Clinical Prediction Model and Tool for Assessing Risk of Persistent Pain After Breast Cancer Surgery.
Abstract
Purpose Persistent pain after breast cancer surgery is a well-recognized problem, with moderate to severe pain affecting 15% to 20% of women at 1 year from surgery. Several risk factors for persistent pain have been recognized, but tools to identify high-risk patients and preventive interventions are missing. The aim was to develop a clinically applicable risk prediction tool. Methods The prediction models were developed and tested using three prospective data sets from Finland (n = 860), Denmark (n = 453), and Scotland (n = 231). Prediction models for persistent pain of moderate to severe intensity at 1 year postoperatively were developed by logistic regression analyses in the Finnish patient cohort. The models were tested in two independent cohorts from Denmark and Scotland by assessing the areas under the receiver operating characteristics curves (ROC-AUCs). The outcome variable was moderate to severe persistent pain at 1 year from surgery in the Finnish and Danish cohorts and at 9 months in the Scottish cohort. Results Moderate to severe persistent pain occurred in 13.5%, 13.9%, and 20.3% of the patients in the three studies, respectively. Preoperative pain in the operative area ( P < .001), high body mass index ( P = .039), axillary lymph node dissection ( P = .008), and more severe acute postoperative pain intensity at the seventh postoperative day ( P = .003) predicted persistent pain in the final prediction model, which performed well in the Danish (ROC-AUC, 0.739) and Scottish (ROC-AUC, 0.740) cohorts. At the 20% risk level, the model had 32.8% and 47.4% sensitivity and 94.4% and 82.4% specificity in the Danish and Scottish cohorts, respectively. Conclusion Our validated prediction models and an online risk calculator provide clinicians and researchers with a simple tool to screen for patients at high risk of developing persistent pain after breast cancer surgery.
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The most frequent psychological risk factors for CPSP and fatigue include anxiety, such as hypervigilance and pain catastrophizing.
“The most frequent tap into anxiety, such as hypervigilance and pain catastrophizing [24–28].”
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- Authors
- Meretoja, T. J., Andersen, K. G., Bruce, J., Haasio, L., Sipilä, R., Scott, N. W., Ripatti, S., Kehlet, H., & Kalso, E.
- Affiliations
- University of Copenhagen (DK)
- ORCID
- Venue
- Journal of Clinical Oncology
- Published
- 2017-05-20
- Volume
- 35
- Issue
- 15
- Pages
- 1660-1667
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- OpenAlex
- W2599071623
- Cited by
- 106
- References
- 31
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 8 · 2023: 8 · 2022: 15 · 2021: 17 · 2020: 12 · 2019: 12 · 2018: 14 · 2017: 5
- FWCI
- 12.04
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Oncology (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Warwick Research Archive Portal (University of Warwick) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Keywords
- chronic postoperative pain, breast cancer surgery, risk prediction model, risk calculator, axillary lymph node dissection, body mass index, preoperative pain, acute postoperative pain, risk factors, online risk assessment tool
- MeSH terms
- Cancer Pain, Breast Neoplasms, Female, Humans, Middle Aged, Postoperative Pain, Predictive Value of Tests, ROC Curve, Models, Statistical, Cohort Studies, Logistic Models, Risk Assessment
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