Women who have mastectomies or undergo chemotherapy for breast cancer have more severe physical symptoms immediately following treatment than women who have lumpectomies without chemotherapy treatment, according to a study by researchers at UCLA’s Jonsson Cancer Center and published in the March 3 issue of the Journal of the National Cancer Institute.

There have been many studies of the physical and emotional experiences of women newly diagnosed with breast cancer, and in recent years several studies have examined the experiences of long-term cancer survivors. However, until this study, there has been little information available on the experiences of women in the transitional period between the end of initial treatment and survivorship, when they must move beyond cancer to reestablish normal life patterns.

“I was surprised by the finding that women who had mastectomies are doing worse after treatment because that is contrary to what we’ve seen in over 20 years of research,� said Dr. Patricia A. Ganz, director of the Division of Cancer Prevention and Control at UCLA’s Jonsson Comprehensive Cancer Center. “What this suggests to me is that with earlier detection we are finding much smaller tumors that result in minimal surgeries and less overall trauma, especially likely for women receiving lumpectomy.�

The researchers found that mood and emotional functioning were similar among all women at the end of their primary treatment, with little evidence of a depressed mood or negative effect.

Yet, a wide variety of physical symptoms were reported in all treatment groups, such as hot flashes, night sweats, aches and pains, and vaginal dryness. Women who had mastectomies reported the poorest physical functioning, both immediately following surgery and at the end of primary treatment. Sexual functioning was worse for women who received chemotherapy than for those who did not, regardless of the type of surgery.

“It is clear that more attention must be paid to the symptoms that women report at the end of treatment because they are associated with poorer physical and emotional well-being. In particular, post-treatment fatigue is a prominent problem. Ongoing studies in our laboratory at UCLA hope to provide more insight into this persistent problem,� Ganz said. The authors are continuing to examine information on this group of women, who were enrolled in a multi-site randomized trial of two behavioral interventions designed to prepare women for recovery after primary breast cancer treatment.

Information from earlier studies suggests that this can be a stressful time period. Women have reported that their fear of recurrence increases, they miss ready access to the health-care system, they may have lingering side effects of therapy and they often feel uncertain about what to expect after treatment. To address this issue, Ganz and her colleagues collected information on the health status and quality of life of 558 women who had just had surgery for breast cancer, one of the largest and most comprehensive studies of such patients.

“In general, oncology clinicians prepare women for the acute side effects of breast cancer treatments, but clinicians have had only limited data on the physical and psychosocial side effects of primary treatments,� writes Ganz and her colleagues. “Indeed, little is known about the pattern of recovery after the end of treatment.�

After the women completed their treatment, they were sent surveys to assess their quality of life, mood, symptoms and sexual functioning. The investigators analyzed the results as a whole and by type of treatment — mastectomy without chemotherapy, lumpectomy without chemotherapy, mastectomy plus chemotherapy and lumpectomy plus chemotherapy. Women who received chemotherapy underwent treatment longer than women who did not — roughly 7 to 8 months versus 2 to 4 months, respectively.

UCLA’s Jonsson Comprehensive Cancer Center is composed of more than 240 cancer researchers and clinicians engaged in cancer research, prevention, detection, control and education. The center, one of the nation’s largest comprehensive cancer centers, is dedicated to promoting cancer research and applying the results to clinical situations. In 2003 the center was named the best cancer center in the Western United States by U.S. News & World Report, a ranking it has held for four consecutive years.