS: Thirty studies, involving a total of 19 813 patients, reported the association of 77 independent variables with persistent pain. High-quality evidence showed increased odds of persistent pain with younger age (OR for every 10-yr decrement 1.36, 95% confidence interval [CI] 1.24-1.48), radiotherapy (OR 1.35, 95% CI 1.16-1.57), axillary lymph node dissection (OR 2.41, 95% CI 1.73-3.35) and greater acute postoperative pain (OR for every 1 cm on a 10-cm visual analogue scale 1.16, 95% CI 1.03-1.30). Moderate-quality evidence suggested an association with the presence of preoperative pain (OR 1.29, 95% CI 1.01-1.64). Given the 30% risk of pain in the absence of risk factors, the absolute risk increase corresponding to these ORs ranged from 3% (acute postoperative pain) to 21% (axillary lymph node dissection). High-quality evidence showed no association with body mass index, type of breast surgery, chemotherapy or endocrine therapy. INTERPRETATION: Development of persistent pain after breast cancer surgery was associated with younger age, radiotherapy, axillary lymph node dissection, greater acute postoperative pain and preoperative pain. Axillary lymph node dissection provides the only high-yield target for a modifiable risk factor to prevent the development of persistent pain after breast cancer surgery.
BACKGROUND: Persistent pain after breast cancer surgery affects up to 60% of patients. Early identification of those at higher risk could help inform optimal management. We conducted a systematic review and meta-analysis of observational studies to explore factors associated with persistent pain among women who have undergone surgery for breast cancer. METHODS: We searched the MEDLINE, Embase, CINAHL and PsycINFO databases from inception to Mar. 12, 2015, to identify cohort or case-control studies that explored the association between risk factors and persistent pain (lasting ≥ 2 mo) after breast cancer surgery. We pooled estimates of association using random-effects models, when possible, for all independent variables reported by more than 1 study. We reported relative measures of association as pooled odds ratios (ORs) and absolute measures of association as the absolute risk increase. RESULTS: Thirty studies, involving a total of 19 813 patients, reported the association of 77 independent variables with persistent pain. High-quality evidence showed increased odds of persistent pain with younger age (OR for every 10-yr decrement 1.36, 95% confidence interval [CI] 1.24-1.48), radiotherapy (OR 1.35, 95% CI 1.16-1.57), axillary lymph node dissection (OR 2.41, 95% CI 1.73-3.35) and greater acute postoperative pain (OR for every 1 cm on a 10-cm visual analogue scale 1.16, 95% CI 1.03-1.30). Moderate-quality evidence suggested an association with the presence of preoperative pain (OR 1.29, 95% CI 1.01-1.64). Given the 30% risk of pain in the absence of risk factors, the absolute risk increase corresponding to these ORs ranged from 3% (acute postoperative pain) to 21% (axillary lymph node dissection). High-quality evidence showed no association with body mass index, type of breast surgery, chemotherapy or endocrine therapy. INTERPRETATION: Development of persistent pain after breast cancer surgery was associated with younger age, radiotherapy, axillary lymph node dissection, greater acute postoperative pain and preoperative pain. Axillary lymph node dissection provides the only high-yield target for a modifiable risk factor to prevent the development of persistent pain after breast cancer surgery.
Authors: J M Ververs; R M Roumen; A J Vingerhoets; G Vreugdenhil; J W Coebergh; M A Crommelin; E J Luiten; O J Repelaer van Driel; M Schijven; J C Wissing; A C Voogd Journal: Eur J Cancer Date: 2001-05 Impact factor: 9.162
Authors: Enja J Bantema-Joppe; Cornelis Schilstra; Geertruida H de Bock; Wil V Dolsma; Dianne M Busz; Johannes A Langendijk; John H Maduro Journal: Int J Radiat Oncol Biol Phys Date: 2012-04-10 Impact factor: 7.038
Authors: Thomas F Hack; Winkle B Kwan; Roanne L Thomas-Maclean; Anna Towers; Baukje Miedema; Andrea Tilley; Dan Chateau Journal: Psychooncology Date: 2010-11 Impact factor: 3.894
Authors: M A Warmuth; G Bowen; L R Prosnitz; L Chu; G Broadwater; B Peterson; G Leight; E P Winer Journal: Cancer Date: 1998-10-01 Impact factor: 6.860
Authors: Dana H Bovbjerg; Francis J Keefe; Mary S Soo; Jessica Manculich; Alyssa Van Denburg; Margarita L Zuley; Gretchen M Ahrendt; Celette S Skinner; Sara N Edmond; Rebecca A Shelby Journal: Acta Oncol Date: 2019-02-12 Impact factor: 4.089
Authors: Frank C Sweeney; Wendy Demark-Wahnefried; Kerry S Courneya; Nathalie Sami; Kyuwan Lee; Debu Tripathy; Kimiko Yamada; Thomas A Buchanan; Darcy V Spicer; Leslie Bernstein; Joanne E Mortimer; Christina M Dieli-Conwright Journal: Phys Ther Date: 2019-10-28
Authors: Li Wang; Brian Y Hong; Sean A Kennedy; Yaping Chang; Chris J Hong; Samantha Craigie; Henry Y Kwon; Beatriz Romerosa; Rachel J Couban; Susan Reid; James S Khan; Michael McGillion; Victoria Blinder; Jason W Busse Journal: J Clin Oncol Date: 2018-05-14 Impact factor: 44.544
Authors: Raymond C Tait; Kim Zoberi; McKenzie Ferguson; Kimberly Levenhagen; Rebecca A Luebbert; Kevin Rowland; Gretchen B Salsich; Christopher Herndon Journal: J Pain Date: 2018-06-30 Impact factor: 5.820
Authors: Marium M Raza; Ruth Zaslansky; Debra B Gordon; Jeanne M Wildisen; Marcus Komann; Ulrike M Stamer; Dale J Langford Journal: J Clin Med Date: 2021-04-27 Impact factor: 4.241