Abstract P2-11-14: Symptoms, Physical Impairments, and Function in Breast Cancer Patients with Negative Axillary Lymph Nodes

Abstract

Abstract Purpose/Objective(s): Breast cancer (BC) patients are recommended for post-operative regional nodal radiation therapy (RNRT) based on the number of positive axillary lymph nodes (LN). While RNRT is recommended for patients with 4 or more positive LN, it remains controversial in patients with 1–3 positive LN. For these patients, consideration of anticipated functional impairments often guides decision making, but these considerations are confounded by the inseparable effects of disease in and treatment of the axilla. The purpose of this analysis is to investigate the effect of various therapies on functional impairments in BC patients without axillary disease. Materials/Methods: 166 women were diagnosed with BC between 2001–05 and enrolled and treated in a prospective surveillance physical therapy program. 110 had zero positive axillary LN on either sentinel LN biopsy or axillary LN dissection and were analyzed for this report. Participants' upper extremity (UE) range of motion, strength, and limb volume were assessed pre-operatively and at 1, 3, 6, 9, and 12+ months post-operatively by a physical therapist. Limb volume was assessed using infrared optoelectronic perometry. At 12+ months, overall health status, UE symptoms and function, and physical activity levels were reported using standardized questionnaires. Chi-square tests and one-way ANOVA analyses were used to determine significance between groups (p ≤ 0.05). Results: Of these 110 patients, 34 received mastectomy without RT, 21 received mastectomy with RNRT, 10 received lumpectomy alone, and 45 received lumpectomy with whole breast tangent RT. No significant differences were found between groups with regard to stage, ER/PR status, and number of dissected LN. Rates of lymphedema, cording, and seroma were not significantly different between groups. By 12+ months post-operatively, there were no differences in shoulder abduction, shoulder flexion, internal rotation, or external rotation between groups. No differences were seen between groups in self-reported fatigue, UE swelling or weakness, arm stiffness, or ability to climb stairs. Conclusions: Functional impairments represent an important category of morbidity for BC survivors and should be considered in pre-treatment decision making. In patients without axillary disease, post-operative RNRT or whole breast tangent RT may not contribute significantly to impairment over the first year of treatment when a prospective surveillance physical therapy program is part of the plan of care. Additional research is needed to assess longer-term changes and the impact of radiation in the context of the aggregate effect of disease burden combined with other BC treatment modalities. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-11-14.