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Open Access 01-06-2019 | Mastectomy | Epidemiology

Upper extremity disability and quality of life after breast cancer treatment in the Greater Plains Collaborative clinical research network

Authors: Elizabeth A. Chrischilles, Danielle Riley, Elena Letuchy, Linda Koehler, Joan Neuner, Cheryl Jernigan, Brian Gryzlak, Neil Segal, Bradley McDowell, Brian Smith, Sonia L. Sugg, Jane M. Armer, Ingrid M. Lizarraga

Published in: Breast Cancer Research and Treatment | Issue 3/2019

Abstract

Purpose

Chronic upper extremity disability (UED) is common after breast cancer treatment but under-identified and under-treated. Although UED has been linked to quality of life (QoL), the role of UED as mediator between contemporary treatment practices and QoL has not been quantified. This investigation describes UED in a contemporary sample of breast cancer patients and examines its relationship with personal and treatment factors and QoL.

Methods

Eight hundred and thirty-three women diagnosed at eight medical institutions during 2013–2014 with microscopically confirmed ductal carcinoma in situ or invasive stage I–III breast cancer were surveyed an average of 22 months after diagnosis. UED was measured with a modified QuickDASH and QoL with the FACT-B. The questionnaire also collected treatments, sociodemographic information, comorbidity, body mass index, and a 3-item health literacy screener.

Results

Women who received post-mastectomy radiation and chemotherapy experienced significantly worse UED and QoL. Women who had lower income, lower health literacy and prior diabetes, arthritis or shoulder diagnoses had worse UED. Patients with worse UED reported significantly worse QoL. Income and health literacy were independently associated with QoL after adjustment for UED but treatment and prior conditions were not, indicating mediation by UED. UED mediated 52–79% of the effect of mastectomy-based treatments on QoL as compared with unilateral mastectomy without radiation. UED and QoL did not differ by type of axillary surgery or post-mastectomy reconstruction.

Conclusions

A large portion of treatment effect on QoL is mediated by UED. Rehabilitation practices that prevent and alleviate UED are likely to improve QoL for breast cancer survivors.

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Title: Upper extremity disability and quality of life after breast cancer treatment in the Greater Plains Collaborative clinical research network
Authors: Elizabeth A. Chrischilles
Danielle Riley
Elena Letuchy
Linda Koehler
Joan Neuner
Cheryl Jernigan
Brian Gryzlak
Neil Segal
Bradley McDowell
Brian Smith
Sonia L. Sugg
Jane M. Armer
Ingrid M. Lizarraga
Publication date: 01-06-2019
Publisher: Springer US
Keywords: Mastectomy
Breast Cancer
Breast Cancer
Cytostatic Therapy
Published in: Breast Cancer Research and Treatment / Issue 3/2019
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-019-05184-1

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