1680P - Factors mediating the association between adverse life experiences and pain in patients with localized breast cancer

Background

Chronic pain is reported by > 50% of patients recovering from breast cancer (BC). Adverse life experiences (ALEs) are associated with decreased psychosocial functioning in BC survivors, but their effect on pain has not been thoroughly explored. Sense of coherence (SOC) is the disposition to feel that life is predictable and manageable. Sense of danger (SOD) reflects expectations of harm from a particular event.

Methods

We are conducting a prospective study to assess if ALEs increase chronic adverse effects in patients with localized BC and identify mediating mechanisms. Patients are recruited before starting (neo)adjuvant oncological treatment and assessed periodically by validated questionnaires, including ALEs, SOC, SOD from BC, FACT-COG, FACT-ES, and brief pain inventory. Blood samples for inflammatory biomarkers are stored. This sub-study tested if ALEs are associated with baseline pain, measured as a composite score of pain intensity and interference, and examined the mediating role of SOC and SOD.

Results

Of 126 participants, 97 provided data on ALEs. Median age was 49 (range 23-75). 53.6% were treated in the neoadjuvant setting. Chemotherapy was planned for 62.9%. More ALEs correlated with more pain (r =. 34, p <. 001). Educational level and planned chemotherapy correlated with less pain. Serial mediation analysis revealed that after controlling for these variables, ALEs were indirectly associated with more pain through lower SOC followed by higher SOD from BC, CIs = 0.001, 0.103. Together, the model explained 38% of the variance in patients’ pain, F (5, 82) = 9.92, p <. 001. Age, BMI, CRP levels, and neutrophils to lymphocytes ratio were not associated with pain scores or with other study variables. Having surgery (vs planned surgery) was not associated with pain scores.

Conclusions

Exposure to a higher number of ALEs was associated with higher baseline pain in early BC patients before oncological treatment, mediated by decreased SOC and higher SOD from BC. These results stress the importance of addressing past trauma, sense of coherence, and sense of danger from BC to improve physical adverse effects such as pain. Further study will explore the effect of ALE, SOC, and SOD on pain persistence after adjuvant therapy.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.