Pain and other symptoms during the first year after radical and conservative surgery for breast cancer

Abstract

Summary This study assessed pain, neurological symptoms, oedema of the ipsilateral arm, anxiety and depression occurring in women treated surgically for breast cancer, the impact of these symptoms on daily life and how they evolved during the 1 year follow-up. Ninety-three consecutive patients with non-metastasised breast cancer who were treated during 1993 -94 were examined before surgery and after 1, 6 and 12 months. They were asked about pain, neurological symptoms and oedema in the breast scar region and/or ipsilateral arm. Sensory testing was performed, and gripping force and the circumference of the arm were measured. Anxiety and depression were evaluated. One year after surgery, 80% of the women had treatment-related symptoms in the breast scar region and virtually all patients had symptoms in the ipsilateral arm. The incidence of chronic post-treatment pain was higher after conservative surgery than after radical surgery (breast area: 33% vs 17%, NS; ipsilateral arm: 23% vs 13%, NS). Numbness occurred in 75% and oedema of the ipsilateral arm in over 30% of the patients after both radical and conservative surgery. Phantom sensations in the breast were reported by 25% of the patients. No difference in psychic morbidity was detected after the two types of surgery. Both the anxiety and depression scores were highest before surgery, decreasing with time, and were significantly correlated with preoperative stressful events.Keywords: breast cancer; breast surgery; chronic pain; quality of life Several recent studies (Rayter et al., 1990;Kuusk et al., 1992;Fisher et al., 1995) found no significant differences in the overall or disease-free survival between patients treated with either total mastectomy or breast-conserving surgery with breast radiation. However, follow-up studies indicate that some women suffer from various chronic treatment-related symptoms such as pain, sensory disturbances, oedema and muscle weakness, the reported incidence of which varies from 5 to 74% (Olsen et al., 1993;Thompson et al., 1995). Recently, Stevens et al. (1995) reported a 20% prevalence rate of the post-surgical pain syndrome in 95 women after breast surgery. The incidence of chronic pain did not differ statistically significantly after mastectomy compared with lumpectomy. In our recent retrospective study, in which 467 women completed a questionnaire on post-treatment symptoms 10-58 months after surgery, pain, paraesthesiae or strange sensations were reported by half of the patients. These chronic treatment-related symptoms were more common after breast resection (BCT) than after modified radical mastectomy (MRM) (Tasmuth et al., 1995). The incidence of pain in the operated breast area after both types of surgery and in the ipsilateral arm after MRM was higher if less time had elapsed since surgery. About 25% of the patients in this study reported chronic pain that affected their daily lives at least moderately.A few studies have examined the time course of various post-treatment symptoms following treatment of breast cancer...

Study of Incidence of Lymphedema in Indian Patients Undergoing Axillary Dissection for Breast Cancer

“…A wide variation in prevalence (2%-40%) is due to lack of consensus regarding the clinical criteria, method of assessment and timing of assessment for lymphedema [4,5,8,10,11]. The incidence of severe lymphedema is less variable with most studies reporting it in less than 10% of the patients with lymphedema [22,23].…”

“…Lymphedema of the upper extremity, in addition to being unsightly, can be painful, can limit the arm movements, increases the risk of infection and is psychologically distressing, serving as a constant reminder of cancer [3][4][5][6][7]. The incidence of lymphedema has been reported with a very wide range from 2%-40% in women treated with modified radical mastectomy or breast conserving surgery with no apparent difference between the two surgeries [4,5,[8][9][10][11].…”

“…Lymphedema of the upper extremity, in addition to being unsightly, can be painful, can limit the arm movements, increases the risk of infection and is psychologically distressing, serving as a constant reminder of cancer [3][4][5][6][7]. The incidence of lymphedema has been reported with a very wide range from 2%-40% in women treated with modified radical mastectomy or breast conserving surgery with no apparent difference between the two surgeries [4,5,[8][9][10][11]. The factors quoted to influence incidence of lymphedema include the level of nodal dissection, the number of nodes removed, the number of involved nodes, presence of extra capsular spread, size and grade of the primary tumor, co-morbid conditions, anthracycline based chemotherapy, axillary irradiation, experience of the surgeon, dominant limb and body mass index [12][13][14][15][16].…”

Late morbidity after treatment of breast cancer in relation to daily activities and quality of life: a systematic review

“…As mentioned, six articles fulfilled ten or more of the methodological criteria (Swedborg et al, 1981, 43 Segerstro È m et al, 1991, 46 Maunsell et al, 1992, 49 Tasmuth et al, 1996, 50 Sugden et al, 1998, 41 Hack et al, 1999 54 ) and these articles will be discussed in more detail ( Table 2). The surgical treatment modalities described in these six articles were modified radical mastectomy or breast conserving treatment both with axillary clearance.…”

“…In two studies a pretreatment baseline assessment was performed. 41,50 All articles described the measurement instruments used (items 12±17). Most frequently these instruments assessed pain, lymph edema or functional performance (items 13, 15 and 16).…”