Association of patient-reported stress and pain with survival in nonmetastatic breast cancer: secondary analysis of Alliance A011502

The phase 3 Alliance A011502 trial, at 534 centers in the United States and Canada, randomized 3020 patients with high-risk nonmetastatic breast cancer 1:1 to receive 300 mg aspirin or placebo once daily for 5 years, with invasive disease-free survival (iDFS) as primary endpoint. The trial was terminated early because of lack of benefit from aspirin. Secondary analysis of the trial, evaluating the association of patient-reported stress and pain with survival, has now been published. Among 2763 women included in the analysis, high stress (Perceived Stress Scale) was associated with worse iDFS (aHR 2.22) and distant recurrence-free survival (DRFS; aHR 2.3). Moderate/severe pain (Brief Pain Inventory) predicted worse iDFS (aHR 1.67), DRFS (aHR 1.83), distant recurrence-free interval (aHR 1.53) and overall survival (aHR 2.21). The authors conclude the patient-reported outcomes may enhance risk stratification in survivorship care.