J Reconstr Microsurg 2016; 32(06): 484-490
DOI: 10.1055/s-0036-1572538
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Quality of Life in Patients with Breast Cancer–Related Lymphedema and Reconstructive Breast Surgery

Tiara R. Lopez Penha
1   Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
,
Bente Botter
1   Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
,
Esther M. Heuts
2   Department of General Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
,
Adri C. Voogd
3   Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
,
Maarten F. von Meyenfeldt
2   Department of General Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
,
René R. van der Hulst
1   Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
› Author Affiliations
Further Information

Publication History

23 August 2015

21 December 2015

Publication Date:
26 February 2016 (online)

Abstract

Background To evaluate the quality of life (QOL) of breast cancer survivors who have undergone breast reconstruction and have breast cancer–related lymphedema (BCRL).

Methods Patients with a unilateral mastectomy with or without breast reconstruction were evaluated for BCRL and their QOL. Patients were divided into a non-BCRL and a BCRL group. Patients with subjective complaints of arm swelling and/or an interlimb volume difference of >200 mL, or undergoing treatment for arm lymphedema were defined as having BCRL. QOL was assessed using cancer-specific (EORTC QLQ-C30 and EORTC QLQ-B23) and disease specific (Lymph-ICF) questionnaires.

Results In total, 253 patients with a mean follow-up time of 51.7 (standard deviation = 18.5) months since mastectomy completed the QOL questionnaires. Of these patients, 116 (46%) underwent mastectomy alone and 137 (54%) had additional breast reconstruction. A comparison of the QOL scores of 180 patients in the non-BCRL group showed a significantly better physical function (p = 0.004) for patients with reconstructive surgery compared with mastectomy patients. In the 73 patients with BCRL, a comparison of the QOL scores showed no significant differences between patients with mastectomy and reconstructive surgery. After adjusting for potential confounders, multivariate analysis showed a significant impact of BCRL on physical function (β =  − 7.46; p = 0.009), role function (β =  − 15.75; p = 0.003), cognitive function (β =  − 11.56; p = 0.005), body vision (β =  − 11.62; p = 0.007), arm symptoms (β = 20.78; p = 0.000), and all domains of the Lymph-ICF questionnaire.

Conclusions This study implies that BCRL has a negative effect on the QOL of breast cancer survivors, potentially negating the positive effects on QOL reconstructive breast surgery has.

Note

The Medical Research Ethics Committee of the Maastricht University Hospital approved this study.


