Introduction
Methods
Patient sampling
Treatment modalities
Measures
Demographic variables
Cancer-related variables and BMI
Clinical assessments of shoulder mobility and lymphedema in 2004
Self-rating of ASPs in 2004
Definition of ASPs present (+) or absent (−) in 2004
Definition of self-rated ASPs in the longitudinal substudy (2004–7)
The IOC version 1 (IOCv1)
The SF-36
Statistical analysis
Ethical considerations
Results
Socio-demographic and cancer-related findings (2004 sample)
Variables in 2004 | ASP- | ASP+ |
p
| ESa
|
---|---|---|---|---|
n = 175 | n = 80 | |||
Mean (SD) | Mean (SD) | |||
Age at survey | 54.5 (8.2) | 54.6 (7.7) | 0.87 | |
Follow up time-years after surgery | 3.9 (0.8) | 4.4 (1.4) | <0.001 | 0.50 |
Body mass index | 26.1 (4.4) | 27.8 (4.9) | 0.01 | 0.37 |
N (%)
|
N (%)
| |||
Paired civil status | 133 (77) | 64 (82) | 0.35 | |
Low level of education (≤12 years) | 99 (58) | 51 (64) | 0.30 | |
Employed | 119 (69) | 37 (46) | 0.001 | 0.47 |
Cancer-related variables | ||||
Type of breast cancer surgery
| <0.001 | 0.52 | ||
Mastectomy | 112 (64) | 69 (86) | ||
Lumpectomy | 63 (36) | 11 (14) | ||
Systemic treatment
| ||||
Received chemotherapy | 138 (79) | 67 (84) | 0.55 | |
Received anti-oesterogen therapy | 134 (76) | 59 (73) | 0.74 | |
Extent of axillary radiotherapy
| 0.005 | 0.39 | ||
Radiotherapy to axillary apex | 121 (69) | 40 (50) | ||
Radiotherapy to entire axilla | 54 (31) | 40 (50) | ||
Tumour size
| 0.20 | |||
pT 1 (≤2 cm) | 102 (59) | 39 (49) | ||
pT 2 (>2- ≤5 cm) | 73 (42) | 41 (51) | ||
Lymph node status, mean (SD)
| ||||
Metastatic lymph nodes | 2.9 (2.6) | 3.3 (3.4) | 0.30 | |
Axillary nodes removed | 12.7 (4.3) | 12.1 (4.6) | 0.30 |
ASP groups and QoL (2004 sample)
Quality of life domains 2004 | ASP- | ASP+ |
p
| ESa
|
---|---|---|---|---|
n = 175 | n = 80 | |||
Mean (SD) | Mean (SD) | |||
SF-36 | ||||
Physical functioning | 82.2 (15.9) | 67.6 (20.3) | <0.001 | 0.84 |
Role physical | 65.7 (39.8) | 37.3 (41.6) | <0.001 | 0.70 |
Bodily pain | 71.0 (26.1) | 49.1 (25.0) | <0.001 | 0.85 |
General health | 74.9 (20.6) | 60.8 (23.9) | <0.001 | 0.65 |
Vitality | 58.2 (21.7) | 44.9 (20.0) | <0.001 | 0.63 |
Social functioning | 87.8 (20.5) | 75.8 (24.1) | <0.001 | 0.55 |
Role emotional | 86.0 (29.7) | 65.2 (42.4) | <0.001 | 0.61 |
Mental health | 80.5 (14.0) | 73.9 (17.4) | 0.007 | 0.44 |
PCS | 46.7 (9.9) | 38.2 (10.4) | <0.001 | 0.85 |
MCS | 53.0 (8.3) | 50.1 (11.1) | 0.13 | – |
Positive IOC dimensions | ||||
Health awareness | 4.0 (0.7) | 4.0 (0.6) | 0.48 | – |
