Acute health-related quality of life outcomes and systemic inflammatory markers following contemporary breast cancer surgery

Abstract

Contemporary breast cancer surgical procedures vary greatly by the amount of tissue removed, anesthesia time, and reconstruction. Despite historical literature comparing the health-related quality of life (HRQOL) after lumpectomy and mastectomy, HRQOL data are limited regarding contemporary surgical procedures. Further, biological processes (e.g., inflammation) associated with HRQOL outcomes have not been described. We conducted two studies to examine differences in post-operative physical and mental functioning, pain, fatigue, and systemic inflammatory markers including interleukin (IL)-6, tumor necrosis factor (TNF)-α, and C-reactive protein (CRP) in women with early-stage breast cancer. Study 1 assessed women before and after surgery (n = 27) and Study 2 used a large cross-sectional sample (n = 240) to confirm findings from Study 1 and included a no-surgery comparison group. In Study 1, women who received mastectomy had lower physical functioning than lumpectomy (ps < 0.05), and those who received bilateral mastectomy had worse pain (p < 0.01) and fatigue (p = 0.029) than lumpectomy. Results were replicated in Study 2: mastectomy groups exhibited poorer physical functioning (ps < 0.01) and greater pain (ps < 0.001) than lumpectomy, and bilateral mastectomy was associated with worse fatigue (p < 0.05). Women who received bilateral mastectomy had higher levels of CRP than lumpectomy (p < 0.01) and higher TNF-α than the no-surgery group (p < 0.05). All surgery groups exhibited higher IL-6 than no-surgery (ps < 0.05). More extensive surgery is associated with poorer postoperative HRQOL. As compared to lumpectomy and no-surgery, mastectomy is associated with higher concentrations of systemic inflammatory markers.

Plasma levels of interleukin‐6 mediate neurocognitive performance in older breast cancer survivors: The Thinking and Living With Cancer study

“…We found that IL‐6, IL‐10, and TNF‐α had a direct relationship with cognition in survivors and controls, findings that parallel prior work by others 13,18–20,22–25,39,40 . The modest but nonsignificant mediation effect of IL‐10, which has regulatory anti‐inflammatory and B cell stimulatory activity, may reflect the dynamic nature of its secondary responses to increased proinflammatory markers 41 .…”

“…We found that IL-6, IL-10, and TNF-α had a direct relationship with cognition in survivors and controls, findings that parallel prior work by others. 13,[18][19][20][22][23][24][25]39,40 The modest but nonsignificant mediation effect of IL-10, which has regulatory anti-inflammatory and B cell stimulatory activity, may reflect the dynamic nature of its secondary responses to increased proinflammatory markers. 41 IFN-γ, which is produced during immune activation and antiviral responses, and IL-8, which is a chemoattractant for neutrophils, were unrelated to cognition.…”

“…We evaluated five immune markers (interleukin‐6 [IL‐6], IL‐8, IL‐10, tumor necrosis factor α [TNF‐α], and interferon γ [IFN‐γ]) previously associated with cognition in cancer survivors 13,18–20,22–25 . Marker plasma levels were determined using an electrochemiluminescent immunoassay (MesoScale Discovery Custom Human Cytokine Proinflammatory Panel, Rockville, Maryland) 26 .…”

“…previously associated with cognition in cancer survivors. 13,[18][19][20][22][23][24][25] Marker plasma levels were determined using an electrochemiluminescent immunoassay (MesoScale Discovery Custom Human Cytokine Proinflammatory Panel, Rockville, Maryland). 26 Assays were performed in duplicate at a 2-fold sample dilution with an extended eight-point standard curve of serial 3-fold dilutions.…”