Characterization of risk factors for adjuvant radiotherapy-associated pain in a tri-racial/ethnic breast cancer population

Eunkyung Lee, Cristiane Takita, Jean L. Wright, Isildinha M. Reis, Wei Zhao, Omar L. Nelson, Jennifer J. Hu

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Pain related to cancer or treatment is a critical quality of life issue for breast cancer survivors. In a prospective study of 375 patients with breast cancer (enrolled during 2008-2014), we characterized the risk factors for adjuvant radiotherapy (RT)-associated pain. Pain score was assessed at pre-RT and post-RT as the mean of 4 pain severity items (ie, pain at its worst, least, average, and now) from the Brief Pain Inventory with 11-point numeric rating scale (0-10). Pain scores of 4 to 10 were considered clinically relevant pain. The study consists of 58 non-Hispanic whites (15%), 78 black or African Americans (AA; 21%), and 239 Hispanic whites (HW; 64%). Overall, the prevalence of pre-RT, post-RT, and RT-associated clinically relevant pain was 16%, 31% and 20%, respectively. In univariate analysis, AA and HW had significantly higher pre-RT and post-RT pain than non-Hispanic whites. In multivariable logistic regression analysis, pre-RT pain was significantly associated with HW and obesity; post-RT pain was significantly associated with AA, HW, younger age, ≥2 comorbid conditions, above-median hotspot volume receiving >105% prescribed dose, and pre-RT pain score ≥4. Radiotherapy-associated pain was significantly associated with AA (odds ratio [OR] 3.27; 95% confidence interval [CI] 1.09-9.82), younger age (OR 2.44, 95% CI 1.24-4.79), and 2 or ≥3 comorbid conditions (OR 3.06, 95% CI 1.32-7.08; OR 4.61, 95% CI 1.49-14.25, respectively). These risk factors may help to guide RT decision-making process, such as hypofractionated RT schedule. Furthermore, effective pain management strategies are needed to improve quality of life in patients with breast cancer with clinically relevant pain.

Original languageEnglish (US)
Pages (from-to)1122-1131
Number of pages10
Issue number5
StatePublished - May 1 2016


  • Breast cancer
  • Cancer disparities
  • Cancer survivorship
  • Pain
  • Radiotherapy

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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