Racial disparities: pain in women treated for breast cancer

 描述(申请人提供)：由于乳腺癌诊断和治疗的进步，乳腺癌幸存者人数急剧增加。慢性疼痛是这一人群的一个主要临床问题，影响到25%-60%的幸存者。明显的种族/民族健康差异是公认的：与非西班牙裔白人相比，非裔美国人乳腺癌幸存者经历了不成比例的痛苦负担。这个项目的长期目标是确定和描述种族群体在病理生理学上的差异。 研究乳腺癌幸存者疼痛的机制和心理社会因素，并利用这一知识(A)确定对于确定哪些患者有发生持续性疼痛的风险具有最重要和最有用的独特变量，以及(B)开发基于机制的有效个体化干预措施，用于在不同种族的乳腺癌幸存者群体中缓解和预防疼痛。我们假设，乳腺癌幸存者的疼痛和疼痛相关残疾的种族组差异将由疼痛处理机制的差异调节，这些差异受自主神经、心理社会和炎症参数的调节。为了确定种族对接受乳腺癌治疗的女性疼痛的影响，我们建议对被诊断为1期和2期乳腺癌的非洲裔美国人和非西班牙裔白人女性进行一项纵向前瞻性研究。目标1将评估非洲裔美国人和非西班牙裔白人乳腺癌幸存者疼痛的患病率、严重程度和发生时间。目的2将使用心理物理测量方法纵向表征非裔美国人和非西班牙裔白人乳腺癌幸存者在实验性疼痛敏感性和疼痛调节参数方面的种族差异。目的3将确定种族对非裔美国人和非西班牙裔白人乳腺癌幸存者自主神经功能和疼痛之间的关联的影响。目标4将评估种族对非裔美国人和非西班牙裔白人乳腺癌幸存者的心理社会过程和疼痛之间的关联的影响。Aim 5将评估接受乳腺癌治疗的非裔美国人和非西班牙裔白人女性的细胞因子和疼痛之间的关系。这些研究的结果预计将对乳腺癌幸存者的种族疼痛差异产生重大影响：(1)确定评估不同种族乳腺癌幸存者慢性疼痛风险的标准化方法，将使临床医生和研究人员能够识别出有风险的患者，并针对这些患者进行早期和量身定制的干预；(2)确定导致种族疼痛差异的病理生理机制，将允许为减少和消除乳腺癌幸存者的疼痛差异的治疗和干预确定重要的新目标；(3)这些研究将提供一个关键数据库，以设计和证明未来预防和治疗不同种族乳腺癌幸存者疼痛的临床试验的合理性；(4)在更大的背景下，这些研究的结果不仅将使患有乳腺癌的非裔美国人和非西班牙裔白人妇女受益，而且将对所有癌症幸存者的种族疼痛差异产生重大影响。

 DESCRIPTION (provided by applicant): Due to advances in breast cancer diagnosis and treatment, there has been a dramatic increase in the breast cancer survivor population. Chronic pain is a major clinical problem in this population, affecting 25 - 60% of survivors. Striking racial/ethnic health disparities are well established: African-American breast cancer survivors experience a disproportionate burden of pain compared to non-Hispanic Whites. The long-term goal of this project is to identify and describe racial group differences in the pathophysiological mechanisms and psychosocial factors contributing to pain in breast cancer survivors, and to use this knowledge (a) to determine unique variables which are of greatest importance and utility for determining which patients are at risk for developing persistent pain and (b) to develop mechanism-based effective individualized interventions for pain relief and pain prevention in racially diverse breast cancer survivor populations. We hypothesize that racial group differences in pain and pain-related disability in breast cancer survivors will be mediated by differences in pain processing mechanisms, modulated by autonomic, psychosocial, and inflammatory parameters. To determine the effect of race on pain in women treated for breast cancer we propose a longitudinal prospective study of African-American and non-Hispanic White women diagnosed with stage 1 and stage 2 breast cancer. Aim 1 will assess the prevalence, severity and timing of occurrence of pain in African-American and non- Hispanic White breast cancer survivors. Aim 2 will characterize racial group differences in experimental pain sensitivity and pain modulatory parameters longitudinally in African-American and non-Hispanic White breast cancer survivors using psychophysical measures. Aim 3 will determine the influence of race on the association between autonomic function and pain in African-American and non-Hispanic White breast cancer survivors. Aim 4 will assess the effect of race on the association between psychosocial processes and pain in African- American and non-Hispanic White breast cancer survivors. Aim 5 will assess the relationships between cytokines and pain in African-American and non-Hispanic White women treated for breast cancer. The results of these studies are expected to have a major impact on racial pain disparities in breast cancer survivors: (1) identification of standardized methods to assess racially diverse breast cancer survivors at-risk for chronic pain will allow clinicians and researchers to identify patients at-risk and to target those patients for early and tailored interventions; (2) identification of pathophysiological mechanisms contributing to racial pain disparities will allow to define important new targets for therapy and intervention to reduce and eliminate pain disparities in breast cancer survivors; (3) these studies will provide a key database to design and justify future clinical trials for the prevention and treatment of pain in racially diverse breast cancer survivors; and (4) in a larger context, the results of these studies will not only benefit African-American and non-Hispanic White women with breast cancer, but will have a significant impact on racial pain disparities in all cancer survivors.