Evaluation of axillary node dissection on measures of upper-extremity disability and overall quality of life after breast cancer surgery.

Abstract

9063 Background: Axillary lymph node dissection (ALND) can increase the risk of upper extremity disability after breast cancer surgery, but there has been little effort to evaluate if this translates to a negative effect on overall quality of life (QoL). Motivated by this, we compare baseline and six-month QoL and upper extremity disability measures between women undergoing ALND or sentinel node biopsy (SLNB). Methods: We prospectively identified 92 women with T1-3 breast cancer undergoing surgery with either SLNB (n=52) or ALND (n=40) between 12/08 and 12/09. A single surgeon (SAM) performed all surgeries. Patients completed the FACT-B (higher score = better QoL) and Disabilities of Arm, Shoulder and Hand (DASH; higher score = more disability) questionnaires prior to surgery and at six months postoperatively. We abstracted demographic and clinical covariates from our ongoing Axillary Surgery Registry database. Results: SLNB and ALND patients were similar in regard to age (p=0.84), marital status (p=0.44), ethnicity (p=0.2), BMI at baseline (p=0.68), and BMI at six months (p=0.59). Women undergoing ALND had a larger median tumor size (2.8cm vs 1.6cm, p<0.001) and were more likely to receive chemotherapy ± radiation therapy (p<0.006). At baseline, the two groups reported similar median FACT-B QoL scores (ALND=117 vs. SLNB=114; p=0.7) while the ALND group reported slightly higher DASH disability (ALND=7.1 vs. SLNB=2.6; p=0.09). At six months, the median FACT-B QoL scores remained similar between the two groups (ALND=114 vs. SLNB=117, p=0.51) despite the fact that the difference in DASH disability scores strengthened (ALND 12.5 vs. SLNB 5.8, p=0.046). Interestingly, the median change in scores from baseline to six months was similar for the two groups on both the FACT-B (ALND= 0.5 vs. SLNB= −1.0, p=0.54) and DASH (ALND= −4.2 vs. SLNB= −2.5, p=0.96). Conclusions: The need for independent validation notwithstanding, our data suggest that increases in upper extremity disability associated with ALND do not translate to a significant effect on disease specific QoL at six months. Continued follow up is necessary to determine if and when QoL outcomes diverge between ALND and SLNB patients. No significant financial relationships to disclose.