Association between C-reactive protein and radiotherapy-related pain in a tri-racial/ethnic population of breast cancer patients

A prospective cohort study

Eunkyung Lee, Omar L. Nelson, Carolina Puyana, Cristiane Takita, Jean L. Wright, Wei Zhao, Isildinha Reis, Rick Y. Lin, WayWay Hlaing, Johnna L. Bakalar, George R. Yang, Jennifer Hu

Research output: Contribution to journalArticle

Abstract

Background: Post-surgery adjuvant radiotherapy (RT) significantly improves clinical outcomes in breast cancer patients; however, some patients develop cancer or treatment-related pain that negatively impacts quality of life. This study examined an inflammatory biomarker, C-reactive protein (CRP), in RT-related pain in breast cancer. Methods: During 2008 and 2014, breast cancer patients who underwent RT were prospectively evaluated for pre- and post-RT pain. Pre- and post-RT plasma CRP levels were measured using a highly sensitive CRP ELISA kit. Pain score was assessed as the mean of four pain severity items (i.e., pain at its worst, least, average, and now) from the Brief Pain Inventory. Pain scores of 4-10 were classified as clinically relevant pain. Multivariable logistic regression analyses were applied to ascertain the associations between CRP and RT-related pain. Results: In 366 breast cancer patients (235 Hispanic whites, 73 black/African Americans, and 58 non-Hispanic whites), 17% and 30% of patients reported pre- and post-RT pain, while 23% of patients had RT-related pain. Both pre- and post-RT pain scores differed significantly by race/ethnicity. In multivariable logistic regression analysis, RT-related pain was significantly associated with elevated pre-RT CRP (≥ 10 mg/L) alone (odds ratio (OR) = 2.44; 95% confidence interval (CI) = 1.02, 5.85); or combined with obesity (OR = 4.73; 95% CI = 1.41, 15.81) after adjustment for age and race/ethnicity. Conclusions: This is the first pilot study of CRP in RT-related pain, particularly in obese breast cancer patients. Future larger studies are warranted to validate our findings and help guide RT decision-making processes and targeted interventions.

Original languageEnglish (US)
Article number70
JournalBreast Cancer Research
Volume21
Issue number1
DOIs
StatePublished - May 28 2019

Fingerprint

C-Reactive Protein
Cohort Studies
Radiotherapy
Prospective Studies
Breast Neoplasms
Pain
Population
Logistic Models
Odds Ratio
Regression Analysis
Confidence Intervals
Adjuvant Radiotherapy
Second Primary Neoplasms
Hispanic Americans
African Americans
Blood Proteins
Decision Making
Obesity
Biomarkers
Enzyme-Linked Immunosorbent Assay

Keywords

  • Breast cancer
  • C-reactive protein
  • Inflammatory biomarker
  • Pain
  • Radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Association between C-reactive protein and radiotherapy-related pain in a tri-racial/ethnic population of breast cancer patients : A prospective cohort study. / Lee, Eunkyung; Nelson, Omar L.; Puyana, Carolina; Takita, Cristiane; Wright, Jean L.; Zhao, Wei; Reis, Isildinha; Lin, Rick Y.; Hlaing, WayWay; Bakalar, Johnna L.; Yang, George R.; Hu, Jennifer.

In: Breast Cancer Research, Vol. 21, No. 1, 70, 28.05.2019.

Research output: Contribution to journalArticle

Lee, Eunkyung ; Nelson, Omar L. ; Puyana, Carolina ; Takita, Cristiane ; Wright, Jean L. ; Zhao, Wei ; Reis, Isildinha ; Lin, Rick Y. ; Hlaing, WayWay ; Bakalar, Johnna L. ; Yang, George R. ; Hu, Jennifer. / Association between C-reactive protein and radiotherapy-related pain in a tri-racial/ethnic population of breast cancer patients : A prospective cohort study. In: Breast Cancer Research. 2019 ; Vol. 21, No. 1.
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title = "Association between C-reactive protein and radiotherapy-related pain in a tri-racial/ethnic population of breast cancer patients: A prospective cohort study",
abstract = "Background: Post-surgery adjuvant radiotherapy (RT) significantly improves clinical outcomes in breast cancer patients; however, some patients develop cancer or treatment-related pain that negatively impacts quality of life. This study examined an inflammatory biomarker, C-reactive protein (CRP), in RT-related pain in breast cancer. Methods: During 2008 and 2014, breast cancer patients who underwent RT were prospectively evaluated for pre- and post-RT pain. Pre- and post-RT plasma CRP levels were measured using a highly sensitive CRP ELISA kit. Pain score was assessed as the mean of four pain severity items (i.e., pain at its worst, least, average, and now) from the Brief Pain Inventory. Pain scores of 4-10 were classified as clinically relevant pain. Multivariable logistic regression analyses were applied to ascertain the associations between CRP and RT-related pain. Results: In 366 breast cancer patients (235 Hispanic whites, 73 black/African Americans, and 58 non-Hispanic whites), 17{\%} and 30{\%} of patients reported pre- and post-RT pain, while 23{\%} of patients had RT-related pain. Both pre- and post-RT pain scores differed significantly by race/ethnicity. In multivariable logistic regression analysis, RT-related pain was significantly associated with elevated pre-RT CRP (≥ 10 mg/L) alone (odds ratio (OR) = 2.44; 95{\%} confidence interval (CI) = 1.02, 5.85); or combined with obesity (OR = 4.73; 95{\%} CI = 1.41, 15.81) after adjustment for age and race/ethnicity. Conclusions: This is the first pilot study of CRP in RT-related pain, particularly in obese breast cancer patients. Future larger studies are warranted to validate our findings and help guide RT decision-making processes and targeted interventions.",
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author = "Eunkyung Lee and Nelson, {Omar L.} and Carolina Puyana and Cristiane Takita and Wright, {Jean L.} and Wei Zhao and Isildinha Reis and Lin, {Rick Y.} and WayWay Hlaing and Bakalar, {Johnna L.} and Yang, {George R.} and Jennifer Hu",
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T1 - Association between C-reactive protein and radiotherapy-related pain in a tri-racial/ethnic population of breast cancer patients

T2 - A prospective cohort study

AU - Lee, Eunkyung

AU - Nelson, Omar L.

AU - Puyana, Carolina

AU - Takita, Cristiane

AU - Wright, Jean L.

AU - Zhao, Wei

AU - Reis, Isildinha

AU - Lin, Rick Y.

AU - Hlaing, WayWay

AU - Bakalar, Johnna L.

AU - Yang, George R.

AU - Hu, Jennifer

PY - 2019/5/28

Y1 - 2019/5/28

N2 - Background: Post-surgery adjuvant radiotherapy (RT) significantly improves clinical outcomes in breast cancer patients; however, some patients develop cancer or treatment-related pain that negatively impacts quality of life. This study examined an inflammatory biomarker, C-reactive protein (CRP), in RT-related pain in breast cancer. Methods: During 2008 and 2014, breast cancer patients who underwent RT were prospectively evaluated for pre- and post-RT pain. Pre- and post-RT plasma CRP levels were measured using a highly sensitive CRP ELISA kit. Pain score was assessed as the mean of four pain severity items (i.e., pain at its worst, least, average, and now) from the Brief Pain Inventory. Pain scores of 4-10 were classified as clinically relevant pain. Multivariable logistic regression analyses were applied to ascertain the associations between CRP and RT-related pain. Results: In 366 breast cancer patients (235 Hispanic whites, 73 black/African Americans, and 58 non-Hispanic whites), 17% and 30% of patients reported pre- and post-RT pain, while 23% of patients had RT-related pain. Both pre- and post-RT pain scores differed significantly by race/ethnicity. In multivariable logistic regression analysis, RT-related pain was significantly associated with elevated pre-RT CRP (≥ 10 mg/L) alone (odds ratio (OR) = 2.44; 95% confidence interval (CI) = 1.02, 5.85); or combined with obesity (OR = 4.73; 95% CI = 1.41, 15.81) after adjustment for age and race/ethnicity. Conclusions: This is the first pilot study of CRP in RT-related pain, particularly in obese breast cancer patients. Future larger studies are warranted to validate our findings and help guide RT decision-making processes and targeted interventions.

AB - Background: Post-surgery adjuvant radiotherapy (RT) significantly improves clinical outcomes in breast cancer patients; however, some patients develop cancer or treatment-related pain that negatively impacts quality of life. This study examined an inflammatory biomarker, C-reactive protein (CRP), in RT-related pain in breast cancer. Methods: During 2008 and 2014, breast cancer patients who underwent RT were prospectively evaluated for pre- and post-RT pain. Pre- and post-RT plasma CRP levels were measured using a highly sensitive CRP ELISA kit. Pain score was assessed as the mean of four pain severity items (i.e., pain at its worst, least, average, and now) from the Brief Pain Inventory. Pain scores of 4-10 were classified as clinically relevant pain. Multivariable logistic regression analyses were applied to ascertain the associations between CRP and RT-related pain. Results: In 366 breast cancer patients (235 Hispanic whites, 73 black/African Americans, and 58 non-Hispanic whites), 17% and 30% of patients reported pre- and post-RT pain, while 23% of patients had RT-related pain. Both pre- and post-RT pain scores differed significantly by race/ethnicity. In multivariable logistic regression analysis, RT-related pain was significantly associated with elevated pre-RT CRP (≥ 10 mg/L) alone (odds ratio (OR) = 2.44; 95% confidence interval (CI) = 1.02, 5.85); or combined with obesity (OR = 4.73; 95% CI = 1.41, 15.81) after adjustment for age and race/ethnicity. Conclusions: This is the first pilot study of CRP in RT-related pain, particularly in obese breast cancer patients. Future larger studies are warranted to validate our findings and help guide RT decision-making processes and targeted interventions.

KW - Breast cancer

KW - C-reactive protein

KW - Inflammatory biomarker

KW - Pain

KW - Radiotherapy

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U2 - 10.1186/s13058-019-1151-y

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