ing, especially those women who have had a mastectomy or receive chemotherapy (Ganz et al., 2004a). Persistent symptoms one year following either lumpectomy or mastectomy to treat early-stage breast cancer can include numbness in the chest wall or axilla, tightness, pulling or stretching in the arm or axilla, less energy or fatigue, difficulty in sleeping, and hot flashes (Shimozuma et al., 1999). Despite these symptoms most women report high levels of functioning and quality of life, with no relationship between the type of surgery and quality of life. By 2 to 3 years following surgery, breast cancer survivors in one study rated their quality of life more favorably than outpatients with other common medical conditions, and they identified many positive aspects from the cancer experience (Ganz et al., 1996). However, some aspects of quality of life (e.g., sexual function and interest, body image) and rehabilitation problems (e.g., physical functioning) worsened after that time. Among the factors that have been associated with poorer ratings of quality of life among breast cancer survivors are impaired physical functioning, poor body image, a lack of social support, coping strategies, and aspects of care such as poor communication with physicians (Mandelblatt et al., 2003; Ganz et al., 2003b, Avis et al., 2005).

Several studies of the long-term consequences of breast cancer and its treatment have been conducted. The largest of these assessed the quality of life of disease-free survivors of Stage I or II breast cancer at 1 to 5 years (baseline) and then at 5 to 10 years following their diagnosis (Ganz et al., 1998b, 2002).4 At baseline, breast cancer survivors were found to function at a high level, similar to healthy women without cancer. However, compared to survivors with no adjuvant therapy, those who received chemotherapy had significantly more sexual problems, and those treated with tamoxifen experienced more vasomotor symptoms such as hot flashes and night sweats (Ganz et al., 1998b). At the 5- to 10-year follow-up, physical well-being and emotional well-being were excellent. The minimal changes between the baseline and follow-up assessments reflected expected age-related changes. Complaints at baseline of hot flashes, night sweats, vaginal discharge, and breast sensitivity were reported less frequently at follow-up. However, symptoms of vaginal dryness and urinary incontinence were increased. In this study, survivors with no past systemic adjuvant therapy had a better quality of life than those who had received systemic adjuvant therapy (chemotherapy, tamoxifen, or both) (Ganz et al., 2002). The asso-


Stage I: primary tumor is 2 cm or less, with no spread to the lymph nodes. Stage II: primary tumor is 2-5 cm with spread to the lymph nodes, or larger than 5 cm with no spread to the lymph nodes.

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