Psychological factors influencing healthcare utilization in breast cancer survivors with pain

Abstract

Introduction Pain is a prevalent side effect seen in breast cancer survivors (BCS). Psychological factors are known role players in pain mechanisms. Both pain and psychological factors contribute to or interact with healthcare use (HCU). However, the association between psychological factors and HCU has never been investigated in BCS with pain, which is the aim of the present study.Methods Belgian BCS with pain (n = 122) were assessed via the Medical Consumption Questionnaire, the Injustice Experienced Questionnaire, the Pain Catastrophizing Scale, the Pain Vigilance and Awareness Questionnaire, the Brief Illness Perceptions Questionnaire, and the Depression, Anxiety, and Stress Scale. Associations were analyzed with logistic and Poisson regressions.Results Opioid use was related to more catastrophizing and less psychological distress. Psychotropic drug use was related to more psychological distress. Endocrine therapy was related to less vigilance and awareness. Psychological distress was related to all types of healthcare provider (HCP) visits, with psychological distress negatively related to physiotherapy, psychology, and other primary HCP visits, and positively related to visiting a general practitioner or secondary HCP. Catastrophizing was related to more visiting behavior to a primary HCP, except to a general practitioner. Perceived injustice was related to more general practitioner and other primary HCP visits but to fewer psychology visits. Illness perceptions were related only to visiting other primary HCPs. Vigilance and awareness were related to more psychologist and secondary HCP visits.Conclusion Our findings underscore the complex interplay between HCU and psychological factors in BCS with pain. Psychological distress was overall the most important psychological factor related to HCU, whether catastrophizing and perceived injustice were the most relevant related to HCP visits.