Pain after quadrantectomy and radiotherapy for early-stage breast cancer: incidence, characteristics and influence on quality of life. Results from a retrospective study

Abstract

Purpose: Conservative breast surgery (CBS) is viewed as a surgical technique able to improve the psychophysical outcome of women who underwent surgery for breast cancer (BC). CBS has clearly improved the impact of local treatment on postoperative body image adjustment, but the effect on patients' quality of life (QL) is similar to that observed after mastectomy. This insufficient adjustment may be related to the fact that sensorial alterations, mainly pain, may produce negative effects on patients' QL. This retrospective study, based on self-completed questionnaires, reports the patients' descriptions of pain and its relationships with QL adjustment after quadrantectomy and radiotherapy for BC.

Patients and methods: We mailed a questionnaire to a consecutive series of 481 patients treated with CBS and radiotherapy from March 1995 to March 1998. The questionnaire, listing 129 items, comprised: (1) a pain assessment module with the short form of the McGill Pain Questionnaire exploring the characteristics and the description of the pain; (2) a QL questionnaire including four subscales (physical well-being, psychological well-being, physical autonomy, and relationships).

Results: Three hundred and forty-eight patients (72%) completed the questionnaire, but 24 were excluded from the analysis due to absence of axillary dissection. One hundred and forty-one patients reported pain as a consequence of treatment. It generally started within 3 months after the completion of therapy, was localized in the axillary region and was intermittent. The pain was mainly described as aching (59%), tender (51%) and cramping (43%). Compared to the patients who did not experience pain, those who suffered from pain had significantly worse scores in physical (p < 0.0001), psychological (p < 0.0001), autonomy (p < 0.05), and relational subscales (p < 0.0001).

Conclusions: Our data support the hypothesis that pain is a frequent sequela of CBS and radiotherapy, and that such symptoms can cause postoperative psychosocial distress, thus limiting patient adaptation and reducing the beneficial effect of CBS on body image.