Clinical Prediction Model and Tool for Assessing Risk of Persistent Pain After Breast Cancer Surgery
Purpose Persistent pain after breast cancer surgery is a well-recognized problem, with moderate to severe pain affecting 15% to 20% of women at 1 year from surgery. Several risk factors for persistent pain have been recognized, but tools to identify high-risk patients and preventive interventions ar...
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| Vydané v: | Journal of clinical oncology Ročník 35; číslo 15; s. 1660 |
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| Hlavní autori: | , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
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United States
20.05.2017
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| ISSN: | 1527-7755, 1527-7755 |
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| Abstract | Purpose Persistent pain after breast cancer surgery is a well-recognized problem, with moderate to severe pain affecting 15% to 20% of women at 1 year from surgery. Several risk factors for persistent pain have been recognized, but tools to identify high-risk patients and preventive interventions are missing. The aim was to develop a clinically applicable risk prediction tool. Methods The prediction models were developed and tested using three prospective data sets from Finland (n = 860), Denmark (n = 453), and Scotland (n = 231). Prediction models for persistent pain of moderate to severe intensity at 1 year postoperatively were developed by logistic regression analyses in the Finnish patient cohort. The models were tested in two independent cohorts from Denmark and Scotland by assessing the areas under the receiver operating characteristics curves (ROC-AUCs). The outcome variable was moderate to severe persistent pain at 1 year from surgery in the Finnish and Danish cohorts and at 9 months in the Scottish cohort. Results Moderate to severe persistent pain occurred in 13.5%, 13.9%, and 20.3% of the patients in the three studies, respectively. Preoperative pain in the operative area ( P < .001), high body mass index ( P = .039), axillary lymph node dissection ( P = .008), and more severe acute postoperative pain intensity at the seventh postoperative day ( P = .003) predicted persistent pain in the final prediction model, which performed well in the Danish (ROC-AUC, 0.739) and Scottish (ROC-AUC, 0.740) cohorts. At the 20% risk level, the model had 32.8% and 47.4% sensitivity and 94.4% and 82.4% specificity in the Danish and Scottish cohorts, respectively. Conclusion Our validated prediction models and an online risk calculator provide clinicians and researchers with a simple tool to screen for patients at high risk of developing persistent pain after breast cancer surgery. |
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| AbstractList | Purpose Persistent pain after breast cancer surgery is a well-recognized problem, with moderate to severe pain affecting 15% to 20% of women at 1 year from surgery. Several risk factors for persistent pain have been recognized, but tools to identify high-risk patients and preventive interventions are missing. The aim was to develop a clinically applicable risk prediction tool. Methods The prediction models were developed and tested using three prospective data sets from Finland (n = 860), Denmark (n = 453), and Scotland (n = 231). Prediction models for persistent pain of moderate to severe intensity at 1 year postoperatively were developed by logistic regression analyses in the Finnish patient cohort. The models were tested in two independent cohorts from Denmark and Scotland by assessing the areas under the receiver operating characteristics curves (ROC-AUCs). The outcome variable was moderate to severe persistent pain at 1 year from surgery in the Finnish and Danish cohorts and at 9 months in the Scottish cohort. Results Moderate to severe persistent pain occurred in 13.5%, 13.9%, and 20.3% of the patients in the three studies, respectively. Preoperative pain in the operative area ( P < .001), high body mass index ( P = .039), axillary lymph node dissection ( P = .008), and more severe acute postoperative pain intensity at the seventh postoperative day ( P = .003) predicted persistent pain in the final prediction model, which performed well in the Danish (ROC-AUC, 0.739) and Scottish (ROC-AUC, 0.740) cohorts. At the 20% risk level, the model had 32.8% and 47.4% sensitivity and 94.4% and 82.4% specificity in the Danish and Scottish cohorts, respectively. Conclusion Our validated prediction models and an online risk calculator provide clinicians and researchers with a simple tool to screen for patients at high risk of developing