 
  • References

  • 1 Berry DA, Inoue L, Shen Y , et al. Modeling the impact of treatment and screening on U.S. breast cancer mortality: a Bayesian approach. J Natl Cancer Inst Monogr 2006; (36) 30-36
  • 2 Maddams J, Brewster D, Gavin A , et al. Cancer prevalence in the United Kingdom: estimates for 2008. Br J Cancer 2009; 101 (3) 541-547
  • 3 Petrek JA, Heelan MC. Incidence of breast carcinoma-related lymphedema. Cancer 1998; 83 (12, Suppl American): 2776-2781
  • 4 Kopec JA, Colangelo LH, Land SR , et al. Relationship between arm morbidity and patient-reported outcomes following surgery in women with node-negative breast cancer: NSABP protocol B-32. J Support Oncol 2013; 11 (1) 22-30
  • 5 Oliveri JM, Day JM, Alfano CM , et al. Arm/hand swelling and perceived functioning among breast cancer survivors 12 years post-diagnosis: CALGB 79804. J Cancer Surviv 2008; 2 (4) 233-242
  • 6 Chachaj A, Małyszczak K, Pyszel K , et al. Physical and psychological impairments of women with upper limb lymphedema following breast cancer treatment. Psychooncology 2010; 19 (3) 299-305
  • 7 Ahmed RL, Prizment A, Lazovich D, Schmitz KH, Folsom AR. Lymphedema and quality of life in breast cancer survivors: the Iowa Women's Health Study. J Clin Oncol 2008; 26 (35) 5689-5696
  • 8 Pusic AL, Cemal Y, Albornoz C , et al. Quality of life among breast cancer patients with lymphedema: a systematic review of patient-reported outcome instruments and outcomes. J Cancer Surviv 2013; 7 (1) 83-92
  • 9 Lee SH, Min YS, Park HY, Jung TD. Health-related quality of life in breast cancer patients with lymphedema who survived more than one year after surgery. J Breast Cancer 2012; 15 (4) 449-453
  • 10 Beaulac SM, McNair LA, Scott TE, LaMorte WW, Kavanah MT. Lymphedema and quality of life in survivors of early-stage breast cancer. Arch Surg 2002; 137 (11) 1253-1257
  • 11 Lopez Penha TR, van Bodegraven J, Winkens B, Heuts EM, Voogd AC, von Meyenfeldt MF. The quality of life in long-term breast cancer survivors with breast cancer related lymphedema. Acta Chir Belg 2014; 114 (4) 239-244
  • 12 Dean C, Chetty U, Forrest AP. Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy. Lancet 1983; 1 (8322) 459-462
  • 13 Lopez Penha TR, Voogd AC, Heuts EM , et al. Reduced prevalence of lymphedema in patients with reconstructive breast surgery. Breast J 2014; 20 (6) 671-673
  • 14 Lette J. A simple and innovative device to measure arm volume at home for patients with lymphedema after breast cancer. J Clin Oncol 2006; 24 (34) 5434-5440
  • 15 Sprangers MA, Groenvold M, Arraras JI , et al. The European Organization for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module: first results from a three-country field study. J Clin Oncol 1996; 14 (10) 2756-2768
  • 16 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) 365-376
  • 17 Sprangers MA, Cull A, Groenvold M, Bjordal K, Blazeby J, Aaronson NK ; EORTC Quality of Life Study Group. The European Organization for Research and Treatment of Cancer approach to developing questionnaire modules: an update and overview. Qual Life Res 1998; 7 (4) 291-300
  • 18 Devoogdt N, Van Kampen M, Geraerts I, Coremans T, Christiaens MR. Lymphoedema Functioning, Disability and Health questionnaire (Lymph-ICF): reliability and validity. Phys Ther 2011; 91 (6) 944-957
  • 19 Jeevan R, Cromwell DA, Browne JP , et al. Findings of a national comparative audit of mastectomy and breast reconstruction surgery in England. J Plast Reconstr Aesthet Surg 2014; 67 (10) 1333-1344
  • 20 Eltahir Y, Werners LL, Dreise MM , et al. Quality-of-life outcomes between mastectomy alone and breast reconstruction: comparison of patient-reported BREAST-Q and other health-related quality-of-life measures. Plast Reconstr Surg 2013; 132 (2) 201e-209e
  • 21 Girotto JA, Schreiber J, Nahabedian MY. Breast reconstruction in the elderly: preserving excellent quality of life. Ann Plast Surg 2003; 50 (6) 572-578
  • 22 Shi HY, Uen YH, Yen LC, Culbertson R, Juan CH, Hou MF. Two-year quality of life after breast cancer surgery: a comparison of three surgical procedures. Eur J Surg Oncol 2011; 37 (8) 695-702
  • 23 Metcalfe KA, Zhong T, Narod SA , et al. A prospective study of mastectomy patients with and without delayed breast reconstruction: long-term psychosocial functioning in the breast cancer survivorship period. J Surg Oncol 2015; 111 (3) 258-264
  • 24 Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg 2009; 124 (2) 345-353
  • 25 Pusic AL, Chen CM, Cano S , et al. Measuring quality of life in cosmetic and reconstructive breast surgery: a systematic review of patient-reported outcomes instruments. Plast Reconstr Surg 2007; 120 (4) 823-837 , discussion 838–839
  • 26 Lee ES, Lee MK, Kim SH , et al. Health-related quality of life in survivors with breast cancer 1 year after diagnosis compared with the general population: a prospective cohort study. Ann Surg 2011; 253 (1) 101-108
  • 27 Parker PA, Youssef A, Walker S , et al. Short-term and long-term psychosocial adjustment and quality of life in women undergoing different surgical procedures for breast cancer. Ann Surg Oncol 2007; 14 (11) 3078-3089
  • 28 Härtl K, Janni W, Kästner R , et al. Impact of medical and demographic factors on long-term quality of life and body image of breast cancer patients. Ann Oncol 2003; 14 (7) 1064-1071
  • 29 Becker C. Autologous lymph node transfers. J Reconstr Microsurg 2016; 32 (1) 28-33
  • 30 Baumeister RG, Mayo W, Notohamiprodjo M, Wallmichrath J, Springer S, Frick A. Microsurgical lymphatic vessel transplantation. J Reconstr Microsurg 2016; 32 (1) 34-41
  • 31 Penha TR, Ijsbrandy C, Hendrix NA , et al. Microsurgical techniques for the treatment of breast cancer-related lymphedema: a systematic review. J Reconstr Microsurg 2013; 29 (2) 99-106