Engaging patient partners in systematic reviews: the example of prevalence of persistent postsurgical pain after breast cancer surgery

Tags: Oral
Wang L1, Cohen J2, Devasenapathy N3, Hong B4, Kheyson S5, Lu D2, Oparin Y2, Kennedy S6, Romerosa B7, Couban R1, Busse J1
1Department of Anesthesia, McMaster University, 2Michael G. DeGroote School of Medicine, McMaster University, 3Indian Institute of Public Health, Delhi, 4Division of Plastic Surgery, University of Toronto, 5Department of Family Medicine, Cumming School of Medicine, 6Department of Medical Imaging, University of Toronto, 7Department of Anesthesia and Critical Care, University Hospital of Toledo

Background:

Persistent postsurgical pain (PPSP) is common after breast cancer surgery; however, the reported prevalence varies widely. Some of the variability in the estimates of PPSP after breast cancer surgery is likely due to how pain is reported (e.g. severity, location). We conducted a systematic review to inform this uncertainty and engaged patient partners to help design our protocol.

Objectives:

We aimed to engage patient partners, who were breast cancer survivors, to guide the approach and interpretation of a systematic review regarding the prevalence of PPSP after breast cancer surgery.

Methods:

Patient partners were involved in the design and interpretation of the systematic review. We searched MEDLINE, EMBASE, CINAHL, and PsycINFO from inception to November 2018, for observational studies reporting the prevalence of PPSP (≥3 months) after breast cancer surgery. We used random-effects meta-analysis and multivariable meta-regression for PPSP prevalence based on patient’s preference. The GRADE approach was used to rate quality of evidence, and our patient partners defined a patient-important threshold for the risk of persistent pain for assessing imprecision.

Results:

There were 146 observational studies (137,675 patients) eligible for review that reported the prevalence of PPSP (ranging from 2% to 78%). The pooled prevalence of PPSP of any severity was 35% (95% CI 32% - 39%). Moderate-quality evidence supported subgroup effects of PPSP prevalence for localized pain vs. any pain (29% vs. 44%), moderate or greater vs. any pain (26% vs. 44%), and clinician-assessed vs. patient-reported pain (23% vs. 36%) (Figure 1, Table 1). Two breast cancer patients were involved in this review; both endorsed that PPSP should be based on patient report, and in any location, but were divided on whether ‘any pain’ or ‘moderate-to-severe pain’ was most important. Based on patients’ preference, multivariable meta-regression found the prevalence of patient-reported PPSP following breast cancer surgery of any severity or location was 46% (95% CI 36% - 56%), and the prevalence of patient-reported moderate-to-severe PPSP at any location was 27% (95% CI 10% - 43%) (Table 2). Our patient partners suggested the following rates of PPSP as important: 20% for any pain, 10% for moderate pain, and 5% for severe pain.

Conclusions:

Moderate-quality evidence suggests almost half of all women undergoing breast cancer surgery develop PPSP, and approximately one in four develop moderate to severe PPSP. Involvement of patient partners in the design of systematic reviews may help ensure that results are reported in a way that is most helpful to patients.

Patient or healthcare consumer involvement:

Patient partners were involved in the design and interpretation of systematic reviews.