Breast Edema Following Breast-Conserving Surgery and Radiotherapy: Patient-Reported Prevalence, Determinants, and Effect on Health-Related Quality of Life

Danny A Young-Afat, Madelijn L Gregorowitsch, Desirée H van den Bongard, Ine Burgmans, Carmen C van der Pol, Arjen J Witkamp, Rhodé M Bijlsma, Ron Koelemij, Ernst J Schoenmaeckers, Yvette Jonasse, Carla H van Gils, Helena M Verkooijen, Danny A Young-Afat, Madelijn L Gregorowitsch, Desirée H van den Bongard, Ine Burgmans, Carmen C van der Pol, Arjen J Witkamp, Rhodé M Bijlsma, Ron Koelemij, Ernst J Schoenmaeckers, Yvette Jonasse, Carla H van Gils, Helena M Verkooijen

Abstract

Background: The association between lymphedema of the arm and impaired health-related QoL (HR-QoL) has led to changes in clinical practice. However, data on lymphedema of the breast (ie, breast edema) are lacking. We prospectively evaluated patient-reported prevalence and determinants of breast edema and its effect on patient-reported HR-QoL and breast pain.

Methods: We prospectively included 836 patients undergoing breast-conserving surgery followed by radiotherapy between October 2013 and October 2016 (UMBRELLA cohort). Patient-reported breast edema, HR-QoL, and breast pain were assessed by means of European Organisation for Research and Treatment of Cancer-C30/BR23 before starting radiotherapy and at 3, 6, 12, and 18 months thereafter. We assessed which patient, tumor, and treatment characteristics were associated with breast edema. With mixed-effects models, we assessed the impact of breast edema on patient-reported HR-QoL domains and breast pain over time, adjusting for confounders.

Results: Within a median follow-up of 28 months (interquartile range [IQR] = 15), 207 (24.8%) patients reported breast edema at some point in time. Prevalence of breast edema was highest at 6 months (12.4%, 95% confidence interval [CI] = 10.0 to 14.7). Larger tumor size, oncoplastic surgery, axillary lymph node dissection, locoregional radiotherapy, radiotherapy boost on the tumor bed, and adjuvant chemotherapy were associated with breast edema. Breast edema was independently associated with more breast pain and with poorer QoL, physical functioning, and body image.

Conclusions: Breast edema occurs frequently within the first year after breast-conserving surgery and radiotherapy and is independently associated with impaired HR-QoL and more breast pain. This information is important for use in clinical practice and should be discussed with patients during shared decision making.

Figures

Figure 1.
Figure 1.
Impact of breast edema on breast pain following breast-conserving surgery and radiotherapy (unadjusted scores). EORTC = European Organisation for Research and Treatment of Cancer.
Figure 2.
Figure 2.
Impact of breast edema on health-related quality-of-life domains following breast-conserving surgery and radiotherapy (unadjusted scores) with 95% confidence bands. EORTC = European Organisation for Research and Treatment of Cancer; QOL = quality of life.

