ORIGINAL ARTICLE Symptoms 2 weeks, 3 months and 12 months after treatment of early breast cancer: the patients’ perspectives N. J. Warner*, M. King † , A. O. Langlands ‡ , P. Kenny and J. Boyages* ‡ *Department of Radiation Oncology, Westmead Hospital, Westmead NSW, † Centre for Health Economics Research & Evaluation, University of Sydney, Camperdown NSW, ‡ NSW Breast Cancer Institute, University of Sydney, Westmead NSW, Australia S U M M A R Y. The physical symptoms and side-effects reported by patients treated for early breast cancer with surgery (S), (breast conservation or mastectomy), radiotherapy (R) and chemotherapy (C) are reported. As part of a large quality- of-life study, eligible patients were invited to complete a questionnaire at three and 12 months after treatment for early breast cancer. Symptoms 2 weeks after surgery were retrospectively collected at the 3-month questionnaire. Comparing the com- monly used different therapy combinations (S, S+R, S+C and S+R+C) we found the only loco-regional symptom to show a significant difference between these groups was chest tightness (P<0.001). Both anxiety about attending for and discom- fort during C were significantly higher than during R (P<0.00005 and 0.00001 respectively). We found that the addition of R and, or, C to S resulted in surprisingly little variation in physical side-effects. © 1999 Harcourt Publishers Ltd. The Breast (1999) 8, 273–277 © 1999 Harcourt Publishers Ltd 273 INTRODUCTION The effects of treatments for cancer on quality of life have been previously addressed in terms of both physical 1–3 and psychological 3–6 effects. These studies, however, have often been limited by their inclusion of only small numbers of patients from any one tumour site. Furthermore, individual patients may receive two or three different modalities of treatment either sequentially or concurrently. The physical effects and impact on quality of life from each treatment modality often overlap, particularly for patients with early stage breast cancer. Documentation of treatment-induced side-effects gener- ally involves reporting ‘events’ in terms of conventional, medically recognized symptom categories. For example, fatigue may be used to describe a subjective feeling of ‘inability to work’, ‘requiring more sleep’ or ‘feeling weak’. 7 There are relatively few reports in the literature of patients’ perceptions of treatment for cancer. Objective medical observation of treatment-induced ‘side-effects’ may not be perceived by patients as having a major impact on their quality of life as much as other (non-medical) issues such as worry about effects on their family or anxi- ety about attending hospital for treatment. This has been addressed previously for single cancer treatment modalities: radiation, 8,9 chemotherapy 10 and surgery. 11 The aim of this study is to report patients’ perceptions of the physical side-effects of the different treatments used for early breast cancer. MATERIALS AND METHODS Five hundred and forty-five women with breast cancer admitted for surgery to Westmead Hospital between May 1993 and May 1995 were assessed for eligibility to enter this study. Patients with early breast cancer (stage I or II) were eligible if they met the following criteria: primary tumour size less than 4 cm and clinical nodal status N 0 and N 1 and no distant metastases. Four hundred and thirteen patients met these criteria: 37 declined to enter the study, 30 were eligible but not recruited owing to administrative delays and 17 spoke no English. Informed consent was obtained from 329 patients during their hospital admission at the time of surgery or when attending the radiation oncology department. A compre- hensive questionnaire was mailed to these patients at 3 and 12 months after their initial surgery. The following areas were covered by 145 questions in the 3-month question- Address correspondence to: Associate Professor John Boyages, NSW Breast Cancer Institute, University of Sydney, PO Box 143, Westmead NSW 2145, Australia. Tel: (02) 9845 8458; Fax: (02) 9845 7246; email: johnb@bci.org.au