Ten-year breast cancer survival - at what cost in human and physical terms? A case-control study of long-term survivors of breast cancer and their physical and functional well-being

Abstract

8010 Background: We sought to clarify the long-term side effects of treatment and quality of life (QOL) of breast cancer survivors. Methods: We conducted a case-control study of survivors, ≤ 10 years disease-free since diagnosis, matched to women with benign breast disease for age, years followed, and demographic profile. Data was collected for routine blood tests, lipids, bone mineral density (BMD), exercise step test, HRT use, vitamin and alternative medication (AM) use, arm strength and measurements, health history, and for survivors, breast cancer demographics. QOL instruments included EORTC QLQ-C30, SF36, and QOL-CS. Results: N = 850, 425 cases, 425 controls. For cases, average tumour size was 2.2 cm, 57% ER +, 40% PR +. 93.8% had axillary nodal dissection, 24.1% had positive nodes, median of 11.8 nodes removed, median of 1 positive. 59.7% had lumpectomy, 50.8% radiotherapy, 33% tamoxifen, 4.9% ovarian ablation, 22.8% chemotherapy, and 13% breast reconstruction. Cases had significantly more pack years smoked (p = 0.04), higher cholesterol (p = 0.01), triglycerides (p = 0.02), LDL (p = 0.04), cholesterol/HDL ratio (p < 0.001); and significantly less arthritis (p = 0.01), GI (p = 0.01) and GU (p = 0.006) complaints, and HRT use (p < 0.0001). BMD was not different. Controls used significantly more AM, cases more mental imagery (p = 0.0002). Cases had significantly larger arm circumferences (p = 0.002), decreased handgrip strength (p = 0.04), controlled for dominant arm and side of surgery. SF 36: social functioning was better for controls (p = 0.03) and role-emotional (p = 0.03). EORTC-QLQ-C30: controls had more pain (p = 0.05), cases had financial difficulties (p = 0.04). QOL-CS: controls had better psychological (p<0.0001) and social functioning (p<0.0001), cases were more spiritual (p<0.0001). Conclusions: Breast cancer survivors had significantly increased arm circumferences, decreased handgrip strength, elevated lipids, decreased psychological and social functioning, but improved spirituality. No significant financial relationships to disclose.