A systematic review and meta-analysis of risk factors influencing patient-reported arm symptoms post-breast cancer treatment: Accounting for radiotherapy impact

Objectives: To systematically review risk factors for patient-reported arm symptoms (AS) in breast cancer (BC), considering radiotherapy (RT) impact, using the EORTC QLQ-BR23 questionnaire (BR23). Methods: PubMed, Embase, Cochrane Library, MEDLINE, and Web of Science were searched using the keywords...

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Main Authors: Yuqin Liang, Yuedan Zhou, Ruud Houben, Karolien Verhoeven, Sofia Rivera, Liesbeth J. Boersma
Format: Article
Language:English
Published: Elsevier 2024-12-01
Series:Breast
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Online Access:http://www.sciencedirect.com/science/article/pii/S0960977624001437
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author Yuqin Liang
Yuedan Zhou
Ruud Houben
Karolien Verhoeven
Sofia Rivera
Liesbeth J. Boersma
author_facet Yuqin Liang
Yuedan Zhou
Ruud Houben
Karolien Verhoeven
Sofia Rivera
Liesbeth J. Boersma
author_sort Yuqin Liang
collection DOAJ
description Objectives: To systematically review risk factors for patient-reported arm symptoms (AS) in breast cancer (BC), considering radiotherapy (RT) impact, using the EORTC QLQ-BR23 questionnaire (BR23). Methods: PubMed, Embase, Cochrane Library, MEDLINE, and Web of Science were searched using the keywords ''breast neoplasms'', ''radiotherapy'', and ''BR23'' up to March 5th, 2024. Inclusion criteria: both univariate and multivariate analyses. Exclusion criteria: pregnancy, recurrence, distant metastasis BC, reirradiation, or lack of RT. The risk of bias of included papers was assessed using the Critical Appraisal Skills Program (CASP) checklist. Descriptive and meta-analyses were conducted using risk ratio (RR) or standardized mean difference (SMD) with 95 % confidence intervals (CI) as effect measures. A random-effects model was applied if I2 > 50 %. Results: Eighteen out of 734 studies were included, with sample sizes ranging from 172 to 2208. Commonly reported risk factors included axillary lymph node dissection (ALND), mastectomy, chemotherapy (CT), and RT (6, 5, 4, and 4 studies, respectively). In meta-analyses, ALND was a risk factor for arm pain (RR [95 % CI] = 1.75 [1.14; 2.71]), lymphedema (RR [95 % CI] = 5.41 [3.48; 8.39]), and overall AS (SMD [95 % CI] = 0.49 [0.14; 0.83]) compared to sentinel lymph node biopsy. RT was not a risk factor, but axillary RT significantly increased overall AS (SMD [95 % CI] = 0.55 [0.40; 0.70]) compared to no axillary RT. Conclusion: ALND and mastectomy were the primary risk factors for patient-reported AS. Axillary RT was a significant risk factor, whereas general RT was not.
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publishDate 2024-12-01
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spelling doaj-art-8f036b9da5b544f19230370b1f38ce2e2024-11-21T06:02:43ZengElsevierBreast1532-30802024-12-0178103812A systematic review and meta-analysis of risk factors influencing patient-reported arm symptoms post-breast cancer treatment: Accounting for radiotherapy impactYuqin Liang0Yuedan Zhou1Ruud Houben2Karolien Verhoeven3Sofia Rivera4Liesbeth J. Boersma5Department of Radiation Oncology (Maastro), GROW-Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands; Corresponding author. Department of Radiation Oncology (Maastro), GROW-Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Dr Tanslaan 12, 6229, ET Maastricht, Maastricht, the Netherlands.Department of Radiation Oncology, Centre Hospitalier Universitaire Amiens-Picardie, 1 rond-point du Professeur Christian Cabrol, 80054, Amiens, FranceDepartment of Radiation Oncology (Maastro), GROW-Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the NetherlandsDepartment of Radiation Oncology (Maastro), GROW-Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the NetherlandsRadiation Oncology Department, Gustave Roussy, F-94805, Villejuif, FranceDepartment of Radiation Oncology (Maastro), GROW-Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the NetherlandsObjectives: To systematically review risk factors for patient-reported arm symptoms (AS) in breast cancer (BC), considering radiotherapy (RT) impact, using the EORTC QLQ-BR23 questionnaire (BR23). Methods: PubMed, Embase, Cochrane Library, MEDLINE, and Web of Science were searched using the keywords ''breast neoplasms'', ''radiotherapy'', and ''BR23'' up to March 5th, 2024. Inclusion criteria: both univariate and multivariate analyses. Exclusion criteria: pregnancy, recurrence, distant metastasis BC, reirradiation, or lack of RT. The risk of bias of included papers was assessed using the Critical Appraisal Skills Program (CASP) checklist. Descriptive and meta-analyses were conducted using risk ratio (RR) or standardized mean difference (SMD) with 95 % confidence intervals (CI) as effect measures. A random-effects model was applied if I2 > 50 %. Results: Eighteen out of 734 studies were included, with sample sizes ranging from 172 to 2208. Commonly reported risk factors included axillary lymph node dissection (ALND), mastectomy, chemotherapy (CT), and RT (6, 5, 4, and 4 studies, respectively). In meta-analyses, ALND was a risk factor for arm pain (RR [95 % CI] = 1.75 [1.14; 2.71]), lymphedema (RR [95 % CI] = 5.41 [3.48; 8.39]), and overall AS (SMD [95 % CI] = 0.49 [0.14; 0.83]) compared to sentinel lymph node biopsy. RT was not a risk factor, but axillary RT significantly increased overall AS (SMD [95 % CI] = 0.55 [0.40; 0.70]) compared to no axillary RT. Conclusion: ALND and mastectomy were the primary risk factors for patient-reported AS. Axillary RT was a significant risk factor, whereas general RT was not.http://www.sciencedirect.com/science/article/pii/S0960977624001437Breast cancerPatient-reported outcome measuresArm symptomRisk factorRadiotherapySystematic review
spellingShingle Yuqin Liang
Yuedan Zhou
Ruud Houben
Karolien Verhoeven
Sofia Rivera
Liesbeth J. Boersma
A systematic review and meta-analysis of risk factors influencing patient-reported arm symptoms post-breast cancer treatment: Accounting for radiotherapy impact
Breast
Breast cancer
Patient-reported outcome measures
Arm symptom
Risk factor
Radiotherapy
Systematic review
title A systematic review and meta-analysis of risk factors influencing patient-reported arm symptoms post-breast cancer treatment: Accounting for radiotherapy impact
title_full A systematic review and meta-analysis of risk factors influencing patient-reported arm symptoms post-breast cancer treatment: Accounting for radiotherapy impact
title_fullStr A systematic review and meta-analysis of risk factors influencing patient-reported arm symptoms post-breast cancer treatment: Accounting for radiotherapy impact
title_full_unstemmed A systematic review and meta-analysis of risk factors influencing patient-reported arm symptoms post-breast cancer treatment: Accounting for radiotherapy impact
title_short A systematic review and meta-analysis of risk factors influencing patient-reported arm symptoms post-breast cancer treatment: Accounting for radiotherapy impact
title_sort systematic review and meta analysis of risk factors influencing patient reported arm symptoms post breast cancer treatment accounting for radiotherapy impact
topic Breast cancer
Patient-reported outcome measures
Arm symptom
Risk factor
Radiotherapy
Systematic review
url http://www.sciencedirect.com/science/article/pii/S0960977624001437
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