Changes in arm morbidities and health-related quality of life after breast cancer surgery – a five-year follow-up study

Figures & data

Table I.  Demographics, preoperatively and at the five-year follow-up time point.

	Preoperatively n = 204	5 years follow-up n = 157
Age (years)	55 (10)	60 (9)
Type of work affecting upper limbs
Heavy physical work (nursing, kindergarten, flight attendant, grocery store worker, etc)	45 (22%)	36 (23%)
Light physical work (administration, teacher, secretary, housewife, retired, etc)	159 (79%)	121 (77%)
Number of lymph nodes removed	13 (4.0)	13 (4)
Number of metastasized lymph nodes	2 (3.3)	1.6 (3)
Breast ablation	106 (52%)	77 (49%)
Breast preservation	98 (48%)	80 (51%)
Surgery at dominant side	109 (53%)	90 (57%)
Radiotherapy of supraclavicular nodes	87 (43%)	62 (40%)
Radiotherapy of breast	151 (74%)	115 (73%)
Chemotherapy	80 (39%)	58 (40%)
Hormone treatment	106 (52%)	81 (52%)
Histology grade 1	44 (22%)	37 (24%)
Histology grade 2	112 (55%)	89 (57%)
Histology grade 3	48 (24%)	30 (19%)
Arm volume (ml), affected side	2 386 (389)	2 555 (468)
Arm volume (ml), control	2 383 (486)	2 496 (465)
Voldiff (ml)	3 (127)	59 (165)
BMI	25 (3.7)	25 (3.9)
Physical activity at leisure time in min per week	126 (82)	124 (76)

Numbers and percent (%), mean and standard deviations (SD)

Table II.  Pain and sensation of heaviness and arm lymphedema (ALE) for the affected limb.

	6 months (n = 190)		5 years (n = 157)
	Mean (SD)	(%)	Mean (SD)	(%)
Arm pain during physical activity (mm)	12 (19)	56	10 (19)	36*
Arm pain during rest (mm)	11 (18)	60	8 (17)	30*
Sensation of heaviness during activity (mm)	9 (17)	46	7 (17)	21*
Sensation of heaviness during rest (mm)	8 (16)	45	6 (18)	20*
ALE		7		13*

*Paired t-tests six months to five years p < 0.05. Mean and standard deviations (SD), and percent (%). Arm pain and sensation of heaviness in millimeters (mm) Visual Analogue Scale.

Table III.  Changes* in arm volume and BMI.

	Baseline to 6 months (n = 190)	6 months to 5 years (n = 157)	Baseline to 5 years (n = 157)
Affected (ml)
Mean difference	113	34	148
95% CI	81–145	−17–86	92–203
p-values	<0.001	0.34	<0.001
Control (ml)
Mean difference	63	38	102
95% CI	36–90	−9–86	54–150
P values	<0.001	0.16	<0.001
Voldiff (ml)
Mean difference	50	6	44
95% CI	21–78	−34–23	11–77
p-values	<0.001	0.64	<0.001
BMI
Mean difference	0.6	−0.1	0.5
95% CI	0.4–0.9	−0.5–0.3	0.1–0.9
p-values	<0.001	0.10	0.009

Changes from baseline (prior to surgery) to six months and five years. BMI and arm volumes, Voldiff (volume difference between affected and control). Mean difference, standard deviations (SD), P values, and 95% Confidence Intervals (CI). *Positive differences imply increase.

Figure 1.  Figure 1. Arm volumes from baseline (n=204) (before surgery) to five years (n=157) after surgery.

Figure 2.  HRQoL scales from baseline (n = 204) (before surgery) to five years (n = 157) after surgery. *p < 0.05.

Table IV.  Changes* in the HRQoL scales from baseline to 6 months and 5 years.

Subscales	Baseline to 6 months	6 months to 5 years	Baseline to 5 years
	n = 204	n = 190	n = 157
Physical Functioning
Mean difference	−1.9	1.6	−1.1
CI	4.4–0.5	−.5–4.6	−4.2–1.9
p-values	0.12	0.31	0.45
Functioning
Mean difference	−4.1	−5	−8.6
CI	−6.7– − 1.6	−7.7– − 2.2	−12.4– − 4.6
p-values	0.002	<0.001	<0.001
Symptoms
Mean difference	5.1	−4.5	1.1
CI	3–7.2	−1.8– − 7.1	−1.6–3.9
p-values	<0.001	<0.001	0.42
Fatigue
Mean difference	6.8	−5.3	1.2
CI	3.5–10	−9.5– − 1.2	−3.4–5.8
p-values	<0.001	0.012	0.62
Global Health Status
Mean difference	3.5	4	7.3
CI	0.0–6.9	0.0–8.2	3.0–11.4
p-values	0.050	0.052	<0.001

Mean change, 95% Confidence Intervals (CI), and P values. * Positive changes imply increase.

Table V.  Predictive factors for HRQoL scales at 5 years after surgery.

Physical functioning
	Univariate analysis			Multivariate analysis
Factors	b*	95% CI	p	b*	95% CI	p
Physical activity at leisure time (min per week) at baseline (prior to surgery)	0.039	0.012–0.067	0.005
Physical activity at leisure time (min per week) at 6 months after surgery	0.076	0.039–0.113	<0.001	0.076	0.039–0.113	<0.001
Functioning
Physical activity at leisure time (min per week) at baseline (prior to surgery)	0.036	0.002–0.070	0.038
The HRQoL subcategory “Functioning” at baseline (prior to surgery)	0.165	0.007–0.323	0.041
Duration of sick leave at 6 months after surgery (weeks)	−0.259	−0.483– − 0.034	0.024	−0.269	−0.494– − 0.045	0.019
Symptoms
Duration of sick leave at 6 months after surgery (weeks)	0.211	0.030–0.392	0.023
Pain in the affected limb during rest 3 months after surgery	0.148	0.024–0.272	0.020
The HRQoL subcategory “Symptoms” at baseline (prior to surgery)	0.334	0.158–0.511	<0.001	0.258	0.065–0.441	0.009
Fatigue
The HRQoL subcategory “Fatigue” at baseline (prior to surgery)	0.271	0.097–0.446	0.003
Global Health
The HRQoL subcategory “Global Health” at baseline (prior to surgery)	0.257	0.077–0.437	0.005	0.224	0.045–0.402	0.015
Duration of sick leave at 6 months after surgery (weeks)	−0.409	−0.667– − 0.140	0.003	−0.368	−0.634– − 0.102	0.007
Chemotherapy	−7.899	−15.050– − 0.748	0.031

b*: the estimated slope i.e. the mean change in the dependent variable (HRQoL dimensions) when the independent variable (factors) increases by 1 unit.