Skip to main content

Advertisement

Log in

Pain in long-term breast cancer survivors: the role of body mass index, physical activity, and sedentary behavior

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Although pain is common among post-treatment breast cancer survivors, studies that are longitudinal, identify a case definition of clinically meaningful pain, or examine factors contributing to pain in survivors are limited. This study describes longitudinal patterns of pain in long-term breast cancer survivors, evaluating associations of body mass index (BMI), physical activity, sedentary behavior with mean pain severity and above-average pain. Women newly diagnosed with stages 0–IIIA breast cancer (N = 1183) were assessed, on average, 6 months (demographic/clinical characteristics), 30 months (demographics), 40 months (demographics, pain), 5 years (BMI, physical activity, and sedentary behavior), and 10 years (demographics, pain, BMI, physical activity, and sedentary behavior) post-diagnosis. This analysis includes survivors who completed pain assessments 40 months post-diagnosis (N = 801), 10 years post-diagnosis (N = 563), or both (N = 522). Above-average pain was defined by SF-36 bodily pain scores ≥1/2 standard deviation worse than age-specific population norms. We used multiple regression models to test unique associations of BMI, physical activity, and sedentary behavior with pain adjusting for demographic and clinical factors. The proportion of survivors reporting above-average pain was higher at 10 years than at 40 months (32.3 vs. 27.8 %, p < 0.05). Approximately one-quarter of survivors reported improved pain, while 9.0 % maintained above-average pain and 33.1 % reported worsened pain. Cross-sectionally at 10 years, overweight and obese survivors reported higher pain than normal-weight survivors and women meeting physical activity guidelines were less likely to report above-average pain than survivors not meeting these guidelines (p < 0.05). Longitudinally, weight gain (>5 %) was positively associated, while meeting physical activity guidelines was inversely associated, with above-average pain (OR, 95 % CI = 1.76, 1.03–3.01 and 0.40, 0.20–0.84, respectively) (p < 0.05). Weight gain and lack of physical activity place breast cancer survivors at risk for pain long after treatment ends. Weight control and exercise interventions should be tested for effects on long-term pain in these women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Alfano CM, Smith AW, Irwin ML, Bowen DJ, Sorensen B, Reeve BB, Meeske KA, Bernstein L, Baumgartner KB, Ballard-Barbash R, Malone KE, McTiernan A (2007) Physical activity, long-term symptoms, and physical health-related quality of life among breast cancer survivors: a prospective analysis. J Cancer Surviv 1:116–128

    Article  PubMed  Google Scholar 

  2. Andrykowski MA, Schmidt JE, Salsman JM, Beacham AO, Jacobsen PB (2005) Use of a case definition approach to identify cancer-related fatigue in women undergoing adjuvant therapy for breast cancer. J Clin Oncol 23:6613–6622

    Article  PubMed  Google Scholar 

  3. Baker F, Haffer SC, Denniston M (2003) Health-related quality of life of cancer and noncancer patients in Medicare managed care. Cancer 97:674–681

    Article  PubMed  Google Scholar 

  4. Basen-Engquist K, Taylor CL, Rosenblum C, Smith MA, Shinn EH, Greisinger A, Gregg X, Massey P, Valero V, Rivera E (2006) Randomized pilot test of a lifestyle physical activity intervention for breast cancer survivors. Patient Educ Couns 64:225–234

    Article  PubMed  Google Scholar 

  5. Basen-Engquist K, Hughes D, Perkins H, Shinn E, Taylor CC (2008) Dimensions of physical activity and their relationship to physical and emotional symptoms in breast cancer survivors. J Cancer Surviv 2:253–261

    Article  PubMed  Google Scholar 

  6. Basen-Engquist K, Scruggs S, Jhingran A, Bodurka DC, Lu K, Ramondetta L, Hughes D, Carmack Taylor C (2009) Physical activity and obesity in endometrial cancer survivors: associations with pain, fatigue, and physical functioning. Am J Obstet Gynecol 200(288):e281–288

    Google Scholar 

  7. Bennett JA, Cameron LD, Brown PM, Whitehead LC, Porter D, Ottaway-Parkes T, Robinson E (2010) Time since diagnosis as a predictor of symptoms, depression, cognition, social concerns, perceived benefits, and overall health in cancer survivors. Oncol Nurs Forum 37:331–338

