Postmastectomy Chronic Pain in Breast Cancer Survivors: an Exploratory Study on Prevalence, Characteristics, Risk Factors, and Impact on Quality of Life

Chronic pain following surgery for breast cancer affects over 50% of patients and is one of the important issues adversely affecting the quality of life of breast cancer survivors. However, there is little information about this problem in Indian patients. Hence, this descriptive study was planned with the objectives to explore the prevalence, pain characteristics, risk factors of postmastectomy chronic pain (PMCP), and its impact on quality of life (QOL). During the period of February 2014 to January 2017, a total of 215 breast cancer survivors, coming for follow-up visits to surgery outpatients department, were evaluated for complaint of PMCP, defined as pain over anterior chest wall, axilla, or ipsilateral arm, which was persistent for more than 3 months after breast cancer surgery. Evaluation of pain severity was done by visual analogue scale (VAS), and characteristic of pain was assessed by Neuropathic Pain Symptom Inventory (NPSI). Body charts were used to define location of pain. Assessment of QOL was done by FACT-B questionnaire. Overall prevalence of PMCP was 41.4 and 19.5% patients had clinically significant pain scores of ≥3. Character of pain was mainly described as pins and needles (59.5%) and burning sensation (30%), and the most common site of pain (52%) was around the mastectomy scar. Younger age was significantly correlated with higher pain scores. Patients with higher pain scores had poorer QOL scores. (104.0 ± 19.27 with a VAS score of <3 vs. 85.26 ± 14.00 with a VAS score of ≥3, p < 0.001). Emotional distress was an important contributor to poor QOL. PMCP is a common problem in Indian breast cancer survivors, which causes considerable emotional distress and negatively impacts QOL. Treating physicians should evaluate and appropriately address this important survivorship issue.