Positive self-evaluation | 3.6 (0.6) | 3.6 (0.6) | 0.80 | – |
Positive outlook | 3.7 (0.8) | 3.7 (0.8) | 0.65 | – |
Values of relationship | 3.5 (0.9) | 3.5 (0.9) | 0.12 | – |
Meaning of cancer | 3.3 (0.7) | 3.4 (0.8) | 0.20 | – |
Negative IOC dimensions | ||||
Body changes | 2.6 (1.0) | 3.6 (0.9) | <0.001 | 1.03 |
Negative self-evaluation | 1.9 (0.8) | 2.3 (0.9) | 0.007 | 0.46 |
Negative outlook | 2.7 (0.9) | 3.1 (1.0) | 0.005 | 0.43 |
Life interference | 2.9 (0.8) | 3.5 (0.7) | <0.001 | 0.78 |
Health worry | 3.5 (0.9) | 3.6 (1.0) | 0.23 | – |
Clinically rated restricted mobility versus lymphedema and QoL (2004 sample)
Quality of life domains 2004 | Restricted mobility | Lymphedema | ||||
---|---|---|---|---|---|---|
+ n = 85 /−n = 170 | + n = 43 /−n = 212 | |||||
OR | (95%CI) |
p
| OR | (95%CI) |
p
| |
SF-36 | ||||||
Physical functioning | 0.96 | (0.95–0.98) | <0.001 | 0.98 | (0.96–0.99) | 0.01 |
Role physical | 0.99 | (0.98–0.99) | <0.001 | 1.00 | (0.99–1.00) | 0.34 |
Bodily pain | 0.99 | (0.98–0.99) | <0.001 | 0.99 | (0.98–1.00) | 0.13 |
General health | 0.99 | (0.98–0.99) | <0.001 | 0.99 | (0.98–1.00) | 0.13 |
Vitality | 0.98 | (0.97–0.99) | 0.002 | 1.00 | (0.98–1.01) | 0.55 |
Social functioning | 0.99 | (0.98–1.00) | 0.04 | 0.99 | (0.98–1.01) | 0.44 |
Role emotional | 0.99 | (0.98–0.99) | <0.001 | 1.00 | (0.99–1.01) | 0.37 |
Mental health | 0.99 | (0.97–1.00) | 0.10 | 1.00 | (0.98–1.02) | 0.67 |
PCS | 0.94 | (0.92–0.97) | <0.001 | 0.98 | (0.94–1.00) | 0.06 |
MCS | 0.98 | (0.98–1.01) | 0.26 | 1.00 | (0.97–1.04) | 0.90 |
Positive IOC dimensions | ||||||
Health awareness | 0.87 | (0.61–1.21) | 0.46 | 0.94 | (0.60–1.49) | 0.80 |
Positive self-evaluation | 0.88 | (0.58–1.34) | 0.54 | 0.89 | (0.53–1.51) | 0.67 |
Positive outlook | 1.06 | (0.75–1.49) | 0.75 | 1.13 | (0.73–1.75) | 0.58 |
Values of relationship | 1.10 | (0.82–1.53) | 0.53 | 1.48 | (0.97–2.24) | 0.07 |
Meaning of cancer | 1.26 | (0.89–1.79) | 0.19 | 1.17 | (0.76–1.82) | 0.47 |
Negative IOC dimensions | ||||||
Body changes | 1.92 | (1.46–2.53) | <0.001 | 1.50 | (1.09–2.07) | 0.01 |
Negative self-evaluation | 1.34 | (0.99–1.83) | 0.06 | 1.43 | (0.98–2.09) | 0.06 |
Negative outlook | 1.32 | (1.00–1.73) | 0.05 | 1.30 | (0.92–1.83) | 0.13 |
Life interference | 1.82 | (1.29–2.56) | 0.001 | 2.08 | (1.34–3.23) | 0.001 |
Health worry | 1.04 | (0.78–1.38) | 0.80 | 1.05 | (0.73–1.49) | 0.81 |
Longitudinal study findings 2004–2007
Short Form 36 Domains | Arm/shoulder paina
| Restricted arm/shoulder mobilityb