    Article  PubMed  Google Scholar 

  8. Braden JB, Young AC, Sullivan MD, Walitt B, LaCroix AZ, Martin L (2012) Predictors of change in pain and physical functioning among post-menopausal women with recurrent pain conditions in the women’s health initiative observational cohort. J Pain 13:64–72

    Article  PubMed  Google Scholar 

  9. Bruce B, Fries JF, Lubeck DP (2005) Aerobic exercise and its impact on musculoskeletal pain in older adults: a 14 year prospective, longitudinal study. Arthritis Res Ther 7:R1263–R1270

    Article  PubMed  Google Scholar 

  10. Chen SM, Liu MF, Cook J, Bass S, Lo SK (2009) Sedentary lifestyle as a risk factor for low back pain: a systematic review. Int Arch Occup Environ Health 82:797–806

    Article  PubMed  Google Scholar 

  11. Clark BK, Sugiyama T, Healy GN, Salmon J, Dunstan DW, Owen N (2009) Validity and reliability of measures of television viewing time and other non-occupational sedentary behaviour of adults: a review. Obes Rev 10:7–16

    Article  PubMed  Google Scholar 

  12. Deimling GT, Sterns S, Bowman KF, Kahana B (2005) The health of older-adult, long-term cancer survivors. Cancer Nurs 28:415–424

    Article  PubMed  Google Scholar 

  13. Dunstan DW, Barr EL, Healy GN, Salmon J, Shaw JE, Balkau B, Magliano DJ, Cameron AJ, Zimmet PZ, Owen N (2010) Television viewing time and mortality: the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Circulation 121:384–391

    Article  PubMed  CAS  Google Scholar 

  14. Ewertz M, Jensen AB (2011) Late effects of breast cancer treatment and potentials for rehabilitation. Acta Oncol 50:187–193

    Article  PubMed  Google Scholar 

  15. Ford ES (2012) Combined television viewing and computer use and mortality from all-causes and diseases of the circulatory system among adults in the United States. BMC Public Health 12:70

    Article  PubMed  Google Scholar 

  16. Gartner R, Jensen MB, Nielsen J, Ewertz M, Kroman N, Kehlet H (2009) Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA 302:1985–1992

    Article  PubMed  Google Scholar 

  17. Gartner R, Jensen MB, Kronborg L, Ewertz M, Kehlet H, Kroman N (2010) Self-reported arm-lymphedema and functional impairment after breast cancer treatment—a nationwide study of prevalence and associated factors. Breast 19:506–515

    Article  PubMed  Google Scholar 

  18. George SM, Alfano CM, Wilder Smith A, Irwin M, McTiernan A, Bernstein L, Baumgartner KB, Ballard-Barbash R (2012) Sedentary behavior, health-related quality of life and fatigue among breast cancer survivors. J Phys Act Health 2012 Jul 9. [Epub ahead of print]

  19. Green CR, Hart-Johnson T, Loeffler DR (2010) Cancer-related chronic pain: examining quality of life in diverse cancer survivors. Cancer 117:1994–2003

    Article  PubMed  Google Scholar 

  20. Grimmett C, Bridgewater J, Steptoe A, Wardle J (2011) Lifestyle and quality of life in colorectal cancer survivors. Qual Life Res 20:1237–1245

    Article  PubMed  Google Scholar 

  21. Hack TF, Kwan WB, Thomas-MacLean RL, Towers A, Miedema B, Tilley A, Chateau D (2010) Predictors of arm morbidity following breast cancer surgery. Psycho-Oncology 19:1205–1212

    Article  PubMed  Google Scholar 

  22. Hays RD, Sherbourne CD, Mazel RM (1993) The RAND 36-Item Health Survey 1.0. Health Econ 2:217–227

    Article  PubMed  CAS  Google Scholar 

  23. Irwin ML, Smith AW, McTiernan A, Ballard-Barbash R, Cronin K, Gilliland FD, Baumgartner RN, Baumgartner KB, Bernstein L (2008) Influence of pre- and postdiagnosis physical activity on mortality in breast cancer survivors: the health, eating, activity, and lifestyle study. J Clin Oncol 26:3958–3964

    Article  PubMed  Google Scholar 

  24. Jacobsen PB, Jim HSL (2011) Consideration of quality of life in cancer survivorship research. Cancer Epidemiol Biomark Prev 20:2035–2041

