Life after breast cancer treatment: racial health disparities and chronic pain in breast cancer survivors.

项目总结 由于早期诊断和非同寻常的原因，乳腺癌幸存者的人数正在显着增长 乳腺癌治疗的进步，这些令人印象深刻的生存结果往往伴随着显著的 生存质量下降。疼痛和与疼痛相关的残疾是主要的负面影响之一 据报道，在接受乳腺癌治疗的妇女中，癌症存活的后果影响了25%-80%的 幸存人口。明显的种族/民族健康差异是公认的：非裔美国人的乳房 与非西班牙裔白人相比，癌症幸存者经历的痛苦负担不成比例。长的- 该项目的学期目标是确定种族差异的病理生理机制和 导致乳腺癌幸存者慢性疼痛的心理社会因素，并利用这一知识(A) 确定对确定哪些患者有患病风险最重要的独特变量 发展慢性疼痛和(B)开发基于机制的有效个体化疼痛干预措施 不同种族乳腺癌存活者的缓解和疼痛预防。我们假设种族 乳腺癌幸存者的疼痛和疼痛相关残疾的组间差异将由 疼痛处理机制，由自主神经、心理社会和炎症参数调节。至 确定种族对接受乳腺癌治疗的女性慢性疼痛的影响我们建议进行一项纵向研究 被诊断为I-IIIB期乳腺癌的非裔美国人和非西班牙裔白人女性中，谁将是 在完成初次乳腺癌治疗一年后登记，并进行一段时间的前瞻性评估 已经18个月了。目标1将前瞻性地确定非洲人疼痛的患病率、严重程度和时间进程- 美国和非西班牙裔白人乳腺癌幸存者。目标2将在以下方面描述种族差异 非裔美国人和非美国人实验性疼痛敏感性和疼痛调节参数的前瞻性研究 西班牙裔白人乳腺癌幸存者使用心理物理测量。目标3将决定 非裔美国人和非美国人自主神经功能与疼痛之间关系的前瞻性竞赛 西班牙裔白人乳腺癌幸存者。目标4将评估种族对人与人之间关系的影响 非裔美国人和非西班牙裔白人乳腺癌的心理社会过程和疼痛的前瞻性研究 幸存者。目标5将评估细胞因子/趋化因子、T细胞类型和疼痛之间的关系 前瞻性地在非裔美国人和非西班牙裔白人妇女中研究乳腺癌幸存者。这些研究的结果 研究预计将对乳腺癌幸存者的种族疼痛差异产生重大影响，方法是提供 基于所涉及的生物-心理-社会机制的个性化医学方法的途径 允许根据每个幸存者的个人特征进行量身定做的治疗，这些幸存者有可能发展为持续性 疼痛。这些研究将提供一个关键靶点的关键数据库，以设计未来的临床试验 预防和治疗不同种族乳腺癌幸存者的疼痛。

PROJECT SUMMARY As the breast cancer survivor population is growing significantly due to earlier diagnosis and extraordinary advancements in breast cancer treatment, these impressive outcomes in survival often come with a markedly decreased quality of life in survivorship. Pain and pain-related disability are one of the key negative consequences of surviving cancer reported in women treated for breast cancer, affecting 25 – 80% of the survivorship population. 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 racial group differences in the pathophysiological mechanisms and psychosocial factors contributing to chronic pain in breast cancer survivors, and to use this knowledge (a) to determine unique variables which are of greatest importance for determining which patients are at risk for developing chronic 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 chronic pain in women treated for breast cancer we propose a longitudinal study of African-American and non-Hispanic White women diagnosed with stage I-IIIB breast cancer, who will be enrolled one year after completion of primary breast cancer treatment and assessed prospectively for a period of 18 months. Aim 1 will determine prospectively the prevalence, severity and time course 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 prospectively 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 prospectively 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 prospectively in African-American and non-Hispanic White breast cancer survivors. Aim 5 will assess the relationships between cytokines/chemokines, T-cell profiles and pain prospectively in African-American and non-Hispanic White women breast cancer survivors. The results of these studies are expected to have a major impact on racial pain disparities in breast cancer survivors by providing pathways for a personalized medicine approach based on the bio-psycho-social mechanisms involved that will allow to tailor treatment to the individual characteristics of each survivor, who is at risk to develop persistent pain. These studies will provide a key database of critical targets to design future clinical trials for the prevention and treatment of pain in racially diverse breast cancer survivors.