Physical and psychosocial symptoms, such as pain, are common after breast cancer treatment is completed. “In some patients, pain becomes chronic, persisting for months or even years,” explains Yaël Slaghmuylder. “Unaddressed needs relating to this problem can cause severe disability and negatively impact well-being and quality of life. Because pain can become a problem that is complex and multidimensional, the prevention and treatment of chronic pain requires a biopsychosocial approach. However, effective and integrated implementation of biomedical and psychosocial interventions to manage chronic pain in breast cancer survivors (BCSs) is often lacking. To optimize patient care, a coordinated, holistic, and interdisciplinary response is needed from healthcare providers (HCPs) from multiple disciplines.”


Gaining Insight Into HCP Perceptions of Pain Prevention & Treatment

For a study published in PLoS One, Slaghmuylder and colleagues gathered HCPs’ perceptions of pain prevention and treatment in breast cancer follow-up care. Four online focus groups were conducted with 22 HCPs from different disciplines. “We wanted to gain a better insight into why some HCPs use a biopsychosocial approach to prevent and treat chronic pain in BCSs while others do not,” says Slaghmuylder.

The researchers identified various factors that influenced the prevention and treatment of chronic pain in breast cancer follow-up care relating to the awareness, knowledge, attitudes, beliefs, experiences, and intentions of HCPs. These factors were distinguished at multiple levels and cross-level relationships between factors were visualized in a causal loop diagram (Figure).


HCP Perceptions Influence Chronic Pain Prevention and Treatment in Breast Cancer Follow-Up

Results from the study showed that lack of knowledge and beliefs regarding chronic pain among HCPs were important factors in pain prevention and treatment in BCSs. “Our study highlights that the individual perceptions of HCPs can influence how chronic pain is managed during breast cancer follow-up,” Slaghmuylder says. “Most HCPs believed preventing and treating chronic pain was complex in BCSs and noted they were not always aware of the severity and impact of pain complaints after cancer treatment. HCPs often felt powerless and frustrated if they thought they couldn’t manage the survivor’s pain.”

According to Slaghmuylder, there may be misconceptions among HCPs that BCSs are difficult patients who complain a lot about pain or exaggerate their complaints. These misconceptions are especially prevalent when there is no personal match between the HCP and survivor. “As a result, HCPs might question the importance of treating pain in some BCSs,” says Slaghmuylder. “Additionally, HCPs attributed follow-up care shortcomings to a lack of time and existing solutions for pain. Some believed that a follow-up care trajectory includes fewer contact moments, making it impossible to build a trusting relationship with patients.”


Efforts Needed to Guide HCPs on Addressing Pain Complaints

Pain complaints are not always addressed or monitored in a standard way during breast cancer follow-up, says Slaghmuylder. “In some cases, survivors feel misunderstood or doubt the credibility of their pain complaints, which in turn can discourage them from reporting pain to HCPs,” she says. “Our findings emphasize the importance of HCPs recognizing their responsibilities and capabilities in pain management but also acknowledging the added value of involving other disciplines in follow-up care and referring patients when necessary.”

Slaghmuylder notes that one approach to addressing this issue could be HCPs supporting survivors in coping and accepting the consequences of pain rather than trying to solve the problem. “This may reduce feelings of frustration and powerlessness and can give HCPs confidence in their pain management approach,” she says. “Furthermore, BCSs often do not expect the HCP to offer a ready-made solution for their pain complaints, but they do want their pain acknowledged. Survivors feel validated, experience fewer prejudices, and feel hopeful and in control when their HCPs listen to pain complaints, show respect, and provide clear information.”

The study provides opportunities for developing and implementing interventions that target influencing factors in the prevention and treatment of chronic pain in breast cancer follow-up. “It’s important to address HCPs’ knowledge about chronic pain, but efforts are also needed to shift beliefs and behaviors regarding interdisciplinary collaboration,” Slaghmuylder says. “Future research should further explore beliefs and prejudices of HCPs regarding chronic pain to assess how they influence care for chronic pain in BCSs and explore how these beliefs change during interactions with patients, colleagues, and the healthcare system.”