    Article  Google Scholar 

  25. Jensen MP, Chang HY, Lai YH, Syrjala KL, Fann JR, Gralow JR (2010) Pain in long-term breast cancer survivors: frequency, severity, and impact. Pain Med 11:1099–1106

    Article  PubMed  Google Scholar 

  26. Katzmarzyk PT, Church TS, Craig CL, Bouchard C (2009) Sitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc 41:998–1005

    Article  PubMed  Google Scholar 

  27. Kim HJ, Barsevick AM, Fang CY, Miaskowski C (2012) Common biological pathways underlying the psychoneurological symptom cluster in cancer patients. Cancer Nurs 35:E1–E20

    Google Scholar 

  28. Kriska AM, Bennett PH (1992) An epidemiologic perspective of the relationship between physical activity and NIDDM—from activity assessment to intervention. Diabetes Metab Rev 8:355–372

    Article  PubMed  CAS  Google Scholar 

  29. Landmark T, Romundstad P, Borchgrevink PC, Kaasa S, Dale O (2011) Associations between recreational exercise and chronic pain in the general population: evidence from the HUNT 3 study. Pain 152:2241–2247

    Article  PubMed  Google Scholar 

  30. Larsson UE (2004) Influence of weight loss on pain, perceived disability and observed functional limitations in obese women. Int J Obes 28:269–277

    Article  Google Scholar 

  31. Lee SA, Kang JY, Kim YD, An AR, Kim SW, Kim YS, Lim JY (2010) Effects of a scapula-oriented shoulder exercise programme on upper limb dysfunction in breast cancer survivors: a randomized controlled pilot trial. Clin Rehabil 24:600–613

    Article  PubMed  Google Scholar 

  32. Lee ES, Lee MK, Kim SH, Ro JS, Kang HS, Kim SW, Lee KS, Yun YH (2011) Health-related quality of life in survivors with breast cancer 1 year after diagnosis compared with the general population: a prospective cohort study. Ann Surg 253:101–108

    Article  PubMed  Google Scholar 

  33. Lu Y, Ma H, Malone KE, Norman SA, Sullivan-Halley J, Strom BL, Marchbanks PA, Spirtas R, Burkman RT, Deapen D, Folger SG, Simon MS, Press MF, McDonald JA, Bernstein L (2011) Obesity and survival among black women and white women 35 to 64 years of age at diagnosis with invasive breast cancer. J Clin Oncol 29:3358–3365

    Article  PubMed  Google Scholar 

  34. Lynch BM, Dunstan DW, Healy GN, Winkler E, Eakin E, Owen N (2010) Objectively measured physical activity and sedentary time of breast cancer survivors, and associations with adiposity: findings from NHANES (2003–2006). Cancer Causes Control 21:283–288

    Article  PubMed  Google Scholar 

  35. Lynch BM, Friedenreich CM, Winkler EAH, Healy GN, Vallance JK, Eakin EG, Owen N (2011) Associations of objectively assessed physical activity and sedentary time with biomarkers of breast cancer risk in postmenopausal women: findings from NHANES (2003–2006). Breast Cancer Res Treat 130:183–194

    Article  PubMed  Google Scholar 

  36. Macdonald L, Bruce J, Scott NW, Smith WC, Chambers WA (2005) Long-term follow-up of breast cancer survivors with post-mastectomy pain syndrome. Br J Cancer 92:225–230

    PubMed  CAS  Google Scholar 

  37. Marchbanks PA, McDonald JA, Wilson HG, Burnett NM, Daling JR, Bernstein L, Malone KE, Strom BL, Norman SA, Weiss LK, Liff JM, Wingo PA, Burkman RT, Folger SG, Berlin JA, Deapen DM, Ursin G, Coates RJ, Simon MS, Press MF, Spirtas R (2002) The NICHD women’s contraceptive and reproductive experiences study: methods and operational results. Ann Epidemiol 12:213–221

    Article  PubMed  Google Scholar 

  38. Marchbanks PA, McDonald JA, Wilson HG, Folger SG, Mandel MG, Daling JR, Bernstein L, Malone KE, Ursin G, Strom BL, Norman SA, Weiss LK, Wingo PA, Burkman RT, Berlin JA, Simon MS, Spirtas R (2002) Oral contraceptives and the risk of breast cancer. N Engl J Med 346:2025–2032

