Physical and psychosocial recovery in the year after primary treatment of breast cancer

Abstract

Purpose: The 2000 National Institutes of Health Consensus Conference on Adjuvant Therapy of Breast Cancer recommended chemotherapy for all women with invasive cancer greater than 1 centimeter. Studies of long-term breast cancer survivors have found poorer quality of life (QOL) in women who received adjuvant chemotherapy. The aim of this article is to characterize physical and psychosocial recovery as a function of chemotherapy receipt in the year after medical treatment completion.

Patients and methods: Prospective longitudinal survey data (RAND SF-36 and Breast Cancer Prevention Trial [BCPT] Symptom Scales) collected from 558 women with breast cancer enrolled on the Moving Beyond Cancer (MBC) psychoeducational intervention trial were compared according to receipt of chemotherapy. MBC study enrollment occurred within 4 weeks after the end of primary treatment (eg, surgery, chemotherapy, radiation). Self-report questionnaire data collected at enrollment and at 2, 6, and 12 months thereafter were examined, controlling for intervention and with propensity score adjustment for imbalance of covariates. Outcome analyses were carried out by fitting linear mixed models by using SAS PROC MIXED.

Results: Longitudinal SF-36 scale scores did not differ by chemotherapy treatment exposure, and both groups improved significantly (P < .01) in the year after primary treatment ended. However, adjuvant chemotherapy treatment was associated with significantly more severe physical symptoms, including musculoskeletal pain (P = .01), vaginal problems (P < .01), weight problems (P = .01), and nausea (P = .03).

Conclusion: Physical and psychosocial functioning improved significantly after breast cancer treatment, independent of receipt of adjuvant chemotherapy. Women who received chemotherapy experienced more severe and persistent physical symptoms that should be more effectively managed as part of survivorship care.

Fig 1.

Propensity-adjusted mixed model results for trajectory of physical and mental component summary scales of the short-form 36 in the year after primary treatment. (A) Physical component summary (PCS; P = .50). (B) Mental component summary (MCS; P = .10). Solid gold line, no chemotherapy (chemo); dashed blue line, chemo.

Fig 2.

Propensity-adjusted mixed model results for trajectory of the eight short-form 36-item (SF-36) scales in the year after primary treatment. (A) SF-36 physical functioning (P = .70); (B) SF-36 mental health (P = .13); (C) SF-36 role-physical functioning (P = .90); (D) SF-36 role-emotional functioning (P = .15); (E) SF-36 vitality/energy (P = .47); (F) SF-36 pain (P = .69); (G) SF-36 social functioning (P = .97); (H) SF-36 general health perceptions (P = .86). Solid gold line, no chemotherapy (chemo); dashed blue line, chemo.

Fig 3.

Propensity-adjusted mixed model results for Breast Cancer Prevention Trial symptom scales showing severity of symptoms after primary treatment. (A) Hot flashes (P = .30); (B) nausea (P = .03); (C) bladder problems (P = .88); (D) vaginal problems (P < .01); (E) musculoskeletal pain (P = .01); (F) weight problems (P = .01); (G) cognitive problems (P = .19); (H) arm problems (P = .15). Solid gold line, no chemotherapy (chemo); dashed blue line, chemo.