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Clinical prediction model and tool for assessing risk of persistent pain after breast cancer surgery
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Meretoja, Tuomo J., Andersen, Kenneth Geving, Bruce, Julie, Haasio, Lassi, Sipilä, Reetta, Scott, Neil W., Ripatti, Samuli, Kehlet, Henrik and Kalso, Eija (2017) Clinical prediction model and tool for assessing risk of persistent pain after breast cancer surgery. Journal of Clinical Oncology, 35 (15). pp. 1660-1667. doi:10.1200/JCO.2016.70.3413
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Official URL: http://dx.doi.org/10.1200/JCO.2016.70.3413
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.
| Item Type: | Journal Article | ||||||
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| Subjects: | R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer) | ||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Journal or Publication Title: | Journal of Clinical Oncology | ||||||
| Publisher: | American Society of Clinical Oncology | ||||||
| ISSN: | 0732-183X | ||||||
| Official Date: | 20 May 2017 | ||||||
| Dates: |
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| Volume: | 35 | ||||||
| Number: | 15 | ||||||
| Page Range: | pp. 1660-1667 | ||||||
| DOI: | 10.1200/JCO.2016.70.3413 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access |
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