Breast Cancer Research and Treatment

, Volume 79, Issue 1, pp 47–57 | Cite as

Axilla Surgery Severely Affects Quality of Life: Results of a 5-Year Prospective Study in Breast Cancer Patients

  • Jutta Engel
  • Jacqueline Kerr
  • Anne Schlesinger-Raab
  • Hansjörg Sauer
  • Dieter Hölzel


No long term prospective study has investigated arm morbidity and patient quality of life. It is unclear to what extent breast cancer patients suffer from arm problems, how long such problems affect their lives, and whether quality of life improves as arm problems abate. This prospective cohort study aims to provide data on the clinical factors associated with arm dysfunction, to estimate its prevalence and to relate arm morbidity to quality of life. The Munich Cancer Registry records clinical details of all cancer patients in and around Munich. Quality of life information was provided directly by breast cancer patients (n = 990) over 5 years. Arm morbidity, including movement limitations, swelling and lymph drainage, and quality of life (EORTC QLQ-C30) were assessed. Up to 5 years after diagnosis, 38% of patients were still experiencing arm problems (swelling and limited movement). Consistently over the 5 years, quality of life was significantly (p < 0.001) lower for patients with arm difficulties. For those whose arm problems dissipated, quality of life significantly improved (p < 0.01). A logistic regression analysis showed that extent of axilla surgery (p < 0.003), comorbidity (CVD and diabetes) (p < 0.003), employment (p < 0.01), younger age (p < 0.02), and operating clinic (p < 0.05) significantly contributed to arm problems. Axilla surgery should be re-evaluated since arm morbidity has such a profound effect on patient quality of life.

