Acute and chronic postoperative pain after breast cancer surgery: the UK Prevention of Shoulder Problems Trial (UK PROSPER) 

Authors: Bruce J, Mazuquin B, Mistry P, Williamson E, Lall R, Rees S, Withers E, Canaway A, Lamb S on behalf of PROSPER Study Group.  



Shoulder dysfunction and chronic pain following breast cancer treatment is common, impacting upon quality of life. Early postoperative exercise may improve function and reduce postoperative complications. We undertook a multicentre RCT to evaluate the clinical and cost-effectiveness of a supervised exercise programme, incorporating behavioural support, compared to usual care, for women at high risk of developing shoulder problems after breast cancer treatment.

Methods 
We randomised 392 women from 17 centres across England. The exercise intervention was delivered by physiotherapists. Follow-up was undertaken at 6 weeks, 6 and 12 months post-randomisation. Primary outcome of upper arm function was assessed using the Disabilities of the Arm Shoulder and Hand (DASH). We report secondary outcomes of acute and chronic pain, measured using VAS (0-10) and neuropathic pain (NeuP), using Doleur Neuropathique (DN4); and health-related quality of life (HRQoL) measured using the SF12 and EQ5D-5L. 

Results
Mean (SD) preoperative pain intensity scores were low (VAS 1.9 (2.5)), with 74 (21%) women reporting preoperative numbness and 33 (9%) being NeuP+ve. At six weeks, over half reported operative site numbness and 19% were NeuP+ve. Mean (SD) SF-12 physical and mental health component (PCS/MCS) scores improved over one year follow-up with differences found by treatment arm for physical HRQoL. Pain data by treatment arm over time will be presented. Findings from the UK PROSPER trial will provide evidence of whether supported exercise can improve the recovery trajectory for women at high risk of shoulder problems after breast cancer treatment.

05 - ACUTE AND CHRONIC POSTOPERATIVE PAIN AFTER BREAST CANCER SURGERY: THE UK PREVENTION OF SHOULDER PROBLEMS TRIAL (UK PROSPER)