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Long-Term Patient-Reported Arm Symptoms in Breast Cancer Survivors

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Understanding long-term arm symptoms in breast cancer survivors is critical given excellent survival in the modern era.

Methods

This cross-sectional study included patients treated for stage 0–III breast cancer at our institution from 2002 to 2012. Patient-reported arm symptoms were collected from the EORTC QLQ-BR23 questionnaire. We used linear regression to evaluate adjusted associations between locoregional treatments and the continuous Arm Symptom (AS) score (0–100; higher score reflects more symptoms).

Results

A total of 1126 patients expressed interest in participating and 882 (78.3%) completed the questionnaire. Mean time since surgery was 10.5 years. There was a broad distribution of locoregional treatments, including axillary lymph node dissection (ALND) in 37.1% of patients, mastectomy with reconstruction in 36.5% of patients, and post-mastectomy radiation in 38.2% of patients. Overall, 64.3% (95% confidence interval [CI] 61.1–67.4%) of patients reported no arm symptoms, 17.0% (95% CI 14.7–19.6%) had one mild symptom, 9.4% (95% CI 7.7–11.5%) had two or more mild symptoms, and 9.3% (95% CI 7.6–11.4%) reported one or more severe symptoms. Adjusted AS scores were significantly higher with ALND versus sentinel node biopsy (β 3.5, p = 0.01), and with autologous reconstruction versus all other breast/reconstructive surgery types (β 4.5–5.5, all p < 0.05). There was a significant interaction between axillary and breast/reconstructive surgery, with the greatest effect of ALND in those with mastectomy with implant (β 9.7) or autologous (β 5.7) reconstruction.

Conclusions

One in three patients reported arm symptoms at a mean of 10 years from treatment for breast cancer, although rates of severe symptoms were low (<10%). Attention is warranted to the arm morbidity related to both axillary and breast surgery during treatment counseling and survivorship.

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References

  1. American Cancer Society Inc. Breast Cancer Statistics. Published 12 January 2022. https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html. Accessed 15 Jul 2022.

  2. Ong WL, Schouwenburg MG, van Bommel ACM, et al. A standard set of value-based patient-centered outcomes for breast cancer: the international consortium for health outcomes measurement (ICHOM) initiative. JAMA Oncol. 2017;3(5):677–85. https://doi.org/10.1001/JAMAONCOL.2016.4851.

    Article  PubMed  Google Scholar 

  3. Ashikaga T, Krag DN, Land SR, et al. Morbidity results from the NSABP B-32 trial comparing sentinel lymph node dissection versus axillary dissection. J Surg Oncol. 2010;102(2):111–8. https://doi.org/10.1002/JSO.21535.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Galimberti V, Cole BF, Viale G, et al. Axillary dissection versus no axillary dissection in patients with breast cancer and sentinel-node micrometastases (IBCSG 23–01): 10-year follow-up of a randomised, controlled phase 3 trial. Lancet Oncol. 2018;19(10):1385–93. https://doi.org/10.1016/S1470-2045(18)30380-2.

    Article  PubMed  Google Scholar 

  5. Lucci A, McCall LM, Beitsch PD, et al. Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011. J Clin Oncol. 2007;25(24):3657–63. https://doi.org/10.1200/JCO.2006.07.4062.

    Article  PubMed  Google Scholar 

  6. Fleissig A, Fallowfield LJ, Langridge CI, et al. Post-operative arm morbidity and quality of life. Results of the ALMANAC randomised trial comparing sentinel node biopsy with standard axillary treatment in the management of patients with early breast cancer. Breast Cancer Res Treat. 2006;95(3):279–93. https://doi.org/10.1007/S10549-005-9025-7.

    Article  PubMed  Google Scholar 

  7. del Bianco P, Zavagno G, Burelli P, et al. Morbidity comparison of sentinel lymph node biopsy versus conventional axillary lymph node dissection for breast cancer patients: results of the sentinella-GIVOM Italian randomised clinical trial. Eur J Surg Oncol. 2008;34(5):508–13. https://doi.org/10.1016/J.EJSO.2007.05.017.

    Article  PubMed  Google Scholar 

  8. Wetzig N, Gill PG, Espinoza D, et al. Sentinel-lymph-node-based management or routine axillary clearance? Five-year outcomes of the RACS sentinel node biopsy versus axillary clearance (SNAC) 1 trial: assessment and incidence of true lymphedema. Ann Surg Oncol. 2017;24(4):1064–70. https://doi.org/10.1245/S10434-016-5669-2.

    Article  PubMed  Google Scholar 

  9. 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(5):365–76. https://doi.org/10.1093/JNCI/85.5.365.

    Article  CAS  PubMed  Google Scholar 

  10. Fayers P, Aaronson N, Bjordal K, et al. The EORTC QLQ-C30 Scoring manual (3rd Edition). European Organisation for Research and Treatment of Cancer; 2001.

