Risk Calculator Determines Likelihood of PPBCS in Breast Cancer

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Risk calculator assesses patients for risk of persistent pain after breast cancer surgery (PPBCS).
Risk calculator assesses patients for risk of persistent pain after breast cancer surgery (PPBCS).

Online risk calculator was helpful in identifying patients at risk for persistent pain after breast cancer surgery, a new paper published in the Journal of Clinical Oncology has reported.1

Breast cancer surgery has been associated with persistent pain in 15% to 20% of patients leading to reduced function and quality of life, according to the investigators. Identifying patients at high risk for persistent pain after breast cancer surgery (PPBCS) is difficult. 

Therefore, Tuomo Meretoja, MD, PhD, and colleagues at the Helsinki University Hospital and Comprehensive Cancer Center in Helsinki, Finland, and colleagues developed a web-based risk calculator to better identify patients at risk for PPBCS.

The investigators used prospective data from Finland (860 patients), Denmark (453 patients), and Scotland (231 patients) to develop and test their prediction model for identifying patients at risk for moderate-to-severe pain 1 year after surgery.

The model determined that 13.5% of the Finnish patients and 13.9% the Danish patients had experienced moderate-to-severe PPBCS at 1 year after surgery. Likewise, 20.3% of the Scottish patients experienced moderate-to-severe PPBCS at 9 months.

Factors associated with PPBCS in the final model included higher BMI (P =.39), preoperative pain (P <.001), axillary lymph node dissection (P =.008), and severe postoperative pain at day 7 (P =.003). These risk factors for PPBCS performed well when the model was applied to the Scottish (ROC-AUC 0.740) and Danish (ROC-AUC 0.739) cohorts.

The model was associated with specificity of 82% to 94% but a sensitivity of 32% to 47% in the Scottish and Danish cohorts. “This means that patients with high risk scores are likely to develop persistent pain, with a low proportion of false positives. On the other hand, a larger proportion of patients with low risk scores are falsely negative and will develop persistent pain despite the low risk score,” the investigators explain.

The risk calculator was designed be used at multiple stages: prior to surgery, after surgery, at discharge, and 1 week postoperatively. The authors note, that the calculator becomes more accurate at identifying high risk patients at each stage.

“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,” the investigators conclude.

The investigators further point out identification of patients at risk for PPBCS can help guide treatment and future research.1

Reference

1. Meretoja TJ, Andersen KG, Bruce J, et al. Clinical prediction model and tool for assessing risk of persistent pain after breast cancer surgery. J Clin Oncol. 2017 Mar 13. doi: 10.1200/JCO.2016.70.3413 [Epub ahead of print]

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