Characterization of risk factors for adjuvant radiotherapy-associated pain in a tri-racial/ethnic breast cancer population

Abstract

Pain related to cancer or treatment is a critical quality of life (QOL) issue for breast cancer survivors. In a prospective study of 375 breast cancer patients (enrolled during 2008–2014), we characterized the risk factors for adjuvant radiotherapy (RT)-associated pain. Pain score was assessed at pre- and post-RT as the mean of four pain severity items (i.e., pain at its worst, least, average, and now) from the Brief Pain Inventory (BPI) with 11-point numeric rating scale (0–10). Pain scores of 4–10 were considered clinically-relevant pain. The study consists of 58 non-Hispanic whites (NHW; 15%), 78 black or African Americans (AA; 21%), and 239 Hispanic whites (HW; 64%). Overall, the prevalence of clinically-relevant pain was 16% at pre-RT, 31% at post-RT, and 20% RT-associated increase. In univariate analysis, AA and HW had significantly higher pre- and post-RT pain compared to NHW. In multivariable logistic regression analysis, pre-RT pain was significantly associated with HW and obesity; post-RT pain was significantly associated with AA, HW, younger age, ≥2 comorbid conditions, above median hotspot volume receiving >105% prescribed dose, and pre-RT pain score ≥4. RT-associated pain was significantly associated with AA (odds ratio [OR]=3.27; 95% confidence interval (CI)=1.09–9.82), younger age (OR=2.44, 95% CI=1.24–4.79), and 2 or ≥3 comorbid conditions (OR=3.06, 95%CI=1.32–7.08; OR=4.61, 95%CI=1.49–14.25, respectively). These risk factors may help to guide RT decision making process, such as hypo-fractionated RT schedule. Furthermore, effective pain management strategies are needed to improve QOL in breast cancer patients with clinically-relevant pain.

Association Between Inflammatory Biomarker C-Reactive Protein and Radiotherapy-Induced Early Adverse Skin Reactions in a Multiracial/Ethnic Breast Cancer Population

“…[6][7][8][9] Breast or chest wall pain, increased risk of rib fracture, increased risk of cardiac morbidity, and lymphedema also are known late adverse effects of radiation. [10][11][12] Inflammation may play a critical role in RT-induced skin toxicities because RT has been observed to induce changes in proinflammatory, profibrotic, proangiogenic, and stem-cellmobilizing cytokines as well as in growth factors that may contribute to normal tissue toxicities or tumor control. 13,14 C-reactive protein (CRP), an inflammatory biomarker, has been associated with vascular atherosclerosis, insulin resistance, type 2 diabetes mellitus, and cancer.…”

Breast size impact on adjuvant radiotherapy adverse effects and dose parameters in treatment planning

“… 11 , 17 , 32 , 36 , 38 , 42 , 80 , 81 Most of the investigators attributed higher toxicity rates in BC radiotherapy to dose inhomogeneity and a higher percentage of hot spots, irrespective of breast volume. 7 , 12 , 17 , 31 V105–107 % of the prescribed dose (PD) was significantly related to increased desquamation, dermatitis, oedema, and pain 12 ; and V105 % PD 82 , 83 or V110 % PD 83 to long-term breast pain. Significant reductions in hot spots can be achieved with 3D-CRT or F-IMRT treatment plans, also in patients with large/pendulous breasts (PTV >1000 cm 3 ).…”

The Necrosis-Avid Small Molecule HQ4-DTPA as a Multimodal Imaging Agent for Monitoring Radiation Therapy-Induced Tumor Cell Death

“…Radiation therapy was selected as the treatment modality for the breast cancer model in the present study because of its wide-spread clinical usage. Breast conserving surgery is the standard treatment for localized breast cancer in combination with (neo-)adjuvant therapies ( 46 ), such as radiation therapy, which has been shown to reduce local recurrence ( 47 ). Radiation therapy is commonly administered in a conventional fractionated schedule (25 fractions of 2 Gy) on the breast with an additional boost of up to 10 Gy on the lumpectomy cavity ( 47 ).…”

“…Breast conserving surgery is the standard treatment for localized breast cancer in combination with (neo-)adjuvant therapies ( 46 ), such as radiation therapy, which has been shown to reduce local recurrence ( 47 ). Radiation therapy is commonly administered in a conventional fractionated schedule (25 fractions of 2 Gy) on the breast with an additional boost of up to 10 Gy on the lumpectomy cavity ( 47 ). Since such treatment schemes cannot be easily replicated in a relevant manner in animal models, we selected a radiation regimen that is isoeffective to a clinically relevant fractionated irradiation regimen based on a BED of 60 Gy in 2 Gy fractions ( 48 , 49 ).…”