A new observational study indicates that for patients undergoing breast radiotherapy, the experience of pain may be associated with numerous factors. Findings of the study were reported in the Journal of Clinical Oncology.

The study examined toxicities associated with breast radiotherapy in 8711 patients treated from 2012 through 2019 across 27 facilities. Assessments were based on patient-reported outcomes. Multivariate analyses were performed to identify possible associations between patient or treatment characteristics and breast pain, fatigue, or other discomforts related to the treatment.

Conventionally fractionated radiotherapy was received by 4268 patients, and hypofractionated radiotherapy was given to 4443 patients. A total of 3233 patients (37.1%) in this study reported moderate to severe breast pain. Nearly a quarter of patients (23.1%; 2008 patients) reported severe fatigue. Other discomforts in the treated breast, which included 1 or more of itching, stinging, swelling, or hurting, were reported as a frequent bother by 4424 patients (50.8%).

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For patients treated with conventionally fractionated radiotherapy, several factors were identified as significant predictors of moderate or severe breast pain. These included younger age, current or past smoking status, larger breast volume, Black race, other race, diabetes, and higher body mass index.

Many significant predictors of moderate or severe breast pain were also reported by patients treated with hypofractionated radiotherapy. These included younger age, current or past smoking status, higher body mass index, receipt of boost treatment, Black race, other race, larger breast volume, lack of chemotherapy treatment, and receipt of treatment at a facility other than a teaching center.

Some of the above factors and others were also linked to fatigue or other discomforts in both treatment groups. Overall, the researchers determined that whole-breast radiotherapy toxicities were associated with dose fractionation and a wide range of other patient or treatment characteristics.

“Of particular concern, race-related differences in breast pain and bother existed despite controlling for multiple other factors, including age, body habitus, comorbidities, and treatment characteristics,” wrote the researchers in their report.


Jagsi R, Griffith KA, Vicini F, et al. Toward improving patients’ experiences of acute toxicity from breast radiotherapy: insights from the analysis of patient-reported outcomes in a large multicenter cohort. J Clin Oncol. Published online September 28, 2020. doi:10.1200/JCO.20.01703