Skip to main content

Advertisement

SpringerLink
Log in

Quality of life over 5 years in women with breast cancer after breast-conserving therapy versus mastectomy: a population-based study

  • Original Paper
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Breast-conserving therapy (BCT) was developed to improve quality of life (QOL) in early stage breast cancer patients. Except for differences in body image, literature comparing the psychosocial sequelae of BCT with mastectomy is ambiguous and shows a lack of substantial benefits. However, knowledge regarding long term effects of treatment on QOL in breast cancer is very limited as most of the pertinent studies have been performed in the early post-operative period. Therefore we compared QOL in women with breast cancer undergoing BCT versus women undergoing mastectomy over a 5-year period following primary surgery.

Methods

QOL was assessed at 1, 3, and 5 years after diagnosis in a population based cohort of 315 women with early stage breast cancer (UICC stage I-II) from Saarland (Germany) using the EORTC QLQ-C30 questionnaire and the breast cancer specific module BR23.

Results

Breast-conserving therapy was performed in 226 women (72%). After control for potential confounding, women with BCT reported better physical and role functioning, were sexually more active and more satisfied with their body image already at 1 year after diagnosis (all P values < 0.05). Differences in overall QOL and social functioning were gradually increasing over time and became statistically significant only at 5 years.

Conclusions

Whereas some, very specific benefits of BCT, such as a better body image, are already visible very timely after completion of therapy, benefits in broader measures such as psychosocial well-being and overall quality of life gradually increase over time and become fully apparent only in the long run.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Aaronson NK, Bartelink H, van Dongen JA, van Dam FS (1988) Evaluation of breast conserving therapy: clinical, methodological and psychosocial perspectives. Eur J Surg Oncol 14:133–140

    PubMed  CAS  Google Scholar 

  • Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JCJM, Kaasa S, Klee M, Osoba D, Razavi D, Rofe PB, Schraub S, Sneeuw K, Sullivan M, Takeda F (1993) 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 85:365–376

    Article  PubMed  CAS  Google Scholar 

  • Arndt V, Merx H, Stegmaier C, Ziegler H, Brenner H (2005) Persistence of restrictions in quality of life from the first to the third year after diagnosis in women with breast cancer. J Clin Oncol 23:4945–4953

    Article  PubMed  Google Scholar 

  • Bloom JR, Stewart SL, Chang S, Banks PJ (2004) Then and now: quality of life of young breast cancer survivors. Psychooncology 13:147–160

    Article  PubMed  Google Scholar 

  • Brenner H, Gondos A, Arndt V (2007) Recent major progress in long-term cancer patient survival disclosed by modeled period analysis. J Clin Oncol 25:3274–3280

    Article  PubMed  Google Scholar 

  • Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  PubMed  CAS  Google Scholar 

  • Cocquyt VF, Blondeel PN, Depypere HT, Van De Sijpe KA, Daems KK, Monstrey SJ, Van Belle SJ (2003) Better cosmetic results and comparable quality of life after skin-sparing mastectomy and immediate autologous breast reconstruction compared to breast conservative treatment. Br J Plast Surg 56:462–470

    Article  PubMed  Google Scholar 

  • Curran D, van Dongen JP, Aaronson NK, Kiebert G, Fentiman IS, Mignolet F, Bartelink H (1998) Quality of life of early-stage breast cancer patients treated with radical mastectomy or breast-conserving procedures: results of EORTC Trial 10801. The European Organization for Research and Treatment of Cancer (EORTC), Breast Cancer Co-operative Group (BCCG). Eur J Cancer 34:307–314

    Article  PubMed  CAS  Google Scholar 

  • Dian D, Schwenn K, Mylonas I, Janni W, Friese K, Jaenicke F (2007) Quality of life among breast cancer patients undergoing autologous breast reconstruction versus breast conserving therapy. J Cancer Res Clin Oncol 133:247–252

    Article  PubMed  CAS  Google Scholar 

  • Dorval M, Maunsell E, Deschenes L, Brisson J (1998) Type of mastectomy and quality of life for long term breast carcinoma survivors. Cancer 83:2130–2138

