Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada.
Support Care Cancer. 2021 Jan;29(1):155-167. doi: 10.1007/s00520-020-05462-5. Epub 2020 Apr 22.
Breast cancer patients receiving radiotherapy (RT) commonly report pain, contributing to physical and emotional distress, and potentially resulting in poor quality of life. This study prospectively identified trends and risk factors in patient-reported pain associated with breast irradiation using the Edmonton Symptom Assessment Scale (ESAS) and a study-specific Skin Symptom Assessment (SSA).
Before RT and once per week during RT, patients completed the ESAS and SSA. Upon RT completion, patients were contacted via telephone to complete both assessments weekly for 6 weeks, and a final assessment was conducted 1-3 months post-RT. Only data from patients who had completed both assessments before, at least once during, and at least once after RT were included in our analysis.
A total of 426 patients provided data for the analysis. Overall acute pain increased significantly at week 1-2 (p < 0.0001), week 5 (p = 0.0011), and at 1-3 months (p < 0.0001) post-RT compared with baseline, and acute breast pain increased significantly at week 1 (p < 0.001) and week 2 (p = 0.0002) post-RT compared with baseline. Previous chemotherapy (adjuvant or neoadjuvant) in mastectomy patients was associated with increased overall pain compared with mastectomy patients without previous chemotherapy (p = 0.017). Younger patients (40-49 or 50-59 years of age) reported more overall pain (p = 0.0001, p = 0.038) and breast pain (p = 0.0003, p = 0.0038) compared with patients ≥ 60 years of age.
Patient-reported pain associated with breast irradiation peaked 1 week after RT completion. Our findings provide support for closer monitoring of acute pain associated with breast RT in younger patients.
接受放疗（RT）的乳腺癌患者常报告疼痛，导致身体和情绪困扰，并可能导致生活质量下降。本研究前瞻性地使用埃德蒙顿症状评估量表（ESAS）和特定的皮肤症状评估（SSA）来确定与乳房照射相关的患者报告疼痛的趋势和危险因素。
在 RT 前和 RT 期间每周一次，患者完成 ESAS 和 SSA。在 RT 完成后，通过电话联系患者，在 6 周内每周完成两次评估，在 RT 后 1-3 个月进行最后一次评估。只有完成 RT 前、至少一次 RT 期间和至少一次 RT 后评估的患者数据才包括在我们的分析中。
共有 426 名患者提供了数据分析数据。与基线相比，总体急性疼痛在 RT 后 1-2 周（p < 0.0001）、第 5 周（p = 0.0011）和 1-3 个月（p < 0.0001）时显著增加，急性乳房疼痛在 RT 后 1 周（p < 0.001）和 2 周（p = 0.0002）时显著增加。与未接受过化疗的乳房切除术患者相比，接受过辅助或新辅助化疗的乳房切除术患者的总体疼痛增加（p = 0.017）。年轻患者（40-49 或 50-59 岁）报告的总体疼痛（p = 0.0001，p = 0.038）和乳房疼痛（p = 0.0003，p = 0.0038）多于≥60 岁的患者。
与乳房放疗相关的患者报告疼痛在 RT 完成后 1 周达到峰值。我们的研究结果为在年轻患者中更密切监测与乳房 RT 相关的急性疼痛提供了支持。