  11. Ousmen A, Conroy T, Guillemin F, et al. Impact of the occurrence of a response shift on the determination of the minimal important difference in a health-related quality of life score over time. Health Qual Life Outcomes. 2016. https://doi.org/10.1186/S12955-016-0569-5.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Reimer T, Stachs A, Veselinovic K, et al. Patient-reported outcomes for the Intergroup Sentinel Mamma study (INSEMA): a randomised trial with persistent impact of axillary surgery on arm and breast symptoms in patients with early breast cancer. EClinicalMedicine. 2022;55:101756. https://doi.org/10.1016/J.ECLINM.2022.101756.

    Article  PubMed  PubMed Central  Google Scholar 

  13. DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol. 2013;14(6):500–15. https://doi.org/10.1016/S1470-2045(13)70076-7.

    Article  PubMed  Google Scholar 

  14. Appelgren M, Sackey H, Wengström Y, et al. Patient-reported outcomes one year after positive sentinel lymph node biopsy with or without axillary lymph node dissection in the randomized SENOMAC trial. Breast. 2022;63:16–23. https://doi.org/10.1016/J.BREAST.2022.02.013.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Rosenberg SM, Dominici LS, Gelber S, et al. Association of breast cancer surgery with quality of life and psychosocial well-being in young breast cancer survivors. JAMA Surg. 2020;155(11):1035–42.

    Article  PubMed  Google Scholar 

  16. Mundy LR, Rosenberger LH, Rushing CN, et al. The evolution of breast satisfaction and well-being after breast cancer: a propensity-matched comparison to the norm. Plast Reconstr Surg. 2020;145(3):595–604.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Weichman KE, Hamill JB, Kim HM, et al. Understanding the recovery phase of breast reconstructions: patient-reported outcomes correlated to the type and timing of reconstruction. J Last Reconstr Aesthet Surg. 2015;68(10):1370–8.

    Article  Google Scholar 

  18. Sentinel Node Vs Observation After Axillary Ultra-souND. ClinicalTrials.gov. https://www.clinicaltrials.gov/ct2/show/NCT02167490. Accessed 20 Feb 2023.

  19. van Roozendaal LM, Vane MLG, van Dalen T, et al. Clinically node negative breast cancer patients undergoing breast conserving therapy, sentinel lymph node procedure versus follow-up: a Dutch randomized controlled multicentre trial (BOOG 2013–08). BMC Cancer. 2017. https://doi.org/10.1186/S12885-017-3443-X.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Jung JG, Ahn SH, Lee S, et al. No axillary surgical treatment for lymph node-negative patients after ultra-sonography [NAUTILUS]: protocol of a prospective randomized clinical trial. BMC Cancer. 2022;22(1):1–7. https://doi.org/10.1186/S12885-022-09273-1/FIGURES/2.

    Article  Google Scholar 

  21. Santosa KB, Qi J, Kim HM, et al. Long-term patient-reported outcomes in postmastectomy breast reconstruction. JAMA Surg. 2018;153(10):891–9. https://doi.org/10.1001/jamasurg.2018.1677.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Jagsi R, Momoh AO, Qi J, et al. Impact of radiotherapy on complications and patient-reported outcomes after breast reconstruction. J Natl Cancer Inst. 2018;110(2):157–65. https://doi.org/10.1093/jnci/djx148.

    Article  PubMed  Google Scholar 

  23. Imayama I, Alfano CM, Neuhouser ML, et al. Weight, inflammation, cancer-related symptoms and health related quality of life among breast cancer survivors. Breast Cancer Res Treat. 2013;140(1):159–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Bartels SAL, Donker M, Poncet C, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer: 10-year results of the randomized controlled EORTC 10981–22023 AMAROS trial. J Clin Oncol. 2023;41(12):2159–65. https://doi.org/10.1200/JCO.22.01565.

    Article  CAS  PubMed  Google Scholar 

  25. Sávolt Á, Péley G, Polgár C, et al. Eight-year follow up result of the OTOASOR trial: the optimal treatment of the axilla—surgery or radiotherapy after positive sentinel lymph node biopsy in early-stage breast cancer: a randomized, single centre, phase III, non-inferiority trial. Eur J Surg Oncol. 2017;43(4):672–9. https://doi.org/10.1016/j.ejso.2016.12.011.

    Article  PubMed  Google Scholar 

  26. Stafford AP, Hoskin TL, Day CN, Sanders SB, Boughey JC. Contemporary axillary management in cT1-2N0 breast cancer with one or two positive sentinel lymph nodes: factors associated with completion axillary lymph node dissection within the national cancer database. Ann Surg Oncol. 2022;29(8):4740–9. https://doi.org/10.1245/S10434-022-11759-Y.

    Article  PubMed  Google Scholar 

  27. Tinterri C, Gentile D, Gatzemeier W, et al. Preservation of axillary lymph nodes compared with complete dissection in T1–2 breast cancer patients presenting one or two metastatic sentinel lymph nodes: the SINODAR-ONE multicenter randomized clinical trial. Ann Surg Oncol. 2022;29(9):5732–44. https://doi.org/10.1245/S10434-022-11866-W.