    Article  PubMed  CAS  Google Scholar 

  • Engel J, Kerr J, Schlesinger-Raab A, Sauer H, Hölzel D (2004) Quality of life following breast-conserving therapy or mastectomy: results of a 5-year prospective study. Breast J 10:223–231

    Article  PubMed  Google Scholar 

  • Fallowfield LJ, Baum M, Maguire GP (1986) Effects of breast conservation on psychological morbidity associated with diagnosis and treatment of early breast cancer. Br Med J (Clin Res Ed) 293:1331–1334

    Article  CAS  Google Scholar 

  • Fayers PM (2001) Interpreting quality of life data: population-based reference data for the EORTC QLQ-C30. Eur J Cancer 37:1331–1334

    Article  PubMed  CAS  Google Scholar 

  • Fayers PM, Aaronson N, Bjordal K, Curran D, Groenvold M (1999) The EORTC QLQ-C30 Scoring Manual, 2 edn. European Organization for Research and Treatment of Cancer, Brussels

    Google Scholar 

  • Ganz PA, Schag AC, Lee JJ, Polinsky ML, Tan SJ (1992) Breast conservation versus mastectomy. Is there a difference in psychological adjustment or quality of life in the year after surgery? Cancer 69:1729–1738

    Article  PubMed  CAS  Google Scholar 

  • Gondos A, Arndt V, Holleczek B, Stegmaier C, Ziegler H, Brenner H (2007) Cancer survival in Germany and the United States at the beginning of the 21st century: an up-to-date comparison by period analysis. Int J Cancer 121:395–400

    Article  PubMed  CAS  Google Scholar 

  • de Haes JC, Welvaart K (1985) Quality of life after breast cancer surgery. J Surg Oncol 28:123–125

    Article  PubMed  Google Scholar 

  • de Haes JC, van Oostrom MA, Welvaart K (1986) The effect of radical and conserving surgery on the quality of life of early breast cancer patients. Eur J Surg Oncol 12:337–342

    PubMed  Google Scholar 

  • de Haes JC, Curran D, Aaronson NK, Fentiman IS (2003) Quality of life in breast cancer patients aged over 70 years, participating in the EORTC 10850 randomised clinical trial. Eur J Cancer 39:945–951

    Article  PubMed  Google Scholar 

  • Härtl K, Janni W, Kästner R, Sommer H, Strobl B, Rack B, Stauber M (2003) Impact of medical and demographic factors on long-term quality of life and body image of breast cancer patients. Ann Oncol 14:1064–1071

    Article  PubMed  Google Scholar 

  • Janz NK, Mujahid M, Lantz PM, Fagerlin A, Salem B, Morrow M, Deapen D, Katz SJ (2005) Population-based study of the relationship of treatment and sociodemographics on quality of life for early stage breast cancer. Qual Life Res 14:1467–1479

    Article  PubMed  Google Scholar 

  • Kemeny MM, Wellisch DK, Schain WS (1988) Psychosocial outcome in a randomized surgical trial for treatment of primary breast cancer. Cancer 62:1231–1237

    Article  PubMed  CAS  Google Scholar 

  • Lasry JC, Margolese RG, Poisson R, Shibata H, Fleischer D, Lafleur D, Legault S, Taillefer S (1987) Depression and body image following mastectomy and lumpectomy. J Chronic Dis 40:529–534

    Article  PubMed  CAS  Google Scholar 

  • Lee MS, Love SB, Mitchell JB, Parker EM, Rubens RD, Watson JP, Fentiman IS, Hayward JL (1992) Mastectomy or conservation for early breast cancer: psychological morbidity. Eur J Cancer 28A:1340–1344

    Article  PubMed  CAS  Google Scholar 

  • Levy SM, Herberman RB, Lee JK, Lippman ME, d’Angelo T (1989) Breast conservation versus mastectomy: distress sequelae as a function of choice. J Clin Oncol 7:367–375

    PubMed  CAS  Google Scholar 

  • Linn BS, Linn MW, Gurel L (1968) Cumulative illness rating scale. J Am Geriatr Soc 16:622–626

    PubMed  CAS  Google Scholar 

  • McCready D, Holloway C, Shelley W, Down N, Robinson P, Sinclair S, Mirsky D (2005) Surgical management of early stage invasive breast cancer: a practice guideline. Can J Surg 48:185–194

