Women who've been successfully treated for breast cancer often call themselves "survivors" as if they've been through a trial by fire and made it through unscathed. Unfortunately, that's often not the case. A new study of nearly 3,800 breast cancer patients published today in the Journal of the American Medical Association suggests that nearly half of all patients still experience pain symptoms two to three years after their treatments end.
The researchers found the risk of pain was highest in younger women, ages 18 to 39, who had breast-conserving surgery accompanied by radiation treatments. Women of all ages who had mastectomies, however, were more likely to have severe pain than light pain. The pain most often occurred in the breast that was operated upon, in the chest area where tissue was removed, in the upper arm where lymph nodes were removed, or down one side of the body. Some women also experienced sensory disturbances like a loss of feeling or tingling sensations near the surgical site as well as elsewhere in the body. On average, those reporting pain had light to moderate pain that they experienced one to three times a week. About 13 percent of the pain sufferers, however, said they were in severe pain, often on a daily basis. (All of the women in the study remained cancer free two to three years after treatment.)
"This study isn't saying to change treatment recommendations based on whether or not a certain treatment is likely to be associated with pain," says Loretta Loftus, a professor of medicine and oncology at H. Lee Moffitt Cancer Center in Tampa, who cowrote an editorial that accompanied the study. "But it's telling oncologists that they need to be more alert to the incidence of pain. It's fairly common, though pretty variable in its intensity."
Options for pain relief vary based on a woman's individual needs, Loftus tells me. If she has mild pain, she may do fine with an over-the-counter analgesic. [More details on determining the best pain medication.] Women with painful arm swelling, called lymphedema and resulting from the removal of lymph nodes, may benefit from wearing a compression sleeve. Others with tingling may be helped by physical therapy, and those with truly excruciating pain, says Loftus, may need a nerve block injection to block pain signals to the local area. Some women may simply have a lower tolerance for discomfort, and they may benefit from speaking to a social worker who specializes in pain management. Loftus says this could help explain why younger breast cancer patients report more pain. "They're less likely to have gone through other surgical experiences like hysterectomies, gallbladder removal, or treatment for other cancers," she says, "so they may not have as much experience with pain." On the other hand, she adds, older women may simply have less pain sensation since the neurological system dulls with age.
What's clear from this study is that breast cancer patients need to have their pain taken seriously. Doctors certainly need to rule out the possibility of a recurrence and then work to find the most appropriate treatment. Many patients could benefit from the pain management clinics that are becoming more common in cancer centers like Moffitt. [Hospitals that are the best at pain management.] Others may need to seek a referral from their oncologist for a specialist who treats post-surgical pain in breast cancer patients. On the positive side, post-treatment pain doesn't usually linger forever. "For most patients," says Loftus, "it does get better over time."