Complications of breast cancer therapy, lymphedema and PBTPS
Abstract F-21 for the American Society of Breast Disease 31st Annual Symposium Society of Clinical Oncology, April 12-14, 2007, San Francisco, CA
Robert Wascher, MD1, Ernest H. Rosenbaum, MD2, Alexandra Andrews2, David Spiegel, MD2, Charles M. Dollbaum, MD, PhD3
1Division of Surgical Oncology, Newark Beth Israel Medical Center, Newark, NJ 07112, 2CancerSupportiveCare.com, Website, Stanford Hospitals and Clinics, Palo Alto, CA, United States, 94304 and 3Carol Franc Buck Breast Care Center, University of California San Francisco, San Francisco, CA, United States, 94115
Introduction-Background-Objective Complications of breast cancer therapy, and lymphedema and PBTPS in particular, can result in a significantly adverse impact on quality of life (QOL) for millions of breast cancer patients. Current standard clinical management approaches are often ad hoc in nature, in the absence of well-defined and evidence-based clinical practice guidelines. Chronic symptoms associated with breast cancer therapy often lead to daily challenges at home and at work, with attendant anxiety and depression for many patients.
Post Breast Therapy Pain Syndrome (PBTPS) is a complex constellation of symptoms. PBTPS can be defined as persistent neuropathic pain, and is often associated with symptoms of numbness, dysesthesia, edema, and allodynia located in the chest wall, axilla, arm, or shoulder of the surgical side. The old term, Post-Mastectomy (after breast amputation) Syndrome, is not sufficiently descriptive with breastpreserving therapy. Recent research suggests that newer approaches to the surgical treatment and staging of breast cancer, such as sentinel lymph node biopsy (SLNB), may significantly decrease the incidence of PBTPS.
Chronic upper extremity swelling, or lymphedema, may also adversely affect breast cancer survivors with short-term or long-term discomfort, chronic pain, debility, and loss of function in the affected limb. Edema adds weight to the limb, causing a sensation of heaviness. Severe lymphedema may, in some cases, put pressure on major motor and sensory nerves causing varying degrees of paresthesia and paralysis. Lymphedema, which may occur in 5 to 15% of patients following breast cancer surgery, is a chronic problem that may lead to distress, pain, and loss of function, anxiety, as well as serving as a daily reminder of a patient's prior treatment for cancer. Another specific area of PBTPS-related functional impairment is the inability to comfortably use a computer which, in the Information Era, may result in significant professional and personal challenges to affected patients.
Methods Health-care providers and patients from 170 countries, including the US, visit CancerSupportiveCare.com. In October of 2005, a MySQL/PHP database was created to investigate and evaluate QOL and supportive care educational strategies regarding PBTS. Specific results will be presented.
Results: (n = 209 PBTPS Respondents, October 2005 - December 2006) Pain Medication Exercise Rest Massage Heat/Ice Pyschosocial /Spritual Nothing Helps 91 (43.5%) 28 (13.4%) 43 (20.6%) 72 (34.4%) 5 (2.09%) 41 (19.6%)
Conclusion Internet-based patient education may allow clinicians to better serve the needs of their patients, with quality of life as one of the end points. A worldwide audience of patients and health-care personnel response to on line questionnaires help gather significant and useful clinical information and insight into the frequently underreported breast cancer treatment complications of Lymphedema and PBTPS
Prior publication or presentation Ongoing publication using the website CancerSupportiveCare.com
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