Evaluating the effect of upper-body morbidity on quality of life following primary breast cancer treatment: a systematic review and meta-analysis

Eliza R Macdonald; Nadia M L Amorim; Amanda D Hagstrom; Katarina Markovic; David Simar; Rachel E Ward; Briana K Clifford

doi:10.1007/s11764-023-01395-0

Evaluating the effect of upper-body morbidity on quality of life following primary breast cancer treatment: a systematic review and meta-analysis

J Cancer Surviv. 2023 May 18. doi: 10.1007/s11764-023-01395-0. Online ahead of print.

Authors

Eliza R Macdonald¹, Nadia M L Amorim², Amanda D Hagstrom³, Katarina Markovic³, David Simar³, Rachel E Ward³, Briana K Clifford^{3

4}

Affiliations

¹ School of Health Sciences, Department of Exercise Physiology, UNSW, Sydney, Sydney, Australia. e.macdonald@unsw.edu.au.
² Centre for Inflammation, Faculty of Science, School of Life Sciences, Centenary Institute and University of Technology Sydney, Sydney, NSW, Australia.
³ School of Health Sciences, Department of Exercise Physiology, UNSW, Sydney, Sydney, Australia.
⁴ School of Nursing, Midwifery and Social Work, The University of Queensland (UQ), Brisbane, Australia.

PMID: 37199900
DOI: 10.1007/s11764-023-01395-0

Abstract

Purpose: Improvements in breast cancer management continue to increase survival and life expectancy after treatment. Yet the adverse effects of treatment may persist long term, threatening physical, psychological, and social wellbeing, leading to impaired quality of life (QOL). Upper-body morbidity (UBM) such as pain, lymphoedema, restricted shoulder range of motion (ROM), and impaired function are widely reported after breast cancer treatment, but evidence demonstrating its impact on QOL is inconsistent. Therefore, the aim of the study was to conduct a systematic review and meta-analysis evaluating the effect of UBM on QOL following primary breast cancer treatment.

Methods: The study was prospectively registered on PROSPERO (CRD42020203445). CINAHL, Embase, Emcare, PsycInfo, PubMed/Medline, and SPORTDiscus databases were searched for studies reporting QOL in individuals with and without UBM following primary breast cancer treatment. Primary analysis determined the standardised mean difference (SMD) in physical, psychological, and social wellbeing scores between UBM + /UBM - groups. Secondary analyses identified differences in QOL scores between groups, according to questionnaire.

Results: Fifty-eight studies were included, with 39 conducive to meta-analysis. Types of UBM included pain, lymphoedema, restricted shoulder ROM, impaired upper-body function, and upper-body symptoms. UBM + groups reported poorer physical (SMD = - 0.99; 95%CI = - 1.26, - 0.71; p < 0.00001), psychological (SMD = - 0.43; 95%CI = - 0.60, - 0.27; p < 0.00001), and social wellbeing (SMD = - 0.62; 95%CI = - 0.83, - 0.40; p < 0.00001) than UBM - groups. Secondary analyses according to questionnaire showed that UBM + groups rated their QOL poorer or at equal to, UBM - groups across all domains.

Conclusions: Findings demonstrate the significant, negative impact of UBM on QOL, pervading physical, psychological, and social domains.

Implications for cancer survivors: Efforts to assess and minimise the multidimensional impact of UBM are warranted to mitigate impaired QOL after breast cancer.

Keywords: Breast cancer; Lymphoedema; Pain; Quality of life; Range of motion; Upper-body morbidity.

Publication types

Review