SAN ANTONIO — Young breast cancer survivors (ages ≤40) reported high rates of arm morbidity a year after treatment, a researcher said here.
Data from a prospective cohort study suggest that despite a move away from axillary node dissection, arm swelling and decreased range of motion remain an issue for many young women, according to Anne Kuijer, PhD, of Diakonessen Hospital Utrecht in the Netherlands.
The findings suggest a need for more pre-operative counseling and early interventions afterward to reduce impairment, Kuijer said at the San Antonio Breast Cancer Symposium (SABCS).
Arm morbidity commonly affects women undergoing surgery for breast cancer, Kuijer said, but is especially important for younger women “given the longer survivorship period and detrimental effects of arm-morbidity on body image and social-, home- and personal-care functions.”
Indeed, severe arm morbidity associated with breast cancer can be “disfiguring and functionally significant” but is less common than it was, commented C. Kent Osborne, MD, of Dan L. Duncan Cancer Center at Baylor College of Medicine in Houston, who was not part of the study.
“With the advent of sentinel node biopsies, it’s much less common. You don’t see the extensive lymphedema that you use to see in the old days,” he told MedPage Today. In the modern era, even when patients have axillary node involvement, an axillary dissection isn’t needed — “radiation is just as good.”
But it can still be an issue. “It’s less, but when it does happen it can be bad for a patient,” he said.
While arm morbidity is the most common late effect following axillary surgery — with rates of 21% for lymphedema and 4% to 28% for shoulder impairment — the issue hasn’t been studied in younger women, Kuijer said.
Kuijer’s group asked participants in the Young Women’s Breast Cancer Study — a prospective cohort established to explore biological, medical, and psychosocial issues in young breast cancer patients — to report their experiences.
From 2006 through 2016, some 1,302 women agreed to take part, answering surveys that included questions on arm morbidity starting 4 months after they joined the study, then every 6 months for 3 years and annually thereafter.
All told, she said the investigators had complete data on 1,037 women and were able to calculate trends in time and crude risks for arm morbidity.
Women in the study were ages ≤40 (median age 37). Most were white, half said they felt financially comfortable, and 61% had a normal weight (BMI 18.5-24.9). Some 79% had either T1 or T2 tumor size, 90% were either pathological N0 or N1, 94% were grade 2 or 3, 72% were estrogen receptor-positive, and 65% were HER2-negative.
About 30% had breast-conserving surgery and the remainder had either a unilateral or bilateral mastectomy. Importantly, 55% had just a sentinel node biopsy (SN), 21% had both SN and an axillary node dissection (AD), and 20% had AD alone (some patients had missing data.)
Overall, 13% of the participants reported arm swelling at 1 year and 33% reported a decreased range of motion. Regardless of the mode of treatment, there was no significant difference in decreased range of motion among those who had SN or AD, Kuijer said.
Arm swelling was significantly more common among women who got AD along with either breast-conserving treatment or mastectomy without radiation. There was a trend in the same direction for women who had a mastectomy with radiation as well as AD.
A logistic regression analysis showed that
Women who were overweight (BMI >25) were 70% more like to report arm swelling than those of normal weight and 40% more likely to report decreased range of motion.
Also, women who said they felt financially comfortable were 40% less likely to report swelling.
Women who had AD were 3.4 times as likely to report swelling than those who had SD, but there was no association with decreased range of motion.
And women who had mastectomy with radiation were 2.1 times as likely to report decreased range of motion than those who had breast-conserving therapy.
The investigators found that, over time, the frequency of AD fell from 24% in 2006-2007 to 11% in 2104-2015. Over the same time period, the frequency of SD rose from 50% to 56%.
The study was supported by the NIH, the Susan G. Komen Foundation, the Pink Agenda, and the Breast Cancer Research Foundation.
Kuijer and co-authors disclosed no relevant relationships with industry.
Osborne disclosed relevant relationships with Pfizer, Astra-Zeneca, and Genentech.
F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner