Breast cancer survivors often rate post-treatment breast appearance only 'fair'

November 2, 2010

A third of breast cancer survivors who received the breast-conserving treatments lumpectomy and radiation rate the appearance of their post-treatment breast as only "fair" or "poor" in comparison to their untreated breast, according to a new University of Pennsylvania School of Medicine study that will be presented today at the 52nd Annual Meeting of the American Society for Radiation Oncology (ASTRO) in San Diego. In addition, one fifth of patients report complications including chronic pain in their breast or arm and loss of arm or shoulder flexibility following their treatment, the study authors found.

The findings, which are the first to examine patients' own impressions of the cosmetic appearance of their breast following treatment, contrast with previous studies in which clinicians were more likely to label post-treatment breasts as "good" or "excellent" in appearance. The authors say that the findings shed light on how patients' treatment expectations may differ from their physicians', and reveal a need for additional patient education about potential outcomes.

"Most patients are ultimately happy they were able to preserve their breast, but our study shows that often, how they feel about the way they look after treatment is not as good as doctors would have predicted," says lead author Christine Hill-Kayser, MD, an assistant professor of at Penn's Abramson Cancer Center.

Among 503 patients surveyed who had a lumpectomy followed by radiotherapy, the findings showed that 16 percent reported "excellent" cosmesis, 52 percent "good," 30 percent "fair," and 2 percent "poor." Forty-three percent of women who had these breast-conserving treatments reported chronic skin or soft tissue changes, 22 percent said they had chronic pain in the breast or arm, 21 percent had suffered a loss of arm or shoulder flexibility, and 8 percent had chronic swelling. The study data was collected from patients who voluntarily created an online survivorship care plan using the LIVESTRONG Care Plan Powered by Penn Medicine's Oncolink (http://www.livestrongcareplan.org). This easy-to-use tool, developed by physicians and nurses from the Abramson Cancer Center, provides users with an easy-to-follow roadmap for managing their health as they finish treatment and transition to life as a cancer survivor.

"It's very important that cancer survivors be empowered by information – they should be aware not only of the possible complications associated with their treatment, but also that there are things that they can do about many of them," Hill-Kayer says.

Currently, more than half of patients undergo both and radiation, a combination of treatments which offer the best chance of cure while avoiding complete removal of the breast among women with Stage I or II cancer. Cosmetic issues that these patients may report include scarring, skin puckering, changes in the color or texture of skin, size or shape asymmetry between the treated and untreated breast, and nipple distortion. Although it may not be possible to correct all of those problems, Hill-Kayser notes there are a variety of therapies available for women with treatment complications, including physical therapy and weight training regimens for patients who experience the painful arm-swelling condition called lymphedema, and shoulder pain and/or stiffening.

"As cure rates for breast and other cancers continue to improve, attention to survivorship issues is more important than ever before," Hill-Kayer says. "Understanding more about the way that survivors feel after their treatment is one step towards helping patients live as well as possible after cancer."

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