Characterization of Preoperative, Postsurgical, Acute and Chronic Pain in High Risk Breast Cancer Patients

Background: Pain after breast cancer surgery remains largely unexplained and inconsistently quantified. This study aims to describe the perioperative pain patterns in patients with breast cancer, up to two years after surgery. Methods: This is a pre-planned sub-study of the Ketorolac in Breast Cancer (KBC) trial. The KBC trial was a multicentre, prospective, double-blind, placebo-controlled, randomised trial of a single dose of 30 mg of ketorolac just before breast cancer surgery, aiming to test its effect on recurrences. This sub-study focuses only on pain outcomes. From 2013 to 2015, 203 patients were randomised to ketorolac (n = 96) or placebo (n = 107). Structured questionnaires were delivered by telephone after one and two years, exploring the presence, location, permanence, and frequency of pain. Patients’ perceptions of pain were captured by an open-ended question, the responses to which were coded and classified using hierarchical clustering. Results: There was no difference in pain between the ketorolac and the placebo group. The reported incidence of permanent pain was 67% and 45% at one and two years, respectively. The largest category was musculoskeletal pain. Permanent pain was mainly described in patients with musculoskeletal pain. The description of pain changed in most patients during the second postoperative year, i.e., moved from one category to another (no pain, permanent, or non-permanent pain, but also, the localisation). This phenomenon includes patients without pain at one year. Conclusions: Pain is a complex phenomenon, but also a fragile and unstable endpoint. Pain after breast cancer surgery does not necessarily mean breast pain but also musculoskeletal and other pains. The permanence of pain and the pain phenotype can change over time.

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Genetic variability of tramadol pharmacokinetic genes and pain treatment outcome after breast cancer surgery.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e23133 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e23133-e23133

Author(s):

Nikola Besic ◽

Katja Goricar ◽

Jakob Jeriha ◽

Vita Dolzan ◽

Branka Strazisar

Keyword(s):

Breast Cancer ◽

Genetic Variability ◽

Cancer Patients ◽

Pain Treatment ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Axillary Lymph ◽

Breast Cancer Patients ◽

Node Dissection ◽

One Year

e23133 Background: Tramadol is a treatment of choice for pain management after axillary lymph node dissection in breast cancer patients. Tramadol is metabolized via CYP2D6 and UGT2B7, while ABCB1, ABCC2 and SLC22A1 are involved in transport of tramadol metabolites. Genetic variability of metabolizing enzymes or drug transporters may therefore affect efficacy and adverse effects of tramadol. The aim of this study was to evaluate the association of genetic variability in tramadol pharmacokinetics pathway on long-term outcome of tramadol pain treatment after breast cancer surgery. Methods: The study included 102 breast cancer patients treated with either 75 or 37.5 mg of tramadol for pain relief after breast cancer surgery including axillary lymph node dissection as part of a randomized clinical trial KCT 04/2015-DORETAonko/si at Institute of Oncology Ljubljana. All patients were genotyped for 14 polymorphisms in ABCB1, ABCC2, CYP2D6, SLC22A1 and UGT2B7 genes, as well as for CYP2D6 duplication and deletion. CYP2D6 phenotype was predicted from the genotype data and patients were categorized as poor (PM), intermediate, extensive or ultrarapid metabolizers. The association of genetic factors with pain one year after treatment was evaluated using logistic regression and Mann-Whitney test. Results: One year after treatment, 21 (20.8%) patients were still experiencing chronic and 25 (24.8%) neuropathic pain. CYP2D6 PMs were significantly more likely to experience chronic and neuropathic pain after tramadol treatment (OR = 5.96, 95% CI = 1.22-29.13, p = 0.027 and OR = 9.31, 95% CI = 1.65-50.59, p = 0.011, respectively), even after adjustment for tramadol dose (p = 0.032 and p = 0.016, respectively). PMs also had higher average pain intensity compared to others regardless of tramadol dose (p = 0.042). In patients receiving lower tramadol dose, ABCB1 rs1128503, rs2032582 and rs1045642 were associated with more chronic pain in the dominant model (p = 0.004, p = 0.004 and p = 0.047, respectively). Conclusions: Genetic variability in tramadol pharmacokinetics pathway may be associated with pain treatment outcome in breast cancer patients, therefore pharmacogenetic testing could enable more effective tramadol treatment. Clinical trial information: EudraCT 2015-000992-28.

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Is It Definitely Clear That Long-Term Survival after Breast Cancer Surgery Is Not Affected by Anaesthetics?

