Pain Catastrophizing as a Predictor of Shoulder Dysfunction and Lymphedema in Geriatric Breast Cancer Survivors

Background: Modified radical mastectomy (MRM) for breast cancer is associated with psychological and physicals equelae, including pain catastrophizing, depression, pain interference, shoulder mobility impairments, and lymphedema. This study investigates their longitudinal associations in geriatric patients over 60 months. Methods: In this retrospective cohort study, 89 geriatric women (medianage = 72, SD = 4.5, range = 65–88) who underwent MRM were assessed at baseline (pre-surgery), 1, 3, post-radiotherapy 2nd month, and 12, 24, 36, 48, and 60 months post-surgery. Pain Catastrophizing Scale (PCS), Geriatric Depression Scale (GDS), Brief Pain Inventory (BPI) interference scores, shoulder range of motion (ROM) differences (flexion and abduction), and lymphedema severity (from 3 months on ward using the Frustum formulaand ISL staging) were measured. Patients were stratified into high (PCS ≥ 25) and low (PCS < 25) pain catastrophizing groups based on baseline PCS median. Spearman correlations, Wilcoxon signed-ranktests, Mann-Whitney U tests, and Fisher’s exact tests analyzed associations and group differences. Results: Strong correlations existed between PCS, GDS, and BPI acrossall time points (ρ = 0.911–1.000, p < 0.001), peaking at 12 months (PCS vs. BPI: ρ = 1.000, p < 0.001). Shoulder ROM differences correlated with PCS, GDS, and BPI from 1 month (ρ = 0.864–0.939, p < 0.001), peaking at 24 months. Lymphedema correlated moderately with PCS, GDS, BPI, and ROM differences at 3 months (ρ = 0.443–0.516, p < 0.001), strengthening by 24–36 months (ρ = 0.687–0.803, p < 0.001). High PCS patients had worse outcomes (p < 0.05). Conclusions: Persistent associations between pain catastrophizing, depression, shoulder dysfunction, and lymphedema under score its critical role as a predictor. Patients should be evaluated and managed based on pain catastrophizing levels to optimize outcomes in geriatric breast cancer survivors.