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Sequelae of axillary lymph node dissection in older women with stage 1 and 2 breast carcinoma
Author(s) -
Mandelblatt Jeanne S.,
Edge Stephen B.,
Meropol Neal J.,
Senie Ruby,
Tsangaris Theodore,
Grey Luther,
Peterson Burt,
Hwang YiTing,
Weeks Jane C.
Publication year - 2002
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.10983
Subject(s) - medicine , breast cancer , breast carcinoma , surgery , axillary lymph node dissection , dissection (medical) , quality of life (healthcare) , population , stage (stratigraphy) , cohort , comorbidity , cancer , sentinel lymph node , biology , paleontology , nursing , environmental health
BACKGROUND There are few data on the long‐term sequelae of axillary dissection among older breast carcinoma patients. We describe the impact of axillary dissection in a cohort of older women. METHODS A longitudinal cohort of 571 patients with Stage 1 and 2 breast carcinoma, 67 years and older, diagnosed between 1995 and 1997 from 29 hospitals in five regions, and followed for 2 years. Data were collected from patients and medical charts. The primary outcome was posttreatment quality of life. Generalized estimation equation longitudinal modeling was used to evaluate the outcome, controlling for baseline function, comorbidity, age, clinical status, and other factors. RESULTS Sixty percent of women reported arm problems at some time in the 2 years after surgery. The cumulative risk of having arm problems 2 years posttreatment was three times higher (95% confidence interval 1.94–4.67) for women who underwent axillary surgery compared with women without axillary surgery, controlling for covariates. The effects of having axillary dissection and arthritis were multiplicative 2 years postsurgery. Arm problems were, in turn, the primary determinate of lower physical and mental functioning ( P = 0.0001 and 0.04, respectively), controlling for other factors. Undergoing axillary dissection did not lessen fears about recurrence. CONCLUSIONS Arm problems after axillary dissection have a consistent negative impact on quality of life, suggesting that the risks may outweigh the potential benefits in this population. Cancer 2002;95:2445–54. © 2002 American Cancer Society. DOI 10.1002/cncr.10983