Chronic post mastectomy pain in adult female patients at Aga Khan University Hospital Nairobi
Date of Award
Master of Medicine (MMed)
Dr Thikra Sharif
Prof. Ronald Wasike
Dr. Wangare Siika
Anaesthesiology (East Africa)
Introduction: Breast cancer is a major cause of morbidity and mortality worldwide among women. The improvement in diagnostic and treatment strategies has led to a larger number of survivors who have breast cancer. However, there are complications attributed to breast cancer treatments, including chronic post mastectomy pain (CPMP). CPMP causes physical, social, emotional and functional disability. Once established, it is difficult to treat and negatively impact quality of life of the affected patients. Despite the big number of patients with breast cancer who undergo mastectomy at AKUHN, the burden of CPMP and factors associated with it remain unknown.
Objectives: To determine the burden of CPMP and its associated risk factors in adult female patients at AKUHN.
Study design: A descriptive cross-sectional study.
Study setting: The AKUHN.
Study population: Female breast cancer patients who underwent mastectomy at AKUHN between January 2008 and December 2017.
Sampling process: Stratified sampling with subgroups based on year of surgery.
Sample size: Assuming a CPMP prevalence of 10% and an attrition rate of 10% in the study population, a sample of 370 patients would be required to detect an odds ratio of developing CPMP of 2.5 with a p-value< 0.05.
Statistical analysis: By the use of SPSS version20. The study outcome: A total of 480 patients’ contacts were successful, of which 49 declined the interview, 22 were deceased, while 409 patients were alive and responded to the study interview. The prevalence of PMCP was 14.4% with 9.3% who also had arm pain. The severity of pain was distributed as mild, moderate and severe at 55.9% (33), 40.7% (24) and 3.4% (2) respectively. The only predictor of CPMP which was statistically significant in this current study was age while the rest were not.
Conclusion: The prevalence of CPMP in the current study in our institution is relatively low compared to other studies. In the study, the only associated factor with CPMP that is statistically significant is age; which corresponds with the studies reviewed.
Recommendation: We recommend a closer follow up of patients under the age of fifty years as they are more prone to develop CPMP. We also recommend a multicenter study which will give a larger sample size with a population of diverse demographic profiles; subjected to different types and techniques of breast surgeries, different surgical set-ups; different post-operative care; and different post-operative pain management for a more conclusive outcome.
Mbete, J. O. (2019). Chronic post mastectomy pain in adult female patients at Aga Khan University Hospital Nairobi (Unpublished master's dissertation). Aga Khan University, East Africa.