| Lymphedemac
| |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
OR |
p
| mean (SD) |
p
| OR |
p
| mean (SD) |
p
| OR |
p
| mean (SD) |
p
| |
Physical functioning 04 | 0.97 | 0.27 | 66.3 (19.9) | 0.08 | 0.96 | <0.001 | 61.5 (19.8) | 0.47 | 0.96 | <0.001 | 62.9 (20.2) | 0.24 |
Physical functioning 07 | 0.98 | 0.21 | 69.5 (20.6) | 0.96 | <0.001 | 63.7 (21.8) | 0.97 | <0.001 | 65.8 (22.2) | |||
Role physical 04 | 0.99 | 0.33 | 35.5 (38.4) | 0.17 | 0.98 | 0.001 | 30.0 (35.6) | 0.67 | 0.98 | <0.001 | 31.6 (39.3) | 0.81 |
Role physical 07 | 0.98 | 0.03 | 40.9 (42.4) | 0.98 | <0.001 | 32.5 (42.6) | 0.99 | <0.001 | 32.9 (42.0) | |||
Bodily pain 04 | 0.95 | 0.01 | 43.8 (20.8) | 0.06 | 0.96 | <0.001 | 40.8 (20.7) | 0.39 | 0.97 | <0.001 | 46.2 (22.2) | 0.62 |
Bodily pain 07 | 0.96 | 0.01 | 48.1 (21.9) | 0.96 | <0.001 | 44.0 (22.6) | 0.97 | <0.001 | 47.7 (21.8) | |||
General health 04 | 0.98 | 0.25 | 57.1 (23.6) | 0.80 | 0.97 | <0.001 | 54.4 (22.5) | 0.73 | 0.96 | <0.001 | 53.7 (25.1) | 0.47 |
General health 07 | 0.97 | <0.001 | 57.7 (26.2) | 0.97 | <0.001 | 52.9 (30.2) | 0.97 | <0.001 | 51.4 (28.6) | |||
Vitality 04 | 0.96 | 0.09 | 43.9 (19.1) | 0.47 | 0.97 | 0.003 | 42.5 (19.0) | 0.87 | 0.97 | <0.001 | 41.5 (16.2) | 0.56 |
Vitality 07 | 0.96 | <0.001 | 45.7 (20.4) | 0.97 | 0.005 | 41.8 (22.4) | 0.98 | 0.03 | 43.0 (21.6) | |||
Social functioning 04 | 0.95 | 0.06 | 75.7 (23.5) | 0.66 | 0.97 | 0.001 | 70.8 (25.7) | 0.85 | 0.98 | 0.004 | 74.0 (23.3) | 0.68 |
Social functioning 07 | 0.98 | 0.001 | 77.0 (24.9) | 0.97 | 0.001 | 70.0 (24.9) | 0.99 | 0.009 | 75.7 (26.3) | |||
Role emotional 04 | 0.98 | 0.13 | 69.3 (41.2) | 0.54 | 0.98 | <0.001 | 54.4 (45.9) | 0.42 | 0.99 | 0.004 | 65.4 (42.9) | 0.95 |
Role emotional 07 | 0.99 | 0.001 | 65.7 (43.9) | 0.99 | 0.02 | 62.2 (46.1) | 0.99 | 0.001 | 64.9 (43.8) | |||
Mental health 04 | 0.95 | 0.13 | 73.1 (16.5) | 0.40 | 0.96 | <0.001 | 69.2 (18.4) | 0.04 | 0.97 | 0.005 | 72.4 (17.4) | 0.62 |
Mental health 07 | 0.97 | 0.006 | 74.6 (17.2) | 0.98 | 0.05 | 73.6 (17.8) | 0.97 | 0.02 | 73.5 (18.2) | |||
PCS 04 | 0.95 | 0.20 | 36.4 (9.7) | 0.03 | 0.93 | <0.001 | 35.6 (8.5) | 0.95 | 0.92 | <0.001 | 35.6 (9.7) | 0.67 |
PCS 07 | 0.91 | <0.001 | 38.3 (10.5) | 0.92 | <0.001 | 35.5 (11.1) | 0.94 | <0.001 | 36.1 (10.9) | |||
MCS 04 | 0.92 | 0.11 | 51.0 (10.5) | 0.71 | 0.95 | 0.007 | 48.3 (11.5) | 0.34 | 0.97 | 0.12 | 50.5 (10.4) | 0.80 |
MCS 07 | 0.97 | 0.10 | 50.6 (10.1) | 0.98 | 0.31 | 50.0 (9.3) | 0.97 | 0.10 | 50.9 (10.1) |
Impact of cancer scale version1 domains | Arm/shoulder paina
