The impact of breast cosmetic and functional outcomes on quality of life: long-term results from the St. George and Wollongong randomized breast boost trial


The aims of this study were to evaluate the impact of cosmetic and functional outcomes after breast-conserving surgery (BCS) and radiation on quality of life (QOL). In this exploratory analysis; baseline, 5 and 10 years data of patient’s assessment of breast cosmesis, arm swelling/pain, limitation of movement, loss of feeling in fingers and breast sensitivity/tenderness were dichotomized and their impact on QOL (QLQ-C30) were assessed. Multivariable modelling was also performed to assess associations with QOL. The St. George and Wollongong randomized trial randomized 688 patients into the boost and no boost arms. 609, 580, and 428 patients had baseline, 5 and 10 years cosmetic data available, respectively. Similar numbers had the various functional assessments in the corresponding period. By univariate analysis, cosmesis and a number of functional outcomes were highly associated with QOL. Adjusted multivariate modelling showed that cosmesis remained associated with QOL at 5 and 10 years. Breast sensitivity, arm pain, breast separation, age and any distant cancer event were also associated with QOL on multivariate modelling at 10 years. This study highlights the importance of maintaining favorable cosmetic and functional outcomes following BCS. In addition, the clinically and statistically significant relationship between functional outcomes and QOL shows the importance for clinicians and allied health professionals in identifying, discussing, managing, and limiting these effects in women with breast cancer in order to maintain QOL.

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  1. 1.

    Nano MT, Gill PG, Kollias J, Bochner MA, Malycha P, Winefield HR (2005) Psychological impact and cosmetic outcome of surgical breast cancer strategies. ANZ J Surg 75(11):940–947

  2. 2.

    Al-Ghazal SK, Fallowfield L, Blamey RW (2000) Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction. Eur J Cancer 36(15):1938–1943

  3. 3.

    Moyer A (1997) Psychosocial outcomes of breast-conserving surgery versus mastectomy: a meta-analytic review. Health Psychol 16(3):284–298

  4. 4.

    Pusic A, Thompson TA, Kerrigan CL, Sargeant R, Slezak S, Chang BW, Kelzlsouer KJ, Manson PN (1999) Surgical options for the early-stage breast cancer: factors associated with patient choice and postoperative quality of life. Plast Reconstr Surg 104(5):1325–1333

  5. 5.

    Curran D, van Dongen JP, Aaronson NK, Kiebert G, Fentiman IS, Mignolet F, Bartelink H (1998) Quality of life of early-stage breast cancer patients treated with radical mastectomy or breast-conserving procedures: results of EORTC Trial 10801. The European Organization for Research and Treatment of Cancer (EORTC), Breast Cancer Co-operative Group (BCCG). Eur J Cancer 34(3):307–314

  6. 6.

    de Haes JC, van Oostrom MA, Welvaart K (1986) The effect of radical and conserving surgery on the quality of life of early breast cancer patients. Eur J Surg Oncol 12(4):337–342

  7. 7.

    Ganz PA, Schag AC, Lee JJ, Polinsky ML, Tan SJ (1992) Breast conservation versus mastectomy. Is there a difference in psychological adjustment or quality of life in the year after surgery? Cancer 69(7):1729–1738

  8. 8.

    Montazeri A (2008) Health-related quality of life in breast cancer patients: a bibliographic review of the literature from 1974 to 2007. J Exp Clin Cancer Res 27:32

  9. 9.

    Waljee JF, Hu ES, Ubel PA, Smith DM, Newman LA, Alderman AK (2008) Effect of esthetic outcome after breast-conserving surgery on psychosocial functioning and quality of life. J Clin Oncol 26(20):3331–3337

  10. 10.

    Graham P, Browne L, Capp A, Fox C, Delaney G, Kearsley H, Millar E, Nasser E, Papadatos G (2010) Randomized trial shows reduced whole breast dose negates benefit of lumpectomy radiotherapy boost. Radioth Oncol 96(Suppl 1):S145

  11. 11.

    Graham P, Capp A, Fox C, Nasser E, Delaney G, Ahern V, Wratten C (2003) Why a breast boost should remain a controversial aspect of routine breast conservation management in Australia and New Zealand in 2002. Australas Radiol 47(1):44–49

  12. 12.

    Hau E, Browne LH, Khanna S, Cail S, Cert G, Chin Y, Clark C, Inder S, Szwajcer A, Graham PH (2012) Radiotherapy breast boost with reduced whole-breast dose is associated with improved cosmesis: the results of a comprehensive assessment from the St. George and Wollongong randomized breast boost trial. Int J Radiat Oncol Biol Phys 82(2):682–689

  13. 13.

    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC et al (1993) 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 85(5):365–376

  14. 14.

