The voices of breast cancer survivors with chronic pain: A qualitative thematic analysis of patients’ challenges to pain management

Abstract Purpose: Breast cancer survivors commonly experience chronic pain following surgery. Despite the existence of treatment guidelines for cancer pain, a significant number of patients do not achieve satisfactory relief with available therapies. To fill this gap, this study aimed to explore the experience of chronic pain further, focusing on needs and obstacles related to its management in breast cancer survivors. Methods: We conducted four focus groups with 17 breast cancer patients (Mage=51, SD=7.99) with chronic pain from mild to severe intensity. The focus groups were audio-recorded, transcribed verbatim and analyzed through qualitative thematic analysis. Results: The thematic analysis of the focus group discussions identified three key themes: (1) The challenges to pain management (with subthemes: (1.1) “Doctor-patients communications barriers” and (1.2) “Contextual and societal barriers”); (2) The self-management needs (subthemes: (2.1) “Psycho-social support”, (2.2) “Care-related needs”, and (2.3) “Shared decision-making”); (3) Treatment preferences and perceptions of pain management (subthemes: (3.1) "Treatment preferences", (3.2) "Institution preference", and (3.3) "Decision role perception”). Conclusions: This study emphasizes the interconnectedness of challenges, self-management needs, and treatment preferences in managing chronic breast cancer pain. It highlights the importance of addressing patients' reluctance to report pain, the normalization of pain, and the role of health providers' attitudes. These findings aid the development of personalized support systems to enhance breast cancer pain management and improve cancer survivors' quality of life. Healthcare provider education, multidisciplinary and biopsychosocial approaches, and the use of eHealth tools are highlighted as important factors in achieving better pain management outcomes.