Patient-reported shoulder morbidity and fatigue among the breast cancer survivors: An insight from a Tertiary Care Cancer Hospital

Context: Breast cancer is the most common cancer in Indian women with an annual mortality of around 87,000. Treatment for breast carcinoma may lead to swelling of the ipsilateral arm and shoulder stiffness and arm pain and cancer-related fatigue. Very few centers in India have reported the arm and shoulder morbidity treated in their hospital. Aims: The study aims to evaluate the predictive factors of arm and shoulder morbidity and fatigue among the survivors. Settings and Design: Retrospective analysis from a prospectively maintained database. Materials and Methods: Early and locally advanced cases of breast cancer patients were screened for the study during 2015–2018. Eligible participants were invited to fill up the predetermined questionnaire and their demographic and treatment-related information was accrued from a file archive. Follow-up period was estimated from the date of tissue diagnosis to last contact/time of interview. Statistical Analysis Used: Predictive factors of shoulder morbidity and fatigue were analyzed by independent sample t-test and univariate analysis. Significant predictive factors were selected for further validation in the multivariate cox regression model. A P ≤ 0.05 was considered significant. Results: Shoulder stiffness was the most common complaint followed by arm numbness. Obesity and diabetes played a crucial role in most of the morbidities and fatigue. The median fatigue score was 34 and the median time of appearance of lymphedema was 13 months. Modified radical mastectomy, and radiotherapy to axilla were significantly associated with greater shoulder stiffness and arm swelling. Conclusions: Obesity, diabetes, type of surgery, the extent of axillary dissection, and radiation plan are the major predictive factors of arm and shoulder morbidity. Further prospective validation is necessary for future breast cancer survivorship programs.