Background & Aims

Breast cancer is the most common cancer in women worldwide. Chronic pain is one of the key negative consequences of surviving cancer reported in breast cancer survivors (Gärtner R et al., JAMA, 2009; Shabangu N et al., BMC Womens Health, 2023) and is associated with increased mortality (Quinten C et al., Lancet Oncol, 2009; Smith D et al., Pain, 2018). Experimental and population-based studies suggest that sleep and pain are reciprocally related. The goal of this study was to assess the relationship of sleep and pain in African-American and Caucasian breast cancer survivors and to evaluate race as a potential effect modifier.

Methods

We examined in a post-hoc exploratory analysis the relationship of sleep (PSQI) and pain (SF-36) in breast cancer survivors (25 African-Americans, 186 Caucasians; Stages 0-IIIA; post-primary treatment – >8 weeks post surgery), who had enrolled in the BEAT Cancer study (Rogers LQ et al., Contemp Clin Trials, 2012).

Results

78% of Caucasian and 72% of African-American breast cancer survivors reported persistent pain and 44% of Caucasian and 60% of African-American breast cancer survivors reported pain-related disability. African-American breast cancer survivors presented with significantly higher pain intensity and more severe pain-related interference than Caucasians (P=0.032, P=0.002). 92% of Caucasians and 100% of African-American breast cancer survivors reported sleep disturbances. There was a significant positive correlation between sleep disturbances and pain severity (p=0.022), but the factors associated with sleep disturbance severity differed between racial groups. African-Americans reported significantly less sleep-duration than Caucasians (P=0.001; 5.98 vs. 6.96 hrs). Pain interference was significantly associated with sleep-duration for Caucasians (P=0.049), but not for African Americans.

Conclusions

There is an association of chronic pain and sleep disturbances in breast cancer survivors, and the relationship of specific sleep disturbances and pain is influenced by race. This correlation might provide an important therapeutic target to improve quality of life in racially diverse populations of breast cancer survivors using a personalized medicine approach to address sleep disturbances and pain.

Conflicts of Interest:
UW has served as a voting member of the FDA Anesthetic and Analgesic Drug Products Advisory Committee. She has received honoraria for consulting for Aphrodite Health Inc., Wilmington, DE, Avenue Therapeutics Inc., New York, NY, Bayer Aktiengesellschaft, Leverkusen, Germany, Biohaven Pharmaceuticals, New Haven, CT, and Syneos Health, Morrisville, NC, all unrelated to the submitted work.

Support:
This work was supported in part by US National Institutes of Health grants R01 CA246708 and R01 CA195060 to Ursula Wesselmann; R01 CA136859 to Laura Q. Rogers.

References

Gärtner, R., Jensen, M. B., Nielsen, J., Ewertz, M., Kroman, N., Kehlet, H, Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA, 302(18),1985-92, 2009.

Quinten, C., Coens, C., Mauer, M., Comte, S., Sprangers, M. A., Cleeland, C., Osoba, D., Bjordal, K., and Bottomley, A., Baseline quality of life as a prognostic indicator of survival: a meta-analysis of individual patient data from EORTC clinical trials. Lancet Oncol, 10, 865-871, 2009.

Rogers, L. Q., McAuley, E., Anton, P. M., Courneya, K. S., Vicari, S., Hopkins-Price, P., Verhulst, S., Mocharnuk, R., and Hoelzer, K., Better exercise adherence after treatment for cancer (BEAT Cancer) study: rationale, design, and methods. Contemp Clin Trials, 33, 124-137, 2012.

Shabangu, N., Thebe, T., Casey, M., Wesselmann, U., Parker, R., Chronic pain in female breast cancer survivors – prevalence, characteristics and contributing factors: a cross-sectional pilot study. BMC Womens Health, 23(1): 613, 2023..

Smith, D., Wilkie, R., Croft, P., Parmar, S., and McBeth, J., Pain and mortality: mechanisms for a relationship. Pain, 159, 1112-1118, 2018.

Presenting Author

Ursula Wesselmann

Poster Authors

Ursula Wesselmann, MD, PhD, DTM&H (Lond.)

MD, PhD, DTM&H (Lond.)

University of Alabama at Birmingham, Depts. of Anesthesiology and Neurology, Birmingham, AL, USA

Lead Author

Robert A. Oster PhD

University of Alabama at Birmingham, Dept. of Medicine, Birmingham, AL, USA

Lead Author

Laura Q. Rogers MD MPH

University of Alabama at Birmingham, Dept. of Medicine, Birmingham, AL, USA

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Cancer Pain & Palliative Care