Breast Edema Following Breast-Conserving Surgery and Radiotherapy: Patient-Reported Prevalence, Determinants, and Effect on Health-Related Quality of Life

Abstract

Background The association between lymphedema of the arm and impaired health-related QoL (HR-QoL) has led to changes in clinical practice. However, data on lymphedema of the breast (ie, breast edema) are lacking. We prospectively evaluated patient-reported prevalence and determinants of breast edema and its effect on patient-reported HR-QoL and breast pain. Methods We prospectively included 836 patients undergoing breast-conserving surgery followed by radiotherapy between October 2013 and October 2016 (UMBRELLA cohort). Patient-reported breast edema, HR-QoL, and breast pain were assessed by means of European Organisation for Research and Treatment of Cancer-C30/BR23 before starting radiotherapy and at 3, 6, 12, and 18 months thereafter. We assessed which patient, tumor, and treatment characteristics were associated with breast edema. With mixed-effects models, we assessed the impact of breast edema on patient-reported HR-QoL domains and breast pain over time, adjusting for confounders. Results Within a median follow-up of 28 months (interquartile range [IQR] = 15), 207 (24.8%) patients reported breast edema at some point in time. Prevalence of breast edema was highest at 6 months (12.4%, 95% confidence interval [CI] = 10.0 to 14.7). Larger tumor size, oncoplastic surgery, axillary lymph node dissection, locoregional radiotherapy, radiotherapy boost on the tumor bed, and adjuvant chemotherapy were associated with breast edema. Breast edema was independently associated with more breast pain and with poorer QoL, physical functioning, and body image. Conclusions Breast edema occurs frequently within the first year after breast-conserving surgery and radiotherapy and is independently associated with impaired HR-QoL and more breast pain. This information is important for use in clinical practice and should be discussed with patients during shared decision making.

Breast edema, from diagnosis to treatment: state of the art

“…Several studies investigated the natural course of breast edema over time and demonstrated similar findings [ 5 , 15 , 23 , 29 , 37 , 38 ]. In Table 2 an overview of the available literature in which all assessment methods and all definitions of breast edema are included, is presented.…”

Does chemotherapy or radiotherapy affect the postoperative complication in breast cancer patients who underwent immediate breast reconstruction with tissue expander?

“…Lymphatic vessels play an important role in wound healing and wound healing is a complex process including inflammation, coagulation, and formation of granulation tissue with angiogenesis and lymphangiogenesis [ 28 ]. Metastatic axillary lymph nodes which have architectural distorsion, loss of hilum, or cortical thickness can affect scar formation and sensory nerves in surrounding tissues, therefore, the higher the N stage, the more the removal of this axillary lymph nodes affects the lymph drainage of the arm, which can result in postoperative complication such as breast edema and delayed wound healing [ 29 ]. In addition, previous studies have demonstrated that sentinel lymph node biopsy and ALND have association with postoperative complication such as lymphedema, wound infection, and seroma formation [ 30 , 31 ].…”

The Acute and Late Toxicities of MRI-Guided External Beam Partial Breast Irradiation Delivered Using a Once-Per-Day Regimen

“…Especially, breast swelling significantly contributed to the difference in late toxicities between the two groups (breast swelling: 9 [5.2%] patients in the APBI vs. 125 [41.7%] in the AWBI group). Young-Afat et al reported that locoregional radiotherapy increased the risk of breast swelling, associated with breast pain and reduced quality of life (17). Generally, breast swelling per se does not require management, but interventions may be required if pain develops.…”