Social Disparities of Pain and Pain Intensity Among Women Diagnosed With Early Stage Breast Cancer

Hyo Young Choi; Ilana Graetz; Arash Shaban-Nejad; Lee Schwartzberg; Gregory Vidal; Robert Lowell Davis; Eun Kyong Shin

doi:10.3389/fonc.2022.759272

Social Disparities of Pain and Pain Intensity Among Women Diagnosed With Early Stage Breast Cancer

Front Oncol. 2022 Feb 8:12:759272. doi: 10.3389/fonc.2022.759272. eCollection 2022.

Authors

Hyo Young Choi^{1

2}, Ilana Graetz³, Arash Shaban-Nejad⁴, Lee Schwartzberg^{2

5

6}, Gregory Vidal⁵, Robert Lowell Davis⁴, Eun Kyong Shin⁷

Affiliations

¹ Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, United States.
² Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States.
³ Department of Health Policy & Management, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
⁴ UTHSC-Oak Ridge National Lab (ORNL) Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States.
⁵ West Cancer Center, Memphis, TN, United States.
⁶ Department of Hematology/Oncology, University of Tennessee Health Science Center, Memphis, TN, United States.
⁷ Department of Sociology, Korea University, Seoul, South Korea.

Abstract

Background: Breast cancer is one of the most commonly diagnosed cancers among women in the United States and pain is the most common side effect of breast cancer and its treatment. Yet, the relationships between social determinants of pain and pain experience/intensity remain under-investigated. We examined the associations between social determinants of pain both at the individual level and the neighborhood level to understand how social conditions are associated with pain perception among early stage breast cancer patients.

Methods: We conducted integrated statistical analysis of 1,191 women with early stage breast cancer treated at a large cancer center in Memphis, Tennessee. Combining electronic health records, patient-reported data and census data regarding residential address at the time of first diagnosis, we evaluated the relationships between social determinants and pain perception. Pain responses were self-reported by a patient as a numerical rating scale score at the patient's initial diagnosis and follow-up clinical visits. We implemented two sets of statistical analyses of the zero-inflated Poisson model and estimated the associations between neighborhood poverty prevalence and breast cancer pain intensity. After adjustment for demographic characteristics, cancer stage, and chemotherapy, pain perception was significantly associated with poverty and blight level of the neighborhood.

Results: Among women living in the highest-poverty areas, the odds of reporting pain were 2.48 times higher than those in the lowest-poverty area. Women living in the highest-blight area had 5.43 times higher odds of reporting pain than those in the lowest-blight area. Neighborhood-level social determinants were significantly associated with pain intensity among women diagnosed with early-stage breast cancer.

Conclusions: Distressed neighborhood conditions are significantly associated with higher pain perception. Breast cancer patients living in socio-economically disadvantaged neighborhoods and in poor environmental conditions reported higher pain severity compared to patients from less distressed neighborhoods. Therefore, post-diagnosis pain treatment design needs to be tailored to the social determinants of the breast cancer patients.

Keywords: breast cancer; cancer disparities; pain treatment; social determinants of health; social epidemiology.