Abstract PS1-03-07: The association between adverse childhood events and pain, subjective cognitive decline and psychosocial distress over time in patients treated for early breast cancer

Abstract Background: Chronic pain, subjective cognitive decline (SCD) and psychosocial distress (PD) are reported by > 40-60 % of patients recovering from breast cancer (BC). We previously reported that adverse childhood experiences (ACEs) are associated with increased pain and SCD before treatment. The effect of ACEs on pain and SCD during follow up has not been explored. Methods: We are conducting a prospective study to assess if ACEs increase chronic adverse effects in patients with localized BC and identify mediating mechanisms. Patients with stage I-III BC, age 18-75 without a history of prior cancer are recruited before starting (neo)adjuvant oncological treatment and assessed every 6 months by validated questionnaires, including ACEs, the brief pain inventory, FACT-COG and FACT-ES (measuring PD). Blood samples for inflammatory biomarkers are stored. This sub-study tested if ACEs are associated with pain, measured as a composite of pain intensity and interference, SCD and PD 6 months after treatment initiation, and with changes in these symptoms over time. Results: This sub-study included 116 patients with data collected 6 months from treatment initiation. Missing data ranged from 0.9% (n = 1) in ACEs to 9.5% (n = 11) in PD at 6 months and were imputed using the expectation maximization algorithm, as data were missing completely at random, Little's MCAR test (229) = 242.51, p = .258. Of study participants, 68.1% were treated with chemotherapy, 62.9% had an academic degree, and 97.4% were employed prior to diagnosis. Univariate analysis did not detect an association between demographic or treatment factors and outcomes at 6 months (p’s > .14). Correlation analyses indicated that a higher number of ACEs was associated with more pain, SCD, and PD across time points (r range = .19 - .31, ps = < .048). A repeated-measures MANCOVA followed by Univariate analyses was conducted to examine changes over time in pain, SCD, and PD. Analyses included the number of ACEs (as a covariate), chemotherapy status (between-subjects variable), and time (within-subjects variable). The multivariate effect of time was significant, indicating that patients’ functioning declined over the 6 months, [Wilk’s lambda = .95, F (3,111) = 6.80, p < .001, partial η2 = .16]. Specifically, pain [F (1,113) = 4.59, p = .034, partial η2 = .04] and SCD [F (1,113) = 16.14, p < .001, partial η2 = .13], but not PD [F (1,113) = 3.24, p = .074, partial η2 = .03], increased between baseline and 6 months. ACEs had a significant main effect, F (3,111) = 4.81, p = .003, partial η2 = .12. , and a higher number of ACEs was associated with worse pain, higher SCD, and higher PD on both timepoints [F pain (1,113) = 13.43, p = .009, partial η2 = .11; F SCD (1,113) = 6.97, p = .009, partial η2 = .06; and F PD (1,113) = 7.96, p = .006, partial η2 = .07]. The interaction between time and ACEs was not significant (p = .210) As expected, the interaction between time and chemotherapy was significant [F (3,111) = 3.50, p = .018, partial η2 = .09; Univarite F’s (1, 113) > 4.14, p’s < 0.019, partial η2’s > .03]. Conclusion: Increasing numbers of ACEs predicts poor functioning of BC patients in terms of pain, SCD, and PD across the first 6 months post-diagnosis. Citation Format: A. Alpert, E. Sher-Cenzor, M. Makarov, A. Shai. The association between adverse childhood events and pain, subjective cognitive decline and psychosocial distress over time in patients treated for early breast cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS1-03-07.