arm dysfunction axilla surgery breast cancer EORTC quality of life 


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  1. 1.
    Sakorafas GH, Tsiotou AG, Balsiger BM: Axillary lymph node dissection in breast cancer-current status and controversies, alternative strategies and future perspectives. Acta Oncol 39: 455–466, 2000Google Scholar
  2. 2.
    Petrek JA, Heelan MC: Incidence of breast carcinoma-related lymphedema. Cancer 83: 2776–2781, 1998Google Scholar
  3. 3.
    Fisher B, Montague E, Redmond C, Bryant J, Fisher ER, Wolmark N: Comparison of radical mastectomy with alternative treatments for primary breast cancer. A first report of results from a prospective randomized clinical trial. Cancer 39: 2827–2839, 1977Google Scholar
  4. 4.
    Walley DR, Augustine E, Saslow D, Bailey S, Jeffs E, Lasinski B, Plotkin J, Walker M: American Cancer Society Lymphedema Workshop. Workgroup IV: Lymphedema treatment resources-professional education and availability of patient services. Cancer 83: 2886–2887, 1998Google Scholar
  5. 5.
    Erickson VS, Pearson ML, Ganz PA, Adams J, Kahn KL: Arm edema in breast cancer patients. J Natl Cancer Inst 93: 96–111, 2001Google Scholar
  6. 6.
    Gemignani ML, Borgen PI: Is there a role for selective axillary dissection in breast cancer? World J Surg 25: 809–818, 2001Google Scholar
  7. 7.
    Kocak Z, Overgaard J: Risk factors of arm lymphedema in breast cancer patients. Acta Oncol 39: 389–392, 2000Google Scholar
  8. 8.
    Bentzen SM, Dische S: Morbidity related to axillary irradiation in the treatment of breast cancer. Acta Oncol 39: 337–347, 2000Google Scholar
  9. 9.
    Blichert-Toft M: Axillary surgery in breast cancer management-background, incidence and extent of nodal spread, extent of surgery and accurate axillary staging, surgical procedures. Acta Oncol 39: 269–275, 2000Google Scholar
  10. 10.
    Spillane AJ, Sacks NP: Role of axillary surgery in early breast cancer: review of the current evidence. Aust N Z J Surg 70: 515–524, 2000Google Scholar
  11. 11.
    Wittekind CW: UICC: TNM-Klassifikation maligner Tumoren. 5th edn, Springer-Verlag, Berlin, Heidelberg, New York, 1997Google Scholar
  12. 12.
    Rutgers EJ: Quality control in the locoregional treatment of breast cancer. Eur J Cancer 37: 447–453, 2001Google Scholar
  13. 13.
    Osoba D, Zee B, Pater J, Warr D, Kaizer L, Latreille J: Psychometric properties and responsiveness of the EORTC quality of life questionnaire (QLQ-C30) in patients with breast, ovarian and lung cancer. Qual Life Res 3: 353–364, 1994Google Scholar
  14. 14.
    Niezgoda HE, Pater JL: A validation study of the domains of the core EORTC quality of life questionnaire. Qual Life Res 2: 319–325, 1993Google Scholar
  15. 15.
    Groenvold M, Klee MC, Sprangers MA, Aaronson NK: Validation of the EORTC QLQ-C30 quality of life questionnaire through combined qualitative and quantitative assessment of patient-observer agreement. J Clin Epidemiol 50: 441–450, 1997Google Scholar
  16. 16.
    King MT: The interpretation of scores from the EORTC quality of life questionnaire QLQ-C30. Qual Life Res 5: 555–567, 1996Google Scholar
  17. 17.
    EORTC: EORTC QLQ-C30 Scoring Manual, 1995Google Scholar
  18. 18.
    Koller M, Lorenz W: Quality of life research in patients with rectal cancer: traditional approaches versus a problem-solving oriented perspective. Langenbecks Arch Surg 383: 427–436, 1998Google Scholar
  19. 19.
    Tengrup I, Tennvall-Nittby L, Christiansson I, Laurin M: Arm morbidity after breast-conserving therapy for breast cancer. Acta Oncol 39: 393–397, 2000Google Scholar
  20. 20.
    Edwards TL: Prevalence and aetiology of lymphoedema after breast cancer treatment in southern Tasmania. Aust N Z J Surg 70: 412–418, 2000Google Scholar
  21. 21.
    Isaksson G, Feuk B: Morbidity from axillary treatment in breast cancer-a follow-up study in a district hospital. Acta Oncol 39: 335–336, 2000Google Scholar
  22. 22.
    Kuehn T, Klauss W, Darsow M, Regele S, Flock F, Maiterth C, Dahlbender R, Wendt I, Kreienberg R: Long-term morbidity following axillary dissection in breast cancer patients-clinical assessment, significance for life quality and the impact of demographic, oncologic and therapeutic factors. Breast Cancer Res Treat 64: 275–286, 2000Google Scholar
  23. 23.
    Runowicz CD, Passik SD, Hann D, Berson A, Chang H, Makar K, Moss R, Osuch J, Petrek JD, Vaillant-Newman M: American Cancer Society Lymphedema Workshop. Workgroup II: Patient education-pre-and posttreatment. Cancer 83: 2880–2881, 1998Google Scholar
  24. 24.
