University of Iowa College of Public Health, Iowa City, IA, USA.
University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA.
Breast Cancer Res Treat. 2019 Jun;175(3):675-689. doi: 10.1007/s10549-019-05184-1. Epub 2019 Mar 9.
Chronic upper extremity disability (UED) is common after breast cancer treatment but under-identified and under-treated. Although UED has been linked to quality of life (QoL), the role of UED as mediator between contemporary treatment practices and QoL has not been quantified. This investigation describes UED in a contemporary sample of breast cancer patients and examines its relationship with personal and treatment factors and QoL.
Eight hundred and thirty-three women diagnosed at eight medical institutions during 2013-2014 with microscopically confirmed ductal carcinoma in situ or invasive stage I-III breast cancer were surveyed an average of 22 months after diagnosis. UED was measured with a modified QuickDASH and QoL with the FACT-B. The questionnaire also collected treatments, sociodemographic information, comorbidity, body mass index, and a 3-item health literacy screener.
Women who received post-mastectomy radiation and chemotherapy experienced significantly worse UED and QoL. Women who had lower income, lower health literacy and prior diabetes, arthritis or shoulder diagnoses had worse UED. Patients with worse UED reported significantly worse QoL. Income and health literacy were independently associated with QoL after adjustment for UED but treatment and prior conditions were not, indicating mediation by UED. UED mediated 52-79% of the effect of mastectomy-based treatments on QoL as compared with unilateral mastectomy without radiation. UED and QoL did not differ by type of axillary surgery or post-mastectomy reconstruction.
A large portion of treatment effect on QoL is mediated by UED. Rehabilitation practices that prevent and alleviate UED are likely to improve QoL for breast cancer survivors.
乳腺癌治疗后常出现慢性上肢功能障碍（UED），但这种情况往往未被充分识别和治疗。尽管 UED 与生活质量（QoL）有关，但 UED 在当代治疗实践与 QoL 之间的中介作用尚未被量化。本研究描述了当代乳腺癌患者的 UED 情况，并探讨了其与个人和治疗因素以及 QoL 的关系。
2013 年至 2014 年间，833 名在 8 家医疗机构确诊为显微镜下证实的导管原位癌或 I 期至 III 期浸润性乳腺癌的女性，在诊断后平均 22 个月接受了调查。采用改良的 QuickDASH 评估 UED，采用 FACT-B 评估 QoL。问卷还收集了治疗、社会人口统计学信息、合并症、体重指数和 3 项健康素养筛查器。
接受乳房切除术和化疗的女性 UED 和 QoL 明显更差。收入较低、健康素养较低以及有糖尿病、关节炎或肩部既往诊断的女性 UED 更差。UED 较差的患者报告 QoL 明显更差。在调整 UED 后，收入和健康素养与 QoL 独立相关，但治疗和既往状况则不然，表明 UED 存在中介作用。与单侧乳房切除术无放疗相比，UED 介导了基于乳房切除术的治疗对 QoL 的 52%-79%的影响。UED 和 QoL 不受腋窝手术类型或乳房切除术后重建的影响。
治疗对 QoL 的影响有很大一部分是通过 UED 介导的。预防和缓解 UED 的康复实践可能会提高乳腺癌幸存者的 QoL。
