Long-term adjustment of survivors of early-stage breast carcinoma, 20 years after adjuvant chemotherapy


  • The following institutions participated in this study: Cancer and Leukemia Group B Statistical Office, Durham, NC (Stephen George, Ph.D., supported by CA33601); Dartmouth Medical School–Norris Cotton Cancer Center, Lebanon, NH (Marc Ernstoff, MD, supported by CA04326); Georgetown University Medical Center, Washington, DC (Edward P. Gelmann, M.D., supported by CA77597); Massachussetts General Hospital, Boston, MA (Michael L. Grossbard, M.D., supported by CA12449); Mount Sinai School of Medicine, New York, NY (Lewis Silverman, M.D., supported by CA04457); North Shore–Long Island Jewish Medical Center, Manhasset, NY (Daniel R. Budman, M.D., supported by CA35279); Rhode Island Hospital, Providence, RI (William Sikov, M.D., supported by CA08025); Roswell Park Cancer Institute, Buffalo, NY (Ellis Levine, M.D., supported by CA02599); SUNY Upstate Medical University, Syracuse, NY (Stephen L. Graziano, M.D., supported by CA21060); University of California at San Diego, San Diego, CA (Stephen Seagren, M.D., supported by CA11789); University of Maryland Cancer Center, Baltimore, MD (David Van Echo, M.D., supported by CA31983); University of Pretoria, Pretoria, South Africa; University of Missouri–Ellis Fischel Cancer Center, Columbia, MO (Michael C. Perry, M.D., supported by CA12046); Wake Forest University School of Medicine, Winston-Salem, NC (David D. Hurd, M.D., supported by CA03927); Walter Reed Army Medical Center, Washington, DC (Joseph J. Drabeck, M.D., supported by CA26806); Weill Medical College of Cornell University, New York, NY (Michael Schuster, M.D., supported by CA07968); Western Pennsylvania Cancer Institute, Pittsburgh, PA (Richard K. Shadduck, M.D.).

    The current study was performed for the Cancer and Leukemia Group B (CALGB), Chicago, IL.



The long-term impact of breast carcinoma and its treatment was assessed in 153 breast carcinoma survivors previously treated on a Phase III randomized trial (Cancer and Leukemia Group B [CALGB 7581]) a median of 20 years after entry to CALGB 7581.


Survivors were interviewed by telephone using the following standardized measures: Brief Symptom Inventory (BSI), PostTraumatic Stress Disorder Checklist with the trauma defined as survivors' response to having had cancer (PCL-C), Conditioned Nausea, Vomiting and Distress, European Organization for Research and Treatment of Cancer QLQ-C30 (quality of life), Life Experience Survey (stressful events), MOS Social Support Survey, comorbid conditions (Older Americans Resources and Services Questionnaire), and items developed to assess long-term breast carcinoma treatment side effects and their interference with functioning.


Only 5% of survivors had scores that were suggestive of clinical levels of distress (BSI), 15% reported 2 or more posttraumatic stress disorder (PTSD) symptoms (PCL-C) that were moderately to extremely bothersome, 1–6% reported conditioned nausea, emesis, and distress as a consequence of sights, smells, and tastes triggered by reminders of their treatment, 29% reported sexual problems attributed to having had cancer, 39% reported lymphedema, and 33%, reported numbness. Survivors who reported greater lymphedema and numbness that interfered with functioning had significantly worse PTSD (PCL-C; P = 0.008) com- pared with survivors who reported less lymphedema and numbness. Survivors with a lower level of education (P = 0.026), less adequate social support (P = 0.0033), more severe negative life events (P = 0.0098), and greater dissatisfaction with their medical care (P = 0.037) had worse PTSD compared with other survivors.


Twenty years after the initial treatment, the impact of breast carcinoma on survivors' adjustment was minimal. However, the higher prevalence of PTSD symptoms in response to having had cancer is indicative of continuing psychologic sequelae long after treatment completion. Findings related to lymphedema and numbness and continued symptoms of PTSD suggest that the long-term psychologic and medical sequelae on adjustment may be underrecognized. To establish in more detail whether survivors' overall psychologic state is any different from that of individuals without cancer, a population of community residents without cancer would need to be studied. Cancer 2003;98:679–89. © 2003 American Cancer Society.

DOI 10.1002/cncr.11531