References

    1. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378(9804):1707–1716.
    1. Litière S, Werutsky G, Fentiman IS, et al. Breast conserving therapy versus mastectomy for stage I-II breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial. Lancet Oncol. 2012;13(4):412–419.
    1. Bosma SC, Van der Leij F, Van Werkhoven E, et al. Very low local recurrence rates after breast-conserving therapy: analysis of 8485 patients treated over a 28-year period. Breast Cancer Res Treat. 2016;156(2):391–400.
    1. Fallowfield L, Jenkins V.. Psychosocial/survivorship issues in breast cancer: are we doing better? J Natl Cancer Inst. 2015;107(1):335.
    1. Runowicz CD, Leach CR, Henry NL, et al. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. CA Cancer J Clin. 2016;34(6):611–635.
    1. Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol. 2018;19(1):27–39.
    1. Losken A, Hart AM, Chatterjee A.. Updated evidence on the oncoplastic approach to breast conservation therapy. Plast Reconstr Surg. 2017;140(5S Advances in Breast Reconstruction):14S–22S.
    1. Adriaenssens N, Verbelen H, Lievens P, Lamote J.. Lymphedema of the operated and irradiated breast in breast cancer patients following breast conserving surgery and radiotherapy. Lymphology. 2012;454:154–164.
    1. Land SR, Kopec JA, Julian TB, et al. Patient-reported outcomes in sentinel node-negative adjuvant breast cancer patients receiving sentinel-node biopsy or axillary dissection: National Surgical Adjuvant Breast and Bowel Project phase III protocol B-32. J Clin Oncol. 2010;2825:3929–3936.
    1. 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;2524:3657–3663.
    1. 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;71:83–92.
    1. Degnim AC, Miller J, Hoskin TL, et al. A prospective study of breast lymphedema: frequency, symptoms, and quality of life. Breast Cancer Res Treat. 2012;1343:915–922.
    1. Verbelen H, Gebruers N, Beyers T, et al. Breast edema in breast cancer patients following breast-conserving surgery and radiotherapy: a systematic review. Breast Cancer Res Treat. 2014;1473:463–471.
    1. International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2013 consensus document of the International Society of Lymphology. Lymphology. 2013;461:1–11.
    1. Young-Afat DA, van Gils CH, van den Bongard H, Verkooijen HM.. UMBRELLA Study Group. The Utrecht Cohort for Multiple Breast Cancer Intervention Studies and Long-term Evaluation (UMBRELLA): objectives, design, and baseline results. Breast Cancer Res Treat. 2017;164(2):445–450. doi:10.1007/s10549-017-4242-4.
    1. U.S. National Library of Medicine. The UMBRELLA cohort, number NCT02839863. . Accessed July 10, 2018.
    1. Sprangers MAG, Groenvold M, Arraras JI, et al. The European Organisation 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.
    1. Dutch Society for Surgery. Dutch breast cancer guidelines; 2012. . Accessed July 10, 2018.
    1. 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;855:365–376.
    1. Atkinson TM, Li Y, Coffey CW, et al. Reliability of adverse symptom event reporting by clinicians. Qual Life Res. 2012;217:1159–1164.
    1. Formenti SC, Hsu H, Fenton-Kerimian M, et al. Prone accelerated partial breast irradiation after breast-conserving surgery: five-year results of 100 patients. Int J Radiat Oncol Biol Phys. 2012;843:606–611.
    1. Toledano A, Garaud P, Serin S, et al. Concurrent administration of adjuvant chemotherapy and radiotherapy after breast-conserving surgery enhances late toxicities: long-term results of the ARCOSEIN multicenter randomized study. Int J Radiat Oncol Biol Phys. 2006;652:324–332.
    1. Kelemen G, Varga Z, Lazar G, et al. Cosmetic outcome 1–5 years after breast conservative surgery, irradiation and systemic therapy. Pathol Oncol Res. 2012;182:421–427.
    1. Chadha M, Vongtama D, Friedmann P, et al. Comparative acute toxicity from whole breast irradiation using 3-week accelerated schedule with concomitant boost and the 6.5-week conventional schedule with sequential boost for early-stage breast cancer. Clin Breast Cancer. 2012;121:57–62. doi: 10.1016/j.clbc.2011.09.002.
    1. Barnett GC, Wilkinson JS, Moody AM, et al. The Cambridge Breast Intensity-Modulated Radiotherapy Trial: patient- and treatment-related factors that influence late toxicity. Clin Oncol. 2011;2310:662–673.
    1. Bartelink H, Maingon P, Poortmans P, et al. Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol. 2015;161:47–56.
    1. Borger JH, Kemperman H, Smitt HS, et al. Dose and volume effects on fibrosis after breast conservation therapy. Int J Radiat Oncol Biol Phys. 1994;305:1073–1081.
    1. Colette S, Collette L, Budiharto T, et al. Predictors of the risk of fibrosis at 10 years after breast conserving therapy for early breast cancer: a study based on the EORTC Trial 22881-10882 ‘boost versus no boost’. Eur J Cancer. 2008;4417:2587–2599.
    1. Donker M, van Tienhoven G, Straver ME, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014;1512:1303–1310.
    1. Gregorowitsch ML, Verkooijen HM, Young-Afat DA, et al. Impact of modern-day axillary treatment on patient reported arm morbidity and physical functioning in breast cancer patients. Radiother Oncol. 2018;131:221–228.

Source: PubMed

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