persistent pain after breast cancer surgery. Purpose Persistent pain after breast cancer surgery is a well-recognized problem, with moderate to severe pain affecting 15% to 20% of women at 1 year from surgery. Several risk factors for persistent pain have been recognized, but tools to identify high-risk patients and preventive interventions are missing. The aim was to develop a clinically applicable risk prediction tool. Methods The prediction models were developed and tested using three prospective data sets from Finland (n = 860), Denmark (n = 453), and Scotland (n = 231). Prediction models for persistent pain of moderate to severe intensity at 1 year postoperatively were developed by logistic regression analyses in the Finnish patient cohort. The models were tested in two independent cohorts from Denmark and Scotland by assessing the areas under the receiver operating characteristics curves (ROC-AUCs). The outcome variable was moderate to severe persistent pain at 1 year from surgery in the Finnish and Danish cohorts and at 9 months in the Scottish cohort. Results Moderate to severe persistent pain occurred in 13.5%, 13.9%, and 20.3% of the patients in the three studies, respectively. Preoperative pain in the operative area ( P < .001), high body mass index ( P = .039), axillary lymph node dissection ( P = .008), and more severe acute postoperative pain intensity at the seventh postoperative day ( P = .003) predicted persistent pain in the final prediction model, which performed well in the Danish (ROC-AUC, 0.739) and Scottish (ROC-AUC, 0.740) cohorts. At the 20% risk level, the model had 32.8% and 47.4% sensitivity and 94.4% and 82.4% specificity in the Danish and Scottish cohorts, respectively. Conclusion Our validated prediction models and an online risk calculator provide clinicians and researchers with a simple tool to screen for patients at high risk of developing persistent pain after breast cancer surgery.Purpose Persistent pain after breast cancer surgery is a well-recognized problem, with moderate to severe pain affecting 15% to 20% of women at 1 year from surgery. Several risk factors for persistent pain have been recognized, but tools to identify high-risk patients and preventive interventions are missing. The aim was to develop a clinically applicable risk prediction tool. Methods The prediction models were developed and tested using three prospective data sets from Finland (n = 860), Denmark (n = 453), and Scotland (n = 231). Prediction models for persistent pain of moderate to severe intensity at 1 year postoperatively were developed by logistic regression analyses in the Finnish patient cohort. The models were tested in two independent cohorts from Denmark and Scotland by assessing the areas under the receiver operating characteristics curves (ROC-AUCs). The outcome variable was moderate to severe persistent pain at 1 year from surgery in the Finnish and Danish cohorts and at 9 months in the Scottish cohort. Results Moderate to severe persistent pain occurred in 13.5%, 13.9%, and 20.3% of the patients in the three studies, respectively. Preoperative pain in the operative area ( P < .001), high body mass index ( P = .039), axillary lymph node dissection ( P = .008), and more severe acute postoperative pain intensity at the seventh postoperative day ( P = .003) predicted persistent pain in the final prediction model, which performed well in the Danish (ROC-AUC, 0.739) and Scottish (ROC-AUC, 0.740) cohorts. At the 20% risk level, the model had 32.8% and 47.4% sensitivity and 94.4% and 82.4% specificity in the Danish and Scottish cohorts, respectively. Conclusion Our validated prediction models and an online risk calculator provide clinicians and researchers with a simple tool to screen for patients at high risk of developing persistent pain after breast cancer surgery. |
| Author | Haasio, Lassi Scott, Neil W Andersen, Kenneth Geving Kalso, Eija Meretoja, Tuomo J Bruce, Julie Sipilä, Reetta Ripatti, Samuli Kehlet, Henrik |
| Author_xml | – sequence: 1 givenname: Tuomo J surname: Meretoja fullname: Meretoja, Tuomo J organization: Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, and Eija Kalso, Helsinki University Hospital; Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, Samuli Ripatti, and Eija Kalso, University of Helsinki, Helsinki, Finland; Kenneth Geving Andersen and Henrik Kehlet, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Julie Bruce, University of Warwick, Coventry; and Neil W. Scott, University of Aberdeen, Aberdeen, United Kingdom – sequence: 2 givenname: Kenneth Geving surname: Andersen fullname: Andersen, Kenneth Geving organization: Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, and Eija Kalso, Helsinki