Quality of Life after Invasive or Breast-Conserving Surgery for Breast Cancer

Breast surgery and its side effects can compromise the ability to perform daily functional activities resulting in impaired quality of life (QoL). Treatment‐related factors, including fatigue, pain, loss of upper extremity range of motion (ROM) and strength, anxiety, weight changes, unemployment, and neuropathy, have also been suggested to compromise functioning and QoL 1. For this reasons surgery is currently moving towards methods that are more conservative. Many studies investigated about cancer response, recovery and survival rate, which is improving in last years. So in the present study we focus on patient well‐being, even if it is very difficult to define QoL because it is a multidimensional measure, involving many different factors such as pain, fear’ and fatigue 2, among others. Breast‐specific concerns, such as altered sense of femininity, feelings of decreased attractiveness, and changes in body image and sexuality could affect general QoL. For the evaluation of QoL, we used the Short Form Health Survey Questionnaire (SF‐36). This questionnaire is composed by 36 items, gathered into eight scales: Physical Activity, Physical Role Limitation, General Health, Bodily Pain, Vitality, Social Activity, Emotional Role Limitation, and Mental Health. The first three scales evaluate physical wellness, whereas the last three are related to psychological wellness. The score for every scale ranges from 0 to 100, with 100 representing health 3. SF‐36 is one of the most used instrument in clinical investigations. We assessed SF‐36 in 63 consecutive unselected patients, followed up between January 2013 and January 2015. All patients underwent surgery for unilateral breast cancer (Breast Surgery Unit and Plastic Surgery Unit). 26 patients who received only sentinel lymph node dissection were excluded. Among the remaining 37 patients (Surgical Group) who received axillary lymphnodes dissection 16 underwent lumpectomy (Lumpectomy Group) and 21 mastectomy (Mastectomy Group) with reconstruction in the same surgery session. After surgery, patients were instructed on how to position their shoulder and arm in bed and how to carry out exercises for upper limbs after discharge. During hospitalization, the same physiotherapist treated all patients. Those who underwent lumpectomy, physical therapy started on the first postoperative day, while those who had mastectomy and immediate reconstruction started on the third postoperative day. All the patients received a brochure with home based exercises, consisting in active, active‐assisted and passive ROM exercises, stretching and upper‐limb strengthening exercises, with the aim of restoring muscular length and joint mobility 4. Evaluations were performed before (T0) and 1 (T1), 3 (T2), 6 (T3), 12 (T4) months after surgery. SF‐36 scores were compared with those of a control group age‐matched to the patients but without a diagnosis of breast cancer. We also aim to assess the impact of different tags as different surgery approach, conservative and demolitive, treatment related conditions, shoulder articular limitation, pain, lymphedema, and chemotherapy on QoL (Table 1).