A longitudinal analysis of chronic arm morbidity following breast cancer surgery.

Arm morbidity (AM) arising from breast cancer (BC) treatment can detrimentally impact quality of life; often limiting a survivor's ability to participate in valued activities. The present study explored (a) the developmental time course of AM [restricted range of motion (ROM), pain, and arm volume changes], negative affect, and perceived disability in the immediate years post-surgery, and (b) the mediating role of perceived disability on the relationship between AM and negative affect over time. In this 5-year longitudinal study, BC survivors from four Canadian oncology clinics (n = 431) completed five annual clinical assessments, where differences in ROM (shoulder abduction, external rotation) and arm volume between the affected and non-affected arm were measured. The profile of mood states (POMS), disability of arm, shoulder, hand, and McGill Pain Questionnaire-Short form were completed. Results from general linear modeling showed that AM, negative affect, and perceived disability were greatest 1-year post-surgery, declined, and with the exception of arm volume changes, were significantly lower 5 years later. Negative affect was significantly associated with restrictions in shoulder abduction and external rotation (average r = -0.15; p < 0.05) and present arm pain (average r = 0.28, p < 0.01) at most assessments. The mediating role of perceived disability on the relationship between AM and negative affect was statistically significant in a majority of assessments. Perceived disability is the underlying factor driving the relationship between AM and mood disturbance over time. Rehabilitative therapy to improve survivors' functional well-being might mitigate the negative impacts of AM on emotional health.

Predictors of arm morbidity following breast cancer surgery.

OBJECTIVE: Arm morbidity post-breast cancer surgery is increasingly being recognized as a chronic problem for some women following breast cancer surgery. The purpose of this study was to examine demographic, disease, and treatment-related predictors of a comprehensive array of chronic arm morbidity (pain, lymphedema, functional disability, and range of motion) post-breast cancer surgery. METHODS: Women (n=316) with a non-metastatic primary diagnosis of breast cancer were accrued from cancer centers in four Canadian cities. Patients completed a clinical assessment and measures of arm morbidity at 6-12 months post-breast cancer surgery. The independent variables in the MANOVA to predict arm morbidity included: Lymph node management type, number of axillary nodes dissected, type of surgery, disease stage, presence of post-operative infection, radiation to the axilla, body mass index (BMI), assessment time post-surgery, education, and partner status. RESULTS: Pain was significantly predicted by axillary lymph node management, lack of a partner, and post-operative infection; lymphedema by axillary lymph node management, number of axillary nodes dissected, radiation to the axilla, and having a modified radical mastectomy; functional disability by post-operative infection and high BMI; and restricted external rotation by axillary lymph node management, low educational attainment, and advanced disease. CONCLUSION: Comprehensive behavioral management and rehabilitation programs are needed to treat arm morbidity following breast cancer surgery. These programs should address the full scope of symptoms and associated psychosocial and functional sequelae.

What is the optimal duration of androgen deprivation therapy in prostate cancer patients presenting with prostate-specific antigen levels > 20 ng/ml?

PURPOSE: To evaluate the optimal duration of androgen deprivation therapy (ADT) in patients with prostate cancer treated with external beam radiotherapy (EBRT), who present with PSA levels > 20 ng/mL. METHODS AND MATERIALS: A total of 307 patients presenting with a PSA > 20 ng/ml were treated with EBRT and ADT. The cohort was divided into four groups according to the duration of ADT: Group 1 received < 6 months (n = 71), group 2 received 6-12 months (n = 80), group 3 received 12-24 months (n = 72), and group 4 received > 24 months (n = 84) of ADT. The endpoints analyzed were biochemical control (bNED), overall survival (OS) and cause-specific survival (CSS). Statistical analysis was conducted using Kaplan-Meier estimates and Cox regression models. RESULTS: Compared to patients who received < 6 months of ADT, patients treated with 12-24 months or > 24 months of ADT experienced significantly improved bNED (p = 0.01 and p < 0.0001, respectively). Cause-specific survival with ADT durations 12-24 and > 24 months were significantly higher compared to < 6 months (p < 0.007 and 0.024, respectively). Overall survival with ADT durations > 24 months was also significantly higher compared to < 6 months (p = 0.0025). CONCLUSIONS: The present analysis supports the hypothesis that longer durations of ADT improves bNED, CSS and OS in patients presenting with a PSA > 20 ng/ml.