    Article  PubMed  CAS  Google Scholar 

  39. Matthews CE, Chen KY, Freedson PS, Buchowski MS, Beech BM, Pate RR, Troiano RP (2008) Amount of time spent in sedentary behaviors in the United States, 2003–2004. Am J Epidemiol 167:875–881

    Article  PubMed  Google Scholar 

  40. Matthews CE, George SM, Moore SC, Bowles HR, Blair A, Park Y, Troiano RP, Hollenbeck A, Schatzkin A (2012) Amount of time spent in sedentary behaviors and cause-specific mortality in US adults. Am J Clin Nutr 95:437–445

    Article  PubMed  CAS  Google Scholar 

  41. McGuire DB (2004) Occurrence of cancer pain. J Natl Cancer Inst Monogr:51–56.

  42. McNeely ML, Parliament MB, Seikaly H, Jha N, Magee DJ, Haykowsky MJ, Courneya KS (2008) Effect of exercise on upper extremity pain and dysfunction in head and neck cancer survivors: a randomized controlled trial. Cancer 113:214–222

    Article  PubMed  Google Scholar 

  43. McTiernan A, Rajan KB, Tworoger SS, Irwin M, Bernstein L, Baumgartner R, Gilliland F, Stanczyk FZ, Yasui Y, Ballard-Barbash R (2003) Adiposity and sex hormones in postmenopausal breast cancer survivors. J Clin Oncol 21:1961–1966

    Article  PubMed  CAS  Google Scholar 

  44. Meeske K, Press M, Patel A, Bernstein L (2004) Impact of reproductive factors and lactation on breast carcinoma in situ risk. Int J Cancer 110:102–109

    Article  PubMed  CAS  Google Scholar 

  45. Mickey RM, Greenland S (1989) The impact of confounder selection criteria on effect estimation. Am J Epidemiol 129:125–137

    PubMed  CAS  Google Scholar 

  46. Mork PJ, Vasseljen O, Nilsen TIL (2010) Association between physical exercise, body mass index, and risk of fibromyalgia: longitudinal Data From the Norwegian Nord-Trondelag Health Study. Arthritis Care Res 62:611–617

    Article  Google Scholar 

  47. Mosher CE, Sloane R, Morey MC, Snyder DC, Cohen HJ, Miller PE, Demark-Wahnefried W (2009) Associations between lifestyle factors and quality of life among older long-term breast, prostate, and colorectal cancer survivors. Cancer 115:4001–4009

    Article  PubMed  Google Scholar 

  48. Neuss MN, Jacobson JO, McNiff KK, Kadlubek P, Eisenberg PD, Simone JV (2009) Evolution and elements of the quality oncology practice initiative measure set. Cancer Control 16:312–317

    PubMed  Google Scholar 

  49. Norman GR, Sloan JA, Wyrwich KW (2003) Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care 41:582–592

    PubMed  Google Scholar 

  50. Patel AV, Press MF, Meeske K, Calle EE, Bernstein L (2003) Lifetime recreational exercise activity and risk of breast carcinoma in situ. Cancer 98:2161–2169

    Article  PubMed  Google Scholar 

  51. Patel AV, Bernstein L, Deka A, Feigelson HS, Campbell PT, Gapstur SM, Colditz GA, Thun MJ (2010) Leisure time spent sitting in relation to total mortality in a prospective cohort of US adults. Am J Epidemiol 172:419–429

    Article  PubMed  Google Scholar 

  52. Paxton RJ, Phillips KL, Jones LA, Chang S, Taylor WC, Courneya KS, Pierce JP (2012) Associations among physical activity, body mass index, and health-related quality of life by race/ethnicity in a diverse sample of breast cancer survivors. Cancer 118:4024–4031

    Article  PubMed  Google Scholar 

  53. Peltonen M, Lindroos AK, Torgerson JS (2003) Musculoskeletal pain in the obese: a comparison with a general population and long-term changes after conventional and surgical obesity treatment. Pain 104:549–557

    Article  PubMed  Google Scholar 

  54. Pereira MA, FitzerGerald SJ, Gregg EW, Joswiak ML, Ryan WJ, Suminski RR, Utter AC, Zmuda JM (1997) A collection of Physical Activity Questionnaires for health-related research. Med Sci Sports Exerc 29:S1–205

