Arm/shoulder problems in breast cancer survivors are associated with reduced health and poorer physical quality of life.
BACKGROUND
Except for lymphedema, the consequences of arm/shoulder problems (ASPs), at long-term in breast cancer survivors (BCSs) have hardly been studied. We examined demography, lifestyle, quality of life (QoL) and somatic morbidity in BCSs with and without ASPs. We also compared the associations of restricted shoulder abduction and lymphedema with QoL.


METHODS
We used a cross-sectional case-control design. A sample of 256 BCSs all with lymph node metastases were examined at a mean of 4.1 (SD 0.9) years post-surgery. Based on objective examinations and self-rating the sample were separated into 81 BCSs (32%) with definite ASP (ASP+ group) and 175 (68%) with minimal or no ASP (ASP- group). The self-rating contained among other schedules the Short Form-36 (SF-36) and the Kwan's arm/shoulder problem scale (KAPS).


RESULTS
In univariate analysis ASP+ was associated with not being employed, having had mastectomy, longer follow-up time, radiotherapy to axilla, poorer self-rated health and physical condition, minimal physical activity, increased body mass index, regularly intake of analgesics, and poorer physical QoL. Multivariate analysis showed that mastectomy, longer follow-up time, minimal physical activity and poorer physical QoL were associated with belonging to ASP+ group. All domains of the SF-36 were significantly associated with having impaired shoulder abduction (> or = 25 degrees difference) while none of the associations with lymphedema were significant.


CONCLUSIONS
In BCSs, at four years after treatment, having ASP was associated with mastectomy, minimal physical activity and poorer physical QoL. Poor physical QoL is strongly associated with reduced shoulder abduction rather than with lymphedema.
Nesvold
Inger-Lise
IL
Department of Clinical Cancer Research, Oslo University Hospital, Rikshospitalet, 0310 Oslo, Norway. inger.lise.nesvold@radiumhospitalet.no
Fosså
Sophie D
SD
Holm
Inger
I
Naume
Bjørn
B
Dahl
Alv A
AA
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001132:Arm / Q000503:physiopathology*; D001365:Axilla; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D006304:Health Status; D006801:Humans; D008019:Life Style; D016014:Linear Models; D016015:Logistic Models; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008209:Lymphedema / Q000209:etiology*; D015411:Mastectomy, Modified Radical; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D009664:Norway; D011788:Quality of Life; D016059:Range of Motion, Articular; D012782:Shoulder / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D017741:Survivors