| Restricted arm/shoulder mobilityb
| Lymphedemac
| |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
OR |
p
| mean (SD) |
p
| OR |
p
| mean (SD) |
p
| OR |
p
| mean (SD) |
p
| |
Health awareness 04 | 1.11 | 0.64 | 4.0 (0.7) | 0.06 | 1.37 | 0.31 | 4.1 (0.7) | 0.93 | 0.46 | 0.20 | 4.0 (0.6) | 0.64 |
Health awareness 07 | 0.06 | 0.46 | 3.9 (0.7) | 1.15 | 0.66 | 4.1 (0.6) | 0.44 | 0.22 | 4.0 (0.6) | |||
Positive self-evaluation 04 | 1.07 | 0.78 | 3.6 (0.6) | 0.03 | 1.50 | 0.23 | 3.8 (0.6) | 0.001 | 0.76 | 0.68 | 3.7 (0.4) | 0.006 |
Positive self-evaluation 07 | 0.15 | 0.05 | 3.6 (0.6) | 1.64 | 0.14 | 3.5 (0.7) | 0.85 | 0.76 | 3.5 (0.5) | |||
Positive outlook 04 | 1.06 | 0.76 | 3.8 (0.8) | 0.22 | 1.26 | 0.38 | 3.9 (0.6) | 1.00 | 1.06 | 0.79 | 3.9 (0.7) | 0.04 |
Positive outlook 07 | 0.11 | 0.16 | 3.7 (0.7) | 1.14 | 0.64 | 3.9 (0.7) | 0.58 | 0.36 | 3.7 (0.7) | |||
Values of relationship 04 | 1.45 | 0.04 | 3.5 (0.9) | 0.03 | 1.41 | 0.17 | 3.7 (0.7) | 0.01 | 0.86 | 0.47 | 3.8 (0.7) | 0.04 |
Values of relationship 07 | 0.06 | 0.47 | 3.4 (0.9) | 1.11 | 0.67 | 3.4 (0.8) | 0.85 | 0.73 | 3.6 (0.6) | |||
Meaning of cancer 04 | 1.28 | 0.21 | 3.3 (0.8) | 0.07 | 1.75 | 0.04 | 3.6 (0.8) | 0.47 | 1.37 | 0.50 | 3.6 (0.7) | 0.38 |
Meaning of cancer 07 | 0.01 | 0.86 | 3.2 (0.8) | 1.30 | 0.30 | 3.5 (1.0) | 0.92 | 0.86 | 3.4 (0.9) | |||
Body changes 04 | 2.57 | <0.001 | 2.9 (1.1) | 0.27 | 2.34 | <0.001 | 3.7 (1.2) | 0.19 | 5.82 | 0.009 | 3.7 (0.9) | 0.04 |
Body changes 07 | 2.15 | <0.001 | 3.0 (1.1) | 1.90 | 0.002 | 3.9 (1.0) | 1.63 | 0.005 | 3.6 (1.1) | |||
Negative self-evaluation 04 | 2.09 | <0.001 | 2.0 (0.9) | 0.58 | 2.02 | 0.002 | 2.5 (1.0) | 0.94 | 3.24 | 0.03 | 2.6 (0.9) | 0.25 |
Negative self-evaluation 07 | 2.10 | <0.001 | 2.0 (0.9) | 1.69 | 0.02 | 2.5 (1.1) | 1.59 | 0.02 | 2.5 (1.0) | |||
Negative outlook 04 | 1.84 | <0.001 | 2.8 (1.0) | 0.002 | 2.00 | 0.002 | 3.3 (1.2) | 0.47 | 1.25 | 0.50 | 3.3 (0.9) | 0.18 |
Negative outlook 07 | 1.77 | <0.001 | 2.6 (1.0) | 1.64 | 0.02 | 3.2 (1.2) | 1.33 | 0.10 | 3.2 (1.0) | |||
Life interferences 04 | 3.30 | <0.001 | 3.1 (0.8) | <0.001 | 3.13 | <0.001 | 3.7 (0.7) | 0.54 | 2.26 | 0.14 | 3.8 (0.7) | 0.55 |
Life interferences 07 | 2.36 | <0.001 | 2.8 (1.2) | 1.88 | 0.001 | 3.2 (1.3) | 1.68 | 0.001 | 3.7 (1.2) | |||
Health worry 04 | 1.67 | 0.007 | 3.5 (0.9) | 0.001 | 2.14 | 0.004 | 4.0 (1.1) | 0.49 | 2.07 | 0.09 | 4.0 (0.8) | 0.11 |
Health worry 07 | 1.64 | 0.003 | 3.4 (1.0) | 1.58 | 0.04 | 3.9 (1.0) | 1.28 | 0.17 | 3.8 (0.9) |