    Rockson SG, Miller LT, Senie R, Brennan MJ, Casley-Smith JR, Foldi E, Foldi M, Gamble GL, Kasseroller RG, Leduc A, Lerner R, Mortimer PS, Norman SA, Plotkin CL, Rinehart-Ayres ME, Walder AL: American Cancer Society Lymphedema Workshop. Workgroup III: Diagnosis and management of lymphedema. Cancer 83: 2882–2885, 1998Google Scholar
  25. 25.
    Hack TF, Cohen L, Katz J, Robson LS, Goss P: Physical and psychological morbidity after axillary lymph node dissection for breast cancer. J Clin Oncol 17: 143–149, 1999Google Scholar
  26. 26.
    Warmuth MA, Bowen G, Prosnitz LR, Chu L, Broadwater G, Peterson B, Leight G, Winer EP: Complications of axillary lymph node dissection for carcinoma of the breast: a report based on a patient survey. Cancer 83: 1362–1368, 1998Google Scholar
  27. 27.
    Liljegren G, Holmberg L: Arm morbidity after sector resection and axillary dissection with or without postoperative radiotherapy in breast cancer stage I. Results from a randomised trial. Uppsala-Orebro Breast Cancer Study Group. Eur J Cancer 33: 193–199, 1997Google Scholar
  28. 28.
    Ververs JM, Roumen RM, Vingerhoets AJ, Vreugdenhil G, Coebergh JW, Crommelin MA, Luiten EJ, Repelaer van Driel OJ, Schijven M, Wissing JC, Voogd AC: Risk, severity and predictors of physical and psychological morbidity after axillary lymph node dissection for breast cancer. Eur J Cancer 37: 991–999, 2001Google Scholar
  29. 29.
    Hojris I, Andersen J, Overgaard M, Overgaard J: Late treatment-related morbidity in breast cancer patients randomized to postmastectomy radiotherapy and systemic treatment versus systemic treatment alone. Acta Oncol 39: 355–372, 2000Google Scholar
  30. 30.
    Velanovich V, Szymanski W: Quality of life of breast cancer patients with lymphedema. Am J Surg 177: 184–188, 1999Google Scholar
  31. 31.
    Passik SD, McDonald MV: Psychosocial aspects of upper extremity lymphedema in women treated for breast carcinoma. Cancer 83: 2817–2820, 1998Google Scholar
  32. 32.
    Johansen J, Overgaard J, Blichert-Toft M, OvergaardM: Treatment of morbidity associated with the management of the axilla in breast-conserving therapy. Acta Oncol 39: 349–354, 2000Google Scholar
  33. 33.
    Schrenk P, Rieger R, Shamiyeh A, Wayand W: Morbidity following sentinel lymph node biopsy versus axillary lymph node dissection for patients with breast carcinoma. Cancer 88: 608–614, 2000Google Scholar
  34. 34.
    Chetty U, Jack W, Prescott RJ, Tyler C, Rodger A: Management of the axilla in operable breast cancer treated by breast conservation: a randomized clinical trial. Edinburgh Breast Unit. Br J Surg 87: 163–169, 2000Google Scholar
  35. 35.
    McCredie M, Dite G, Porter L et al.: Prevalence of selfreported arm morbidity following treatment for breast cancer in the Australian Breast Cancer Family Study. The Breast 10: 515–522, 2001Google Scholar
  36. 36.
    Fisher B, Jeong JH, Anderson S, Bryant J, Fisher ER, Wolmark N: Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med 347: 567–575, 2002Google Scholar
  37. 37.
    Veronesi U, Galimberti V, Zurrida S, Pigatto F, Veronesi P, Robertson C, Paganelli G, Sciascia V, Viale G: Sentinel lymph node biopsy as an indicator for axillary dissection in early breast cancer. Eur J Cancer 37: 454–458, 2001Google Scholar
  38. 38.
    von Smitten K: Surgical management of breast cancer in the future. Acta Oncol 39: 437–439, 2000Google Scholar
  39. 39.
    Goldhirsch A, Glick JH, Gelber RD, Coates AS, Senn HJ: Meeting highlights: International Consensus Panel on the Treatment of Primary Breast Cancer. Seventh International Conference on Adjuvant Therapy of Primary Breast Cancer. J Clin Oncol 19: 3817–3827, 2001Google Scholar
  40. 40.
    Keshtgar MR, Baum M: Axillary dissection over the years: where to from here? World J Surg 25: 761–766, 2001Google Scholar
  41. 41.
    Leitch AM, Meek AG, Smith RA, Boris M, Bourgeois P, Higgins S, Pressman PI, Stevens J, Stevens RE: American Cancer Society Lymphedema Workshop. Workgroup I: Treatment of the axilla with surgery and radiation-preoperative and postoperative risk assessment. Cancer 83: 2877–2879, 1998Google Scholar
  42. 42.
    Meek AG: Breast radiotherapy and lymphedema. Cancer 83: 2788–2797, 1998Google Scholar

Copyright information

© Kluwer Academic Publishers 2003

Authors and Affiliations

  • Jutta Engel
    • 1
  • Jacqueline Kerr
    • 1
  • Anne Schlesinger-Raab
    • 1
  • Hansjörg Sauer
    • 2
  • Dieter Hölzel
    • 1
  1. 1.Munich Field Study, Munich Cancer RegistryLudwig-Maximilians-UniversityMunichGermany
  2. 2.Med. Klinik III, Klinikum Groß hadernLudwig-Maximilians-UniversityMunichGermany

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