Pain Associated with Radiation Treatment for Breast Cancer

Abstract

Breast cancer is the most frequently diagnosed cancer and the second leading cause of cancer death in American women. Postsurgical adjuvant radiotherapy (RT) significantly improves local-regional recurrence and breast cancer survival, so currently most breast cancer patients receive RT after surgery. However, pain related to cancer or treatment is a critical quality of life issue for breast cancer survivors. Most of the previous studies have focused on chemotherapy-related neuropathy; however, many breast cancer patients undergoing RT experience clinically significant levels of unrelieved cancer pain despite standard pain management. Multiple risk factors contribute to pre-RT, post-RT, and RT-related pain. Considering pre-RT pain is an independent risk factor for post-RT pain, and also RT-associated pain can last for many decades, pain management during RT may be an effective preventive strategy. Furthermore, if hypo-fractionation RT can provide equivalent long-term tumor control and survival but with reduced RT-associated pain, it may present a cost-effective treatment strategy to improve RT outcomes. Lastly, compared to non-Hispanic Whites, underserved minorities are more likely to suffer worse RT-related pain. Therefore, future research is warranted to characterize the molecular mechanisms of RT-related pain disparities and identify high-risk population for precision intervention.