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Longitudinal Prospective Evaluation of Quality of Life After Axillary Lymph Node Dissection

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Patients often fear axillary lymph node dissection (ALND) because of its associated complications; however, its effect on quality of life (QOL) is not well described. We aimed to evaluate the effect of ALND on QOL over time and to identify predictors of worse QOL.

Patients and Methods

Breast cancer patients undergoing ALND were enrolled in a prospective lymphedema screening study. Arm volumes were measured and QOL questionnaires completed at baseline, postoperatively, and at 6-month intervals. The upper limb lymphedema-27 questionnaire was used to assess the effect of upper extremity symptoms on QOL in three domains (physical, psychological, and social). Predictors of QOL were identified by univariate and multivariable regression analyses.

Results

From November 2016 through March 2020, 304 ALND patients were enrolled; 242 patients with at least two measurements and 6 months of follow-up were included. Median age was 48 years, and median follow-up was 1.2 years. The 18-month lymphedema rate was 18%. Overall, QOL scores in all three domains decreased postoperatively and improved over time. On multivariable analysis, after adjusting for baseline scores, symptoms necessitating lymphedema therapy referral (p = 0.006) were associated with worse physical QOL. Younger age (p = 0.005) and lymphedema therapy referral (p = 0.006) were associated with worse psychological QOL. Arm volume was not correlated with QOL.

Conclusions

QOL scores initially decreased after ALND but improved by 6 months post-surgery. Decreases in QOL were independent of arm volume. Patients with worse QOL more often sought lymphedema therapy, although the effect of therapy on QOL remains unknown.

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Acknowledgements

This study was presented in poster format at the Society of Surgical Oncology 2021 International Conference on Surgical Cancer Care Virtual Meeting, March 18–20, 2021.

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Authors and Affiliations

  1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Jennifer Q. Zhang MD, Giacomo Montagna MD, MPH, Kelly Abbate BS, Jillian Charyn BA, Monica Morrow MD & Andrea V. Barrio MD

  2. Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Varadan Sevilimedu MBBS, DrPH

  3. Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Babak Mehrara MD

Authors
  1. Jennifer Q. Zhang MD
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  2. Giacomo Montagna MD, MPH
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  3. Varadan Sevilimedu MBBS, DrPH
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  4. Kelly Abbate BS
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  5. Jillian Charyn BA
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  6. Babak Mehrara MD
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  7. Monica Morrow MD
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  8. Andrea V. Barrio MD
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Corresponding author

Correspondence to Andrea V. Barrio MD.

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Disclosures

The preparation of this study was supported in part by NIH/NCI Cancer Center Support Grant No. P30 CA008748 to Memorial Sloan Kettering Cancer Center, and this study was supported in part by a Chanel Survivorship Endowment Award and the Manhasset Women’s Coalition Against Breast Cancer. Dr. Babak Mehrara is an advisor to PureTech Corp and the principal investigator of an investigator-initiated research grant from Regeneron Pharmaceuticals. Dr. Monica Morrow has received honoraria from Exact Sciences and Roche. All other authors have no conflicts of interest to disclose.

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Zhang, J.Q., Montagna, G., Sevilimedu, V. et al. Longitudinal Prospective Evaluation of Quality of Life After Axillary Lymph Node Dissection. Ann Surg Oncol 29, 4127–4136 (2022). https://doi.org/10.1245/s10434-022-11623-z

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  • DOI: https://doi.org/10.1245/s10434-022-11623-z

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