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Lymphedema, musculoskeletal events and arm function in older patients receiving adjuvant chemotherapy for breast cancer (Alliance A171302)

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Abstract

Purpose

Musculoskeletal events (MEs) resulting from breast cancer treatment can significantly interfere with the quality of life (QOL) of older adults. We evaluated the incidence of MEs in women 65 years and older who had surgery and adjuvant chemotherapy for breast cancer, and the impact of treatment on MEs and arm function.

Patients and methods

Patient-reported data in Alliance/CALGB 49907 were collected using the EORTC QLQ-BR23 and physician-reported adverse events to characterize self-reported MEs and incidence of lymphedema. EORTC QLQ-BR23 items related to musculoskeletal events were analyzed in this study and data collected at study entry (post-operative) and 12 and 24 months post-entry.

Results

Lymphedema, arm function, and ME data were available for 321 patients. One or more MEs were reported by 87% (median number = 3) and 64% (median number = 1) of patients post-operatively and at 24 months. At 24 months 2% had persistence of six MEs. Seventy-four percent experienced at least ≥3/6 types of MEs over the 24-month period. Detection of lymphedema at any time during the study was noted in 7.5% of the patients and appeared to be associated with the type of chemotherapy given: CMF 16.4%, capecitabine 5.8%, and AC 4%. Mastectomy and axillary node dissection were associated with the most MEs. LROM correlated with poorer arm function at all time periods.

Conclusion

Potentially debilitating MEs occur in three-fourths of elderly women undergoing standard therapy for breast cancer. Emphasis should be placed on prevention, identification, and treatment of these MEs to improve QOL.

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Funding

Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under the Award Number UG1CA189823 (Alliance for Clinical Trials in Oncology NCORP Grant), U10CA032291, U10CA047559, U10CA047577, U10CA077597, U10CA077651, U10CA180791, U10CA180838, U10CA180857, and U10CA180867. Supported, in part, by grants from the National Cancer Institute (U10CA031946 and U10CA033601), the National Institute on Aging (U10CA85850), the Breast Cancer Research Foundation, the Coalition of Cancer Cooperative Groups, and Roche Biomedical Laboratories. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Novant Health Forsyth Medical Center, 3333 Silas Creek Parkway, Winston-Salem, NC, 27103, USA

    Judith O. Hopkins

  2. Mayo Clinic, Alliance Statistics and Data Center, Rochester, MN, USA

    Jake Allred & Jacqueline M. Lafky

  3. Mayo Clinic, Rochester, MN, USA

    Jake Allred, Aminah Jatoi & Jacqueline M. Lafky

  4. City of Hope, Duarte, CA, USA

    Arti Hurria

  5. Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA

    Harvey Cohen

  6. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Clifford Hudis

  7. Dana-Farber/Partners CancerCare, Boston, MA, USA

    Eric Winer & Ann Partridge

  8. MedStar Georgetown University Hospital, Washington, DC, USA

    Jeanne Mandelblatt

  9. University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Lisa Carey & Hyman B. Muss

Authors
  1. Judith O. Hopkins
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  2. Jake Allred
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  3. Arti Hurria
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  4. Aminah Jatoi
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  5. Jacqueline M. Lafky
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  6. Harvey Cohen
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  7. Clifford Hudis
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  8. Eric Winer
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  9. Jeanne Mandelblatt
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  10. Ann Partridge
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  11. Lisa Carey
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  12. Hyman B. Muss
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Corresponding author

Correspondence to Judith O. Hopkins.

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Conflict of interest

The authors declare that they have no conflict of interest.

Appendix

Appendix

See Tables 6, 7 8, 9, 10, 11, 12.

Table 7 Limited range of motion
Full size table
Table 8 Breast swelling
Full size table
Table 9 Breast sensitivity
Full size table
Table 10 Breast pain
Full size table
Table 11 Arm/shoulder pain
Full size table
Table 12 Post op arm/shoulder pain versus breast pain
Full size table

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Hopkins, J.O., Allred, J., Hurria, A. et al. Lymphedema, musculoskeletal events and arm function in older patients receiving adjuvant chemotherapy for breast cancer (Alliance A171302). Breast Cancer Res Treat 166, 793–808 (2017). https://doi.org/10.1007/s10549-017-4454-7

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  • DOI: https://doi.org/10.1007/s10549-017-4454-7

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