Abstract
PURPOSE: Long-term breast symptoms (pain, sensitivity, swelling and skin problems) after breast cancer treatment can affect survivors' quality-of-life. The trajectory of breast symptoms over time and risk factors associated with their development are not well understood. METHODS: This study built on the work of the international prospective REQUITE cohort study. Patients who underwent breast-conserving surgery and adjuvant radiotherapy (± chemotherapy) completed the EORTC-QLQ-BR23 questionnaire items relating to breast symptoms at four timepoints up to 24 months following radiotherapy. Patients at were re-contacted to complete additional psychometric questionnaires on different aspects of pain perception and the Hospital Anxiety & Depression Scale (HADS), with 237 respondents. RESULTS: Average breast symptoms peaked on completion of radiotherapy but returned to levels equal to or below baseline by 24 months. Patients with more severe breast symptoms at baseline continued to have worse symptoms long-term. In multivariable mixed models, higher breast symptom scores were associated with smoking (p = 0.036), any analgesic use at baseline (p = 0.005), and post-operative haematoseroma (p = 0.034), while older age and use of intensity modulated radiotherapy (IMRT) were protective (p = < 0.001 and p = 0.045 respectively). Psychometric questionnaire scores for life interference and pain severity perception were associated with persistently increased breast symptoms at 24 months on multivariable analysis, while anxiety (as determined by HADS) was associated on univariable analysis. CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS: This study identifies several risk factors for persistent breast symptoms including younger age, smoking, and post-operative haematoseroma. This particularly highlights the importance of smoking cessation and use of IMRT in women at higher risk of side effects.