Evolution of health-related quality of life after breast cancer surgery: longitudinal follow-up of climacteric symptoms.

Abstract

Objectives: To evaluate longitudinal changes in climacteric symptom burden and health-related quality of life between 6 and 12 months after breast cancer surgery and to assess whether symptom trajectories differ according to age or clinical and treatment-related factors using the minimal clinically important difference (MCID).

Methods: Prospective longitudinal cohort study including women surgically treated for breast cancer at Hospital General Universitario Dr. Balmis (Alicante, Spain) between April 2023 and April 2024. Of the 196 women assessed at 6 months, 181 completed the 12-month follow-up and were included in the final longitudinal analysis. Climacteric symptoms were assessed at 6 and 12 months post-surgery using the 16-item Cervantes Scale. Within-participant changes were analyzed using the Wilcoxon signed-rank test, estimating the Hodges-Lehmann shift and effect size. Subgroup comparisons were performed using nonparametric tests with Bonferroni correction. Age-stratified analyses were conducted across five predefined age groups. Clinical relevance was evaluated against the MCID.

Results: The 16-item Cervantes Scale total score showed a statistically significant change between 6 and 12 months; however, the magnitude of this change was small and remained below the MCID, indicating overall symptom stability. Age-stratified analyses identified statistically significant changes in women aged 40-49, 50-59, and 60-69 years, but these remained below the MCID thresholds, and did not reflect clinically meaningful improvement. No clinical, lifestyle, or treatment-related variables were associated with differential symptom trajectories.

Conclusions: Between 6 and 12 months after surgery, climacteric symptom burden in breast cancer survivors showed minimal change. Although statistically significant differences were observed, these remained below the MCID and are therefore unlikely to represent clinically meaningful changes. These findings support the need for early, proactive, and multidisciplinary management strategies to optimize health-related quality of life during survivorship in this population.