    Article  PubMed  Google Scholar 

  28. de Boniface J, Frisell J, Andersson Y, et al. Survival and axillary recurrence following sentinel node-positive breast cancer without completion axillary lymph node dissection: the randomized controlled SENOMAC trial. BMC Cancer. 2017. https://doi.org/10.1186/S12885-017-3361-Y.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Goyal A, Mann GB, Fallowfield L, et al. POSNOC-POsitive Sentinel NOde: adjuvant therapy alone versus adjuvant therapy plus Clearance or axillary radiotherapy: a randomised controlled trial of axillary treatment in women with early-stage breast cancer who have metastases in one or two sentinel nodes. BMJ Open. 2021. https://doi.org/10.1136/BMJOPEN-2021-054365.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Axillary node dissection versus no dissection in breast cancer with positive sentinel lymph node. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT01717131. Accessed 20 Feb 2023.

  31. Gregorowitsch ML, Verkooijen HM, Houweling A, et al. Impact of modern-day axillary treatment on patient reported arm morbidity and physical functioning in breast cancer patients. Radiother Oncol. 2019;131:221–8. https://doi.org/10.1016/J.RADONC.2018.07.006.

    Article  PubMed  Google Scholar 

  32. Shaitelman SF, Chiang YJ, Griffin KD, et al. Radiation therapy targets and the risk of breast cancer-related lymphedema: a systematic review and network meta-analysis. Breast Cancer Res Treat. 2017;162(2):201–15. https://doi.org/10.1007/S10549-016-4089-0.

    Article  CAS  PubMed  Google Scholar 

  33. Kantor O, Means J, Grossmith S, et al. Optimizing axillary management in clinical T1–2N0 mastectomy patients with positive sentinel lymph nodes. Ann Surg Oncol. 2022;29(2):972–80. https://doi.org/10.1245/s10434-021-10726-3.

    Article  PubMed  Google Scholar 

  34. Tsangaris E, Edelen M, Means J, et al. User-centered design and agile development of a novel mobile health application and clinician dashboard to support the collection and reporting of patient-reported outcomes for breast cancer care. BMJ Surg Interv Health Technol. 2022;4(1):e000119. https://doi.org/10.1136/bmjsit-2021-000119.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgment

The authors would like to acknowledge Kaitlyn T. Bifolck, BA, for editorial and submission assistance in the preparation of this manuscript. She is a full-time employee of Dana-Farber Cancer Institute.

Funding

No sources of funding were used to assist in the preparation of this article.

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Authors and Affiliations

  1. Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Alison Laws MD, MPH, Samantha Grossmith MS, Elizabeth A. Mittendorf MD, PhD, MHCM, Tari A. King MD & Laura S. Dominici MD

  2. Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA

    Alison Laws MD, MPH, Melissa Hughes MSc, Nancy U. Lin MD, Elizabeth A. Mittendorf MD, PhD, MHCM, Tari A. King MD & Laura S. Dominici MD

  3. Harvard Medical School, Boston, MA, USA

    Alison Laws MD, MPH, Nancy U. Lin MD, Elizabeth A. Mittendorf MD, PhD, MHCM, Tari A. King MD & Laura S. Dominici MD

  4. Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands

    Mirelle Lagendijk MD

  5. Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    A. Heather Eliassen ScD

  6. Departments of Nutrition and Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA

    A. Heather Eliassen ScD

Authors
  1. Alison Laws MD, MPH
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Contributions

Conceptualization: AL, ML, TAK, LSD. Data curation: ML, SG, MH, AL, LSD. Formal Analysis: AL. Methodology: AL, ML, AHE, TAK, LSD. Project administration: SG, MH. Supervision: NUL, EAM, AHE, TAK, LSD. Writing—original draft: AL. Writing—review and editing: All authors

Corresponding author

Correspondence to Laura S. Dominici MD.

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Disclosure

Elizabeth A. Mittendorf reports compensated service on scientific advisory boards for Astra Zeneca, BioNTech and Merck; uncompensated service on steering committees for Bristol Myers Squibb and Roche/Genentech; speakers honoraria and travel support from Merck Sharp & Dohme; and institutional research support from Roche/Genentech (via an SU2C grant) and Gilead. She also reports research funding from Susan Komen for the Cure for which she serves as a Scientific Advisor, and uncompensated participation as a member of the American Society of Clinical Oncology Board of Directors. Tari A. King reports speakers honoraria and compensated service on the scientific advisory board of Exact Sciences (formerly Genomic Health); compensated service as faculty, PrecisCa cancer information service; and compensated service for a Global Advisory Board of Berins Healthcare. Alison Laws, Mirelle Lagendijk, Samantha Grossmith, Melissa Hughes, Nancy U. Lin, A. Heather Eliassen, and Laura S. Dominici report no conflicts of interest.

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Prior presentation: Presented in part at the Society of Surgical Oncology Annual Meeting in March 2022.

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Laws, A., Lagendijk, M., Grossmith, S. et al. Long-Term Patient-Reported Arm Symptoms in Breast Cancer Survivors. Ann Surg Oncol 31, 1623–1633 (2024). https://doi.org/10.1245/s10434-023-14711-w

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  • DOI: https://doi.org/10.1245/s10434-023-14711-w

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