    Bland M (2000) An introduction to medical statistics, 3rd edn. Oxford University Press, Oxford

  15. 15.

    Patterson MP, Pezner RD, Hill LR, Vora NL, Desai KR, Lipsett JA (1985) Patient self-evaluation of cosmetic outcome of breast-preserving cancer treatment. Int J Radiat Oncol Biol Phys 11(10):1849–1852

  16. 16.

    Hopwood P, Haviland JS, Sumo G, Mills J, Bliss JM, Yarnold JR (2010) Comparison of patient-reported breast, arm, and shoulder symptoms and body image after radiotherapy for early breast cancer: 5 year follow-up in the randomised standardisation of breast radiotherapy (START) trials. Lancet Oncol 11(3):231–240

  17. 17.

    Osoba D, Rodrigues G, Myles J, Zee B, Pater J (1998) Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol 16(1):139–144

  18. 18.

    King MT (1996) The interpretation of scores from the EORTC quality of life questionnaire QLQ-C30. Qual Life Res 5(6):555–567

  19. 19.

    Heil J, Czink E, Golatta M, Schott S, Hof H, Jenetzky E, Blumenstein M, Maleika A, Rauch G, Sohn C (2011) Change of aesthetic and functional outcome over time and their relationship to quality of life after breast conserving therapy. Eur J Surg Oncol 37(2):116–121

  20. 20.

    Nesvold IL, Reinertsen KV, Fossa SD, Dahl AA (2011) The relation between arm/shoulder problems and quality of life in breast cancer survivors: a cross-sectional and longitudinal study. J Cancer Surviv 5(1):62–72

  21. 21.

    Stanton AL, Krishnan L, Collins CA (2001) 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 91(12):2273–2281

  22. 22.

    Krishnan L, Stanton AL, Collins CA, Liston VE, Jewell WR (2001) Form or function? Part 2. Objective cosmetic and functional correlates of quality of life in women treated with breast-conserving surgical procedures and radiotherapy. Cancer 91(12):2282–2287

  23. 23.

    Ashikaga T, Krag DN, Land SR, Julian TB, Anderson SJ, Brown AM, Skelly JM, Harlow SP, Weaver DL, Mamounas EP et al (2010) Morbidity results from the NSABP B-32 trial comparing sentinel lymph node dissection versus axillary dissection. J Surg Oncol 102(2):111–118

  24. 24.

    Deutsch M, Flickinger JC (2003) Patient characteristics and treatment factors affecting cosmesis following lumpectomy and breast irradiation. Am J Clin Oncol 26(4):350–353

  25. 25.

    Wazer DE, DiPetrillo T, Schmidt-Ullrich R, Weld L, Smith TJ, Marchant DJ, Robert NJ (1992) Factors influencing cosmetic outcome and complication risk after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol 10(3):356–363

  26. 26.

    Barnett GC, Wilkinson JS, Moody AM, Wilson CB, Twyman N, Wishart GC, Burnet NG, Coles CE (2011) The Cambridge breast intensity-modulated radiotherapy Trial: patient-and treatment-related factors that influence late toxicity. Clin Oncol (R Coll Radiol) 23(10):662–673

  27. 27.

    Barnett GC, Wilkinson JS, Moody AM, Wilson CB, Twyman N, Wishart GC, Burnet NG, Coles CE (2012) Randomized controlled trial of forward-planned intensity modulated radiotherapy for early breast cancer: interim results at 2 years. Int J Radiat Oncol Biol Phys 82(2):715–723

  28. 28.

    Deshields TL, Reschke A, Walker MS, Brewer A, Taylor M (2007) Psychological status at time of diagnosis and patients’ ratings of cosmesis following radiation therapy for breast cancer. J Psychosoc Oncol 25(2):103–116

  29. 29.

    Charles C, Gafni A, Whelan T (1997) Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med 44(5):681–692

  30. 30.

    NHMRC/NBCC: National Breast Cancer Centre and National Cancer Control Initiative (2003) National guidelines for the psychosocial care of adults with cancer. NBCC, Camperdown

  31. 31.

    Charles C, Whelan T, Gafni A (1999) What do we mean by partnership in making decisions about treatment? BMJ 319(7212):780–782

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Conflict of interest


Ethical standard

Ethics approval was obtained for the St George and Wollongong Randomized Trial. The trial is registered with (NCT00138814).

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Correspondence to Eric Hau.

Additional information

Annual scientific meeting in Cairns, Australia as poster presentation in July 2012.

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Hau, E., Browne, L., Capp, A. et al. The impact of breast cosmetic and functional outcomes on quality of life: long-term results from the St. George and Wollongong randomized breast boost trial. Breast Cancer Res Treat 139, 115–123 (2013).

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  • Breast cancer
  • Cosmesis
  • Functional outcome
  • Quality of life