Patient-reported pain, stress linked to poorer breast cancer outcomes
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Patients with breast cancer who reported high burdens of pain and stress had poorer outcomes than those with lower pain or stress levels, according to research presented at ASCO Annual Meeting.
The findings emerged from a secondary analysis of the phase 3 A011502 trial, sponsored by the Alliance for Clinical Trials in Oncology, in which researchers randomly assigned 3,020 individuals with high-risk nonmetastatic breast cancer to daily aspirin or placebo.
Participants completed baseline questionnaires, including the Perceived Stress Scale, the Center for Epidemiologic Studies Depression Scale Revised, the Brief Pain Inventory and the Pittsburgh Sleep Quality Index.
The analysis revealed that high stress and pain were associated with shorter iDFS and OS.
“I believe this is the first prospective phase 3 clinical trial that has reported this finding linking high stress with worse clinical outcomes,” Shipra Gandhi, MD, MS, associate professor of oncology at Roswell Park Comprehensive Cancer Center, told Healio. “We also have some collaborators at Roswell Park who have shown in preclinical models that tumors in mice experiencing thermal stress grow faster. Now, with the secondary analysis from this clinical trial, we have observed similar findings in a clinical setting.”
Healio spoke with Gandhi about the findings and their potential implications as well as strategies that may help patients with cancer manage stress.
Healio: What motivated you to conduct this secondary analysis?
Gandhi: The secondary endpoint of the study was to see if there were any high-risk, inflammation-affiliated factors that could be associated with outcomes. That is why all these questionnaires that captured lifestyle factors associated with inflammation were collected at the time of the study design. We selected four validated questionnaires for perceived stress, pain, sleep quality and depression.
Healio: What are the potential long-term implications of these findings?
Gandhi: This study clearly tells us that those who are reporting moderate to severe pain or higher stress have worse outcomes.
In clinical practice, if I see a patient who reports moderate to severe pain, this underscores how important it is to adequately address and manage that pain. If patients are experiencing pain, they may be in stress, and they may not be able to engage in their normal activities. Addressing these symptoms in the clinic is very important.
Additionally, the study also shows that we need to address stress and help patients cope with it. We need to acknowledge that when patients are reporting stress, there could be many other things going on in their life. There are so many social determinants of health — they could be having problems with finances for their treatment or other causes of stress in their families or relationships. In this study, we did not have the details regarding social determinants of health or comorbidities that could have impacted stress, and hence, were unable to adjust for those factors. There are nonpharmacologic and pharmacologic ways of addressing stress. Patients could practice yoga and meditation in order to relieve stress.
Additionally, there are data using preclinical models showing that chronic stress is associated with an increase in hormones like epinephrine and norepinephrine, which could cause the tumor to grow, and that use of strategies to block the beta-adrenergic signaling pathway — that is, beta-blockers — could counter the tumor growth. At Roswell Park, we are leading a few clinical trials to evaluate whether giving beta-blockers to patients could improve their outcomes.
Healio: Is there anything else you’d like to mention?
Gandhi: This was a prospective phase 3 clinical trial. It provides high-level evidence in a very large number of patients, and we tried to adjust for many of the variables that we think would impact the results.
Another takeaway from this study is that when clinical trials are being designed, we should be incorporating these questionnaires capturing inflammation-affiliated factors during study design, because we know they can tell us which patients are at risk for worse outcomes. Once we identify these patients at high risk upfront, we need to devise strategies in our clinic to address these symptoms.
Reference:
- Gandhi S, et al. Abstract 11016. Presented at: ASCO Annual Meeting; May 31-June 4, 2024; Chicago.
For more information:
Shipra Gandhi, MD, MS, can be reached at shipra.gandhi@roswellpark.org.
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