Cancers ◽

10.3390/cancers13143390 ◽

2021 ◽

Vol 13 (14) ◽

pp. 3390

Author(s):

Mats Enlund

Keyword(s):

Breast Cancer ◽

Survival Data ◽

Retrospective Studies ◽

Breast Cancer Surgery ◽

Breast Cancer Patients ◽

Term Survival ◽

Long Term Survival ◽

Significant Difference ◽

One Year

Retrospective studies indicate that cancer survival may be affected by the anaesthetic technique. Propofol seems to be a better choice than volatile anaesthetics, such as sevoflurane. The first two retrospective studies suggested better long-term survival with propofol, but not for breast cancer. Subsequent retrospective studies from Asia indicated the same. When data from seven Swedish hospitals were analysed, including 6305 breast cancer patients, different analyses gave different results, from a non-significant difference in survival to a remarkably large difference in favour of propofol, an illustration of the innate weakness in the retrospective design. The largest randomised clinical trial, registered on clinicaltrial.gov, with survival as an outcome is the Cancer and Anesthesia study. Patients are here randomised to propofol or sevoflurane. The inclusion of patients with breast cancer was completed in autumn 2017. Delayed by the pandemic, one-year survival data for the cohort were presented in November 2020. Due to the extremely good short-term survival for breast cancer, one-year survival is of less interest for this disease. As the inclusions took almost five years, there was also a trend to observe. Unsurprisingly, no difference was found in one-year survival between the two groups, and the trend indicated no difference either.

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Surgical Predictive Model for Breast Cancer Patients Assessing Acute Postoperative Complications: The Breast Cancer Surgery Risk Calculator

Annals of Surgical Oncology ◽

10.1245/s10434-021-09710-8 ◽

2021 ◽

Author(s):

Michael M. Jonczyk ◽

Carla Suzanne Fisher ◽

Russell Babbitt ◽

Jessica K. Paulus ◽

Karen M. Freund ◽

...

Keyword(s):

Breast Cancer ◽

Postoperative Complications ◽

Predictive Model ◽

Cancer Patients ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Risk Calculator ◽

Breast Cancer Patients

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Breast Cancer Surgery

Breast cancer: Global quality care ◽

10.1093/med/9780198839248.003.0013 ◽

2019 ◽

pp. 144-156

Author(s):

Peter A. van Dam ◽

Cary Kaufman ◽

Carlos Garcia-Etienne ◽

Marie-Jeanne Vrancken Peeters ◽

Robert Mansel

Keyword(s):

Breast Cancer ◽

Early Stage ◽

Breast Conserving Surgery ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Breast Diseases ◽

Breast Cancer Patients ◽

Breast Conserving Treatment ◽

Sentinel Node Concept

Abstract: The role of the surgeon managing breast diseases has been the subject of continuous evolution, moving from the cancer-extirpative surgeon to a deeply informed surgical leader, who interacts in a multidisciplinary setting also encompassing tasks for risk assessment, genetic counselling, and new diagnostic approaches. Surgical removal of the tumour remains the cornerstone in treating early stage breast cancer. During the last century, breast cancer surgery became less radical, breast-conserving treatment emerged, and the role of axillary lymphadenectomy changed from a therapeutic procedure into a staging procedure with prognostic implications. Later, the sentinel node concept reduced the need for complete axillary clearance in most cases. Nowadays, thanks to breast-conserving surgery, oncoplastic techniques, and reconstructive procedures, most breast cancer patients can overcome this disease without serious permanent physical mutilation. A multidisciplinary approach, benchmarking, and quality assurance have improved outcomes markedly.

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Magnetic Seed (Magseed) Localisation in Breast Cancer Surgery: A Multicentre Clinical Trial

Breast Care ◽

10.1159/000510380 ◽

2020 ◽

pp. 1-6

Author(s):

Jan Žatecký ◽

Otakar Kubala ◽

Oldřich Coufal ◽

Markéta Kepičová ◽

Adéla Faridová ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Surgical Oncology ◽

Breast Tumour ◽

Axillary Node ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Breast Cancer Patients ◽

Magnetic Marker ◽

Magnetic Seeds

Introduction: The aim of this study was to evaluate the accuracy and reliability of the Magseed magnetic marker in breast cancer surgery. Methods: Thirty-nine patients with 41 implanted Magseeds undergoing surgical treatment in 3 surgical oncology departments were included in the retrospective trial to study pilot use of the Magseed magnetic marker in the Czech Republic for localisation of breast tumours or pathological axillary nodes in breast cancer patients. Results: Thirty-four breast cancer and 7 pathological lymph node localisations were performed by Magseed implantation. No placement failures, or perioperative detection failures of Magseeds were observed (0/41, 0.0%), but one case of Magseed migration was present (1/41, 2.4%). All magnetic seeds were successfully retrieved (41/41, 100.0%). Negative margins were achieved in 29 of 34 (85.3%) breast tumour localisations by Magseed. Conclusion: Magseed is a reliable marker for breast tumour and pathological axillary node localisation in breast cancer patients. Magseed is comparable to conventional localisation methods in terms of oncosurgical radicality and safety.

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