University Hospital; Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, Samuli Ripatti, and Eija Kalso, University of Helsinki, Helsinki, Finland; Kenneth Geving Andersen and Henrik Kehlet, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Julie Bruce, University of Warwick, Coventry; and Neil W. Scott, University of Aberdeen, Aberdeen, United Kingdom – sequence: 3 givenname: Julie surname: Bruce fullname: Bruce, Julie organization: Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, and Eija Kalso, Helsinki University Hospital; Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, Samuli Ripatti, and Eija Kalso, University of Helsinki, Helsinki, Finland; Kenneth Geving Andersen and Henrik Kehlet, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Julie Bruce, University of Warwick, Coventry; and Neil W. Scott, University of Aberdeen, Aberdeen, United Kingdom – sequence: 4 givenname: Lassi surname: Haasio fullname: Haasio, Lassi organization: Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, and Eija Kalso, Helsinki University Hospital; Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, Samuli Ripatti, and Eija Kalso, University of Helsinki, Helsinki, Finland; Kenneth Geving Andersen and Henrik Kehlet, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Julie Bruce, University of Warwick, Coventry; and Neil W. Scott, University of Aberdeen, Aberdeen, United Kingdom – sequence: 5 givenname: Reetta surname: Sipilä fullname: Sipilä, Reetta organization: Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, and Eija Kalso, Helsinki University Hospital; Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, Samuli Ripatti, and Eija Kalso, University of Helsinki, Helsinki, Finland; Kenneth Geving Andersen and Henrik Kehlet, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Julie Bruce, University of Warwick, Coventry; and Neil W. Scott, University of Aberdeen, Aberdeen, United Kingdom – sequence: 6 givenname: Neil W surname: Scott fullname: Scott, Neil W organization: Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, and Eija Kalso, Helsinki University Hospital; Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, Samuli Ripatti, and Eija Kalso, University of Helsinki, Helsinki, Finland; Kenneth Geving Andersen and Henrik Kehlet, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Julie Bruce, University of Warwick, Coventry; and Neil W. Scott, University of Aberdeen, Aberdeen, United Kingdom – sequence: 7 givenname: Samuli surname: Ripatti fullname: Ripatti, Samuli organization: Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, and Eija Kalso, Helsinki University Hospital; Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, Samuli Ripatti, and Eija Kalso, University of Helsinki, Helsinki, Finland; Kenneth Geving Andersen and Henrik Kehlet, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Julie Bruce, University of Warwick, Coventry; and Neil W. Scott, University of Aberdeen, Aberdeen, United Kingdom – sequence: 8 givenname: Henrik surname: Kehlet fullname: Kehlet, Henrik organization: Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, and Eija Kalso, Helsinki University Hospital; Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, Samuli Ripatti, and Eija Kalso, University of Helsinki, Helsinki, Finland; Kenneth Geving Andersen and Henrik Kehlet, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Julie Bruce, University of Warwick, Coventry; and Neil W. Scott, University of Aberdeen, Aberdeen, United Kingdom – sequence: 9 givenname: Eija surname: Kalso fullname: Kalso, Eija organization: Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, and Eija Kalso, Helsinki University Hospital; Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, Samuli Ripatti, and Eija Kalso, University of Helsinki, Helsinki, Finland; Kenneth Geving Andersen and Henrik Kehlet, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Julie Bruce, University of Warwick, Coventry; and Neil W. Scott, University of Aberdeen, Aberdeen, United Kingdom |
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| Snippet | Purpose Persistent pain after breast cancer surgery is a well-recognized problem, with moderate to severe pain affecting 15% to 20% of women at 1 year from... |
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| SubjectTerms | Breast Neoplasms - pathology Breast Neoplasms - surgery Cancer Pain - etiology Cohort Studies Female Humans Logistic Models Middle Aged Models, Statistical Pain, Postoperative - etiology Predictive Value of Tests Risk Assessment ROC Curve |
| Title | Clinical Prediction Model and Tool for Assessing Risk of Persistent Pain After Breast Cancer Surgery |
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