Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2022

Evaluating the effect of upper-body morbidity on quality of life after primary breast cancer treatment: a systematic review and meta-analysis (#413)

Eliza Macdonald 1 , David Simar 1 , Amanda Hagstrom 1 , Nadia Amorim 2 , Katarina Markovic 1 , Rachel Ward 1 , Briana Clifford 1 3
  1. UNSW, Sydney, Randwick, NSW, Australia
  2. University of Technology Sydney, Sydney, NSW, Australia
  3. The University of Queensland, Brisbane, NSW, Australia

Aim

Improvements in breast cancer management continue to increase survival rates and life expectancy after treatment[1]. Yet the adverse effects of treatment may persist long term, threatening physical, psychological, and social wellbeing, leading to impaired quality of life (QOL). Upper-body morbidity (UBM) such as pain, lymphedema, restricted shoulder range of motion (ROM), and impaired function are widely reported after breast cancer treatment [2], but evidence demonstrating the impact of UBM on QOL is inconsistent.  Therefore, the aim of the study was to conduct a systematic review and meta-analysis evaluating the effect of UBM on QOL following primary breast cancer treatment.

Methods

The study was prospectively registered in PROSPERO (CRD42020203445). CINAHL, Embase, Emcare, PsycInfo, PubMed/Medline and SPORTDiscus databases were searched to identify studies reporting QOL in individuals with and without UBM following primary breast cancer treatment, using a multidimensional QOL questionnaire. The primary analysis determined the standardised mean difference (SMD) in physical, psychological, and social wellbeing scores between UBM+/UBM- groups. Secondary analyses identified differences in domain scores between groups, according to QOL questionnaire. 

Results

Fifty-four studies were included, of which 37 were conducive to meta-analysis. Types of UBM included pain, lymphedema, restricted shoulder ROM, impaired upper-body function, and upper-body symptoms. UBM+ groups reported poorer physical (SMD -1.01); psychological (SMD = -0.43) and social wellbeing (SMD = -0.61) than UBM- groups. Secondary analyses showed individuals with UBM reported having QOL poorer, or at least equal to, those without UBM across all domains.

Conclusions

The findings of this systematic review and meta-analysis demonstrate the significant and negative impact of treatment related UBM on QOL, pervading physical, psychological, and social domains. Efforts to assess and minimise the impact of UBM across multiple life domains are warranted to mitigate impairment to QOL after breast cancer.

  1. [1] Sung, H., et al., Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians, 2021. 71(3): p. 209-249 https://doi.org/10.3322/caac.21660
  2. [2] Hayes, S.C., et al., Upper-body morbidity after breast cancer: incidence and evidence for evaluation, prevention, and management within a prospective surveillance model of care. Cancer, 2012. 118(8 Suppl): p. 2237-49 https://dx.doi.org/10.1002/cncr.27467