Can illness representations be used to understand pain experienced in breast cancer survivorship-a cross-sectional study

Lewis Langford; Gary Latchford; Matt Mulvey

doi:10.1007/s11764-024-01533-2

Can illness representations be used to understand pain experienced in breast cancer survivorship-a cross-sectional study

J Cancer Surviv. 2024 Jan 29. doi: 10.1007/s11764-024-01533-2. Online ahead of print.

Authors

Lewis Langford^{1

2}, Gary Latchford³, Matt Mulvey³

Affiliations

¹ Clinical Neuropsychology, Salford Royal Hospital, Salford, M6 8HD, UK. lewis.langford@nca.nhs.uk.
² Institute of Health Sciences, University of Leeds, Leeds, UK. lewis.langford@nca.nhs.uk.
³ Institute of Health Sciences, University of Leeds, Leeds, UK.

PMID: 38285112
DOI: 10.1007/s11764-024-01533-2

Abstract

Background: Chronic pain is a recognised long-term consequence associated with breast cancer and its treatment; however, it is often underdiagnosed and undertreated. This study aims to explore the associations between illness representations, chronic cancer pain, and HRQoL in women who have survived breast cancer.

Design and methods: A cross-sectional online survey design was used. Data from 182 women who participated in the survey were analysed.

Results: Chronic cancer pain was reported by 66% of respondents. Using the BPI-SF (score 0-10), participants were categorised into one of four pain categories: no chronic pain (BPI score 0; 34.1%), mild pain (BPI score 1-3; 35.7%), moderate pain (BPI score 4-6; 25.3%), and severe pain (BPI score 7 + ; 4.9%). The main findings were that having a strong illness identity (IPQ-R subscale which assesses the number of symptoms an individual attributes to their illness) was found to be a significant predictor of pain severity (OR 1.21 (95% CI 1.07-1.37), p = 0.003). Furthermore, HRQoL was significantly associated and predictive of pain severity (OR 0.97 (95% CI 0.95-0.99), p < 0.001). An additional finding was that not being in paid work was strongly associated with being in a higher pain category (OR 5.92 (95% CI 1.84-19.05), p = 0.003).

Conclusions: The findings of this study highlight the high prevalence of chronic cancer pain experienced by this population. Results show that dimensions of illness representations are associated with chronic cancer pain experienced by breast cancer survivors. Furthermore, having a strong illness identity and HRQoL were found to be independent, significant predictors of pain severity.

Implications for cancer survivors: These findings demonstrate that chronic pain is an unmet clinical need experienced by breast cancer survivors, which is associated with reduced overall HRQoL. Therefore, consideration is needed regarding the assessment and management of chronic pain experienced by this population.

Keywords: Breast cancer survivors; Cancer; Common sense model; Illness representations; Oncology; Pain; Quality of life.