Profile and Predictors of Long-term Morbidity in Breast Cancer Survivors
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
A sound understanding of the benefits of different treatment options and their health-related quality of life (HRQoL) impacts is required for optimal breast cancer care.
A cross-sectional cohort study was conducted to determine the prevalence and severity of persistent functional decrements and symptoms and identify demographic, clinical and treatment variables associated with poorer outcomes. Four hundred English-speaking women treated for ductal carcinoma-in-situ or stage I to III breast cancer between 1999 and 2009, at least 12 months after surgery and currently disease free, were randomly selected and invited to complete (1) the Breast Cancer Treatment Outcome Scale and (2) the EORTC core Quality of Life Questionnaire, version 3.
The response rate was 85.60 %. Many participants reported moderate to severe decrements in a number of HRQoL domains, including functional well-being (15 %), cosmetic status (32 %) and overall quality of life (21 %). There were significant associations (p < .05) between younger age and poorer HRQoL but none between time since surgery and morbidity (p > .05). Different treatments were associated with different HRQoL impacts. Poorer functional status was predicted by axillary dissection (p = .011), and adjuvant radiotherapy was a significant predictor of breast-specific pain (p < .05).
Many breast cancer survivors report long-term morbidity that is unaffected by time since surgery. The significant associations between the extent of locoregional therapies and poorer HRQoL outcomes emphasize the importance of the safe tailoring of these treatments.
- Ganz PA, Kwan L, Stanton AL, et al. Physical and psychosocial recovery in the year after primary treatment of breast cancer. J Clin Oncol. 2011;29:1101–9. CrossRef
- Back M, Ahern V, Delaney G, et al. Absence of adverse early quality of life outcomes of radiation therapy in breast conservation therapy for early breast cancer. Australas Radiol. 2005;49:39–43. CrossRef
- Hurria A, Hurria A, Zuckerman E, et al. A prospective, longitudinal study of the functional status and quality of life of older patients with breast cancer receiving adjuvant chemotherapy. J Am Geriatr Soc. 2006;54:1119–24. CrossRef
- Hürny C, Bernhard J, Coates AS, et al. Impact of adjuvant therapy on quality of life in women with node-positive operable breast cancer. International Breast Cancer Study Group. Lancet. 1996;347:1279.
- Vilholm OJ, Cold S, Rasmussen L, Sindrup SH. The postmastectomy pain syndrome: an epidemiological study on the prevalence of chronic pain after surgery for breast cancer. Br J Cancer. 2008;99:604–10. CrossRef
- Janni W, Rjosk D, Dimpfl TH, et al. Quality of life influenced by primary surgical treatment for stage I–III breast cancer—long-term follow-up of a matched-pair analysis. Ann Surg Oncol. 2001;8:542–8.
- Arndt V, Merx H, Sturmer T, et al. Age-specific detriments to quality of life among breast cancer patients one year after diagnosis. Eur J Cancer. 2004;40:673–80. CrossRef
- Arndt V, Stegmaier C, Ziegler H, Brenner H. Quality of life over 5 years in women with breast cancer after breast-conserving therapy versus mastectomy: a population-based study. J Cancer Res Clin Oncol. 2008;134:1311–8. CrossRef
- Crane-Okada R, Wascher RA, Elashoff D, Giuliano AE. Long-term morbidity of sentinel node biopsy versus complete axillary dissection for unilateral breast cancer. Ann Surg Oncol. 2008;15:1996–2005. CrossRef
- Gartner R, Jensen MB, Nielsen J, et al. Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA. 2009;302:1985. CrossRef
- Heil J, Czink E, Golatta M, et al. Change of aesthetic and functional outcome over time and their relationship to quality of life after breast conserving therapy. Eur J Surg Oncol. 2011;37:116–21. CrossRef
- Kudel I, Edwards RR, Kozachik S, et al. Predictors and consequences of multiple persistent postmastectomy pains. J Pain Symptom Manage. 2007;34:619–27. CrossRef
- Montazeri A, Vahdaninia M, Harirchi I, et al. Quality of life in patients with breast cancer before and after diagnosis: an eighteen months follow-up study. BMC Cancer. 2008;8:330. CrossRef
- Cocks K, King M, Velikova G, et al. Evidence-based guidelines for determination of sample size and interpretation of the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30. J Clin Oncol. 2011;29:89. CrossRef
- Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30—a quality of life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365–76. CrossRef
- Stanton AL, Krishnan L, Collins CA. Form or function? Part 1. Subjective cosmetic and functional correlates of quality of life in women treated with breast-conserving surgical procedures and radiotherapy. Cancer. 2001;91:2273–81. CrossRef
- Fayers PM, Aaronson NK, Bjordal K, et al. The EORTC QLQ-C30 scoring manual. Brussels: European Organisation for Research and Treatment of Cancer; 2001.
- Land S, Kopec J, Julian T, et al. Patient-reported outcomes in sentinel node-negative adjuvant breast cancer patients receiving sentinel-node biopsy or axillary dissection: National Surgical Adjuvant Breast and Bowel Project phase III protocol B-32. J Clin Oncol. 2010;28:3929. CrossRef
- Cohen J. Statistical power analysis for the behavioral sciences. Hillside, NJ: Lawrence Erlbaum Associates; 1988.
- Hjermstad MJ, Fayers PM, Bjordal K, Kaasa S. Health-related quality of life in the general Norwegian population assessed by the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire: the QLQ = C30 (+3). J Clin Oncol. 1998;16:1188–96.
- Cohen J, Cohen P, West SG, Aiken LS. Applied multiple regression/correlation analysis for the behavioral sciences. Mahwah: Lawrence Erlbaum Associates; 2003.
- Arndt V, Merx H, Stegmaier C, et al. Persistence of restrictions in quality of life from the first to the third year after diagnosis in women with breast cancer. J Clin Oncol. 2005;23:4945–53. CrossRef
- Freedman G, Li T, Anderson P, et al. Health states of women after conservative surgery and radiation for breast cancer. Breast Cancer Res Treat. 2010;121:519. CrossRef
- Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305:569–75. CrossRef
- Pazaiti A, Fentiman IS. Which patients need an axillary clearance after sentinel node biopsy? Int J Breast Cancer. 2011. doi:10.4061/2011/195892.
- Darby S, McGale P, Correa C, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378:1707–16. CrossRef
- Hughes KS, Schnaper LA, Berry D, et al. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med. 2004;351:971–7. CrossRef
- Hughes LL, Wang M, Page DL, et al. Local excision alone without irradiation for ductal carcinoma in situ of the breast: a trial of the Eastern Cooperative Oncology Group. J Clin Oncol. 2009;27:5319–24. CrossRef
- Fisher B, Bryant J, Dignam JJ, et al. Tamoxifen, radiation therapy, or both for prevention of ipsilateral breast tumor recurrence after lumpectomy in women with invasive breast cancers of one centimeter or less. J Clin Oncol. 2002;20:4141–9. CrossRef
- Fyles AW, McCready DR, Manchul LA, et al. Tamoxifen with or without breast irradiation in women 50 years of age or older with early breast cancer. N Engl J Med. 2004;351:963–70. CrossRef
- Wapnir IL, Dignam JJ, Fisher B, et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst. 2011;103:478–88. CrossRef
- Profile and Predictors of Long-term Morbidity in Breast Cancer Survivors
Annals of Surgical Oncology
Volume 20, Issue 11 , pp 3453-3460
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
- 2. Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
- 3. Royal Women’s Hospital Breast Service, The University of Melbourne, Parkville, VIC, Australia