Chronic post-treatment symptoms in patients with breast cancer operated in different surgical units

Aims: This study was designed to find out whether women operated in high volume surgical units have less chronic symptoms than women operated in smaller volume units. Methods: A questionnaire was sent to 265 consecutive women treated at the Department of Oncology, Helsinki University Central Hospital, from January to June 1996. Of the patients, 129 were operated in hospitals experienced in breast cancer surgery (high volume units = HVU) and 92 patients in district hospitals with less experience in breast surgery (low volume units = LVU). Results: Chronic symptoms were less common in HVU than in LVU: chronic pain (56 vs 43%, P<0.05) or strange sensations (45 vs 26%, P<0.01) in the ipsilateral arm or phantom sensations in the removed breast (66 vs 26%, P<0.001). The risk factors included in the multivariate model for chronic pain in the breast area were: intensity of acute post-operative pain, radiotherapy and depression and for the chronic arm pain: low volume unit and depression. Conclusions: More careful surgical technique seems to reduce the risk of chronic pain following treatment of breast cancer. Chronic pain is associated with more intense post-operative pain and depression.