    PubMed  Google Scholar 

  • Moyer A (1997) Psychosocial outcomes of breast-conserving surgery versus mastectomy: a meta-analytic review. Health Psychol 16:284–298

    Article  PubMed  CAS  Google Scholar 

  • Nano MT, Gill PG, Kollias J, Bochner MA, Malycha P, Winefield HR (2005) Psychological impact and cosmetic outcome of surgical breast cancer strategies. ANZ J Surg 75:940–947

    Article  PubMed  Google Scholar 

  • Ohsumi S, Shimozuma K, Kuroi K, Ono M, Imai H (2007) Quality of life of breast cancer patients and types of surgery for breast cancer—current status and unresolved issues. Breast Cancer 14:66–73

    Article  PubMed  Google Scholar 

  • Osoba D, Rodrigues G, Myles J, Zee B, Pater J (1998) Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol 16:139–144

    PubMed  CAS  Google Scholar 

  • Pauler DK, McCoy S, Moinpour C (2003) Pattern mixture models for longitudinal quality of life studies in advanced stage disease. Stat Med 22:795–809

    Article  PubMed  Google Scholar 

  • Poulsen B, Graversen HP, Beckmann J, Blichert-Toft M (1997) A comparative study of post-operative psychosocial function in women with primary operable breast cancer randomized to breast conservation therapy or mastectomy. Eur J Surg Oncol 23:327–334

    Article  PubMed  CAS  Google Scholar 

  • Rowland JH, Desmond KA, Meyerowitz BE, Belin TR, Wyatt GE, Ganz PA (2000) Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst 92:1422–1429

    Article  PubMed  CAS  Google Scholar 

  • Schain WS, d’Angelo TM, Dunn ME, Lichter AS, Pierce LJ (1994) Mastectomy versus conservative surgery and radiation therapy. Psychosocial consequences. Cancer 73:1221–1228

    Article  PubMed  CAS  Google Scholar 

  • Schain W, Edwards BK, Gorrell CR, de Moss EV, Lippman ME, Gerber LH, Lichter AS (1983) Psychosocial and physical outcomes of primary breast cancer therapy: mastectomy vs. excisional biopsy and irradiation. Breast Cancer Res Treat 3:377–382

    Article  PubMed  CAS  Google Scholar 

  • Schwarz R, Hinz A (2001) Reference data for the quality of life questionnaire EORTC QLQ-C30 in the general German population. Eur J Cancer 37:1345–1351

    Article  PubMed  CAS  Google Scholar 

  • Sprangers MA, Groenvold M, Arraras JI, Franklin J, te Velde A, Muller M, Franzini L, Williams A, de Haes HC, Hopwood P, Cull A, Aaronson NK (1996) The European Organization 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 14:2756–2768

    PubMed  CAS  Google Scholar 

  • Tomich PL, Helgeson VS (2002) Five years later: a cross-sectional comparison of breast cancer survivors with healthy women. Psychooncology 11:154–169

    Article  PubMed  Google Scholar 

  • Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, Marubini E (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347:1227–1232

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by two grants of the German Cancer Foundation (Deutsche Krebshilfe), Project Nos. 70-1816, 70-2413. The funding agency had no involvement in the study design; nor in the collection, analysis and interpretation of data; nor in the writing of the manuscript; and nor the decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Bergheimer Strasse 20, 69115, Heidelberg, Germany

    Volker Arndt & Hermann Brenner

  2. Saarland Cancer Registry, Postbox 10 24 64, 66024, Saarbrücken, Germany

    Christa Stegmaier & Hartwig Ziegler

Authors
  1. Volker Arndt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christa Stegmaier
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hartwig Ziegler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hermann Brenner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Volker Arndt.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Arndt, V., Stegmaier, C., Ziegler, H. et al. Quality of life over 5 years in women with breast cancer after breast-conserving therapy versus mastectomy: a population-based study. J Cancer Res Clin Oncol 134, 1311–1318 (2008). https://doi.org/10.1007/s00432-008-0418-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00432-008-0418-y

Keywords

Search

Navigation