Persistent breast pain in post-surgery breast cancer survivors and women with no history of breast surgery or cancer: associations with pain catastrophizing, perceived breast cancer risk, breast cancer worry, and emotional distress
Persistent breast pain in post-surgery breast cancer survivors and women with no history of breast surgery or cancer: associations with pain catastrophizing, perceived breast cancer risk, breast cancer worry, and emotional distress
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DOI：
10.1080/0284186x.2019.1574023
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发表时间：
2019-05-04
期刊：
影响因子：
3.1
通讯作者：
Shelby, Rebecca A.
中科院分区：
文献类型：
--
作者：
Bovbjerg, Dana H.;Keefe, Francis J.;Shelby, Rebecca A.
背景：持续性乳房疼痛（PBP）在乳腺癌幸存者中普遍存在，并具有强大的负面心理后果。本研究提供了对以下假设的第一次检验：（a）疼痛灾难化，（B）癌症感知风险增加，以及（c）担心疼痛表明癌症可能是乳腺癌幸存者PBP经历和情绪困扰增加之间的独立中介联系。（存活者组：n=417; I-IIIA期;白色= 88.7%;年龄M=59.4岁）术后（6-15个月）首次监测乳房X线照片。无乳腺手术史或癌症史的女性对照组（非癌症组：n=587;白色= 78.7%;年龄M=57.4岁）在常规筛查乳房X线检查时进行类似评估。所有女性都完成了乳房疼痛，疼痛灾难化，感知乳腺癌风险，担心乳房疼痛表明癌症，以及情绪困扰（焦虑症状，抑郁症状和乳房X线摄影特定的困扰）的测量。分析包括种族、年龄、BMI、教育和绝经状态作为协变量，显著性设置为0.05。结果：正如预期的那样，幸存者组的PBP患病率显著高于非癌症组（50.6%对17.5%）。与PBP-幸存者相比，PBP+幸存者的情绪困扰、疼痛灾难化、乳房X线摄影特异性困扰以及担心乳房疼痛表明癌症的水平也显著更高。结构方程模型的结果是显着的所有假设的中介途径。有趣的是，非癌症组中PBP+与PBP-女性的比较显示出相似的结果。这些研究结果表明，（a）疼痛灾难化，（B）感知乳腺癌风险和（c）担心乳房疼痛可能表明癌症的重要性，作为旨在减少PBP对术后乳腺癌幸存者的负面心理影响的干预措施的潜在目标，以及未受影响的女性PBP由于未知的原因。
Background: Persistent breast pain (PBP) is prevalent among breast cancer survivors and has powerful negative psychological consequences. The present study provided a first test of the hypothesis that: (a) pain catastrophizing, (b) heightened perceived risk of cancer, and (c) worry that pain indicates cancer may be independent mediating links between breast cancer survivors' experiences of PBP and heightened emotional distress.Methodology: We assessed levels of PBP and psychological factors in breast cancer survivors (Survivor Group: n=417; Stages I-IIIA; White = 88.7%; Age M=59.4 years) at their first surveillance mammogram post-surgery (6-15 months). A comparison group of women without histories of breast surgery or cancer (Non-cancer Group: n=587; White = 78.7%; Age M=57.4 years) was similarly assessed at the time of a routine screening mammogram. All women completed measures of breast pain, pain catastrophizing, perceived breast cancer risk, and worry that breast pain indicates cancer, as well as measures of emotional distress (symptoms of anxiety, symptoms of depression, and mammography-specific distress). Analyses included race, age, BMI, education, and menopausal status as covariates, with significance set at 0.05.Results: As expected, PBP prevalence was significantly higher in the Survivor Group than in the Non-cancer Group (50.6% vs. 17.5%). PBP+ survivors also had significantly higher levels of emotional distress, pain catastrophizing, mammography-specific distress, and worry that breast pain indicates cancer, compared to PBP- survivors. Structural equation modeling results were significant for all hypothesized mediational pathways. Interestingly, comparisons of PBP+to PBP-women in the Non-cancer Group showed similar results.Conclusion: These findings suggest the importance of (a) pain catastrophizing, (b) perceived breast cancer risk and, (c) worry that breast pain may indicate cancer, as potential targets for interventions aimed at reducing the negative psychological impact of PBP in post-surgery breast cancer survivors, as well as in unaffected women with PBP due to unknown reasons.