    PubMed  CAS  Google Scholar 

  55. Peuckmann V, Ekholm O, Rasmussen NK, Groenvold M, Christiansen P, Moller S, Eriksen J, Sjogren P (2009) Chronic pain and other sequelae in long-term breast cancer survivors: nationwide survey in Denmark. Eur J Pain 13:478–485

    Article  PubMed  CAS  Google Scholar 

  56. Rosemann T, Kuehlein T, Laux G, Szecsenyi J (2008) Factors associated with physical activity of patients with osteoarthritis of the lower limb. J Eval Clin Pract 14:288–293

    Article  PubMed  Google Scholar 

  57. Sagen A, Karesen R, Sandvik L, Risberg MA (2009) Changes in arm morbidities and health-related quality of life after breast cancer surgery—a five-year follow-up study. Acta Oncol 48:1111–1118

    Article  PubMed  Google Scholar 

  58. Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E (2010) The association between obesity and low back pain: a meta-analysis. Am J Epidemiol 171:135–154

    Article  PubMed  Google Scholar 

  59. Smith AW, Reeve BB, Bellizzi KM, Harlan LC, Klabunde CN, Amsellem M, Bierman AS, Hays RD (2008) Cancer, comorbidities, and health-related quality of life of older adults. Health Care Financ Rev 29:41–56

    PubMed  Google Scholar 

  60. Solberg Nes L, Liu H, Patten CA, Rausch SM, Sloan JA, Garces YI, Cheville AL, Yang P, Clark MM (2012) Physical activity level and quality of life in long term lung cancer survivors. Lung Cancer 21:98

    Google Scholar 

  61. Stamatakis E, Hamer M, Dunstan DW (2011) Screen-based entertainment time, all-cause mortality, and cardiovascular events: population-based study with ongoing mortality and hospital events follow-up. J Am Coll Cardiol 57:292–299

    Article  PubMed  Google Scholar 

  62. Stone AA, Broderick JE (2012) Obesity and pain are associated in the United States. Obesity (Silver Spring) 20:1491–1495

    Article  Google Scholar 

  63. Sweeney C, Schmitz KH, Lazovich D, Virnig BA, Wallace RB, Folsom AR (2006) Functional limitations in elderly female cancer survivors. J Natl Cancer Inst 98:521–529

    Article  PubMed  Google Scholar 

  64. Thomas E, Peat G, Harris L, Wilkie R, Croft PR (2004) The prevalence of pain and pain interference in a general population of older adults: cross-sectional findings from the North Staffordshire Osteoarthritis Project (NorStOP). Pain 110:361–368

    Article  PubMed  Google Scholar 

  65. Thompson WD (1994) Statistical analysis of case-control studies. Epidemiol Rev 16:33–50

    PubMed  CAS  Google Scholar 

  66. U.S. Department of Health and Human Services (2008) Physical Activity Guidelines for Americans. Accessed at: www.health.gov/paguidelines

  67. van der Ploeg HP, Chey T, Korda RJ, Banks E, Bauman A (2012) Sitting time and all-cause mortality risk in 222 497 Australian adults. Arch Intern Med 172:494–500

    Article  PubMed  Google Scholar 

  68. Ware JE, Snow KK, Kosinski M, Gandek B (1993) SF-36 health survey. Manual and interpretation guide, The Health institute, New England Medical Center, Boston

    Google Scholar 

  69. Wright LJ, Schur E, Noonan C, Ahumada S, Buchwald D, Afari N (2010) Chronic pain, overweight, and obesity: findings from a community-based twin registry. J Pain 11:628–635

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The HEAL study is supported by the National Cancer Institute (Grants N01-CN-75036-20, NO1-CN-05228, NO1-PC-67010). We would also like to thank the HEAL study managers, Todd Gibson of Information Management Systems, and the HEAL study participants.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Laura P. Forsythe.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Forsythe, L.P., Alfano, C.M., George, S.M. et al. Pain in long-term breast cancer survivors: the role of body mass index, physical activity, and sedentary behavior. Breast Cancer Res Treat 137, 617–630 (2013). https://doi.org/10.1007/s10549-012-2335-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-012-2335-7

Keywords

Navigation