title: Axilla surgery severely affects quality of life: results of a 5-year prospective study in breast cancer patients.
abstract: 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.
authors.affiliation: Munich Field Study, Munich Cancer Registry, Munich, Germany. engel@ibe.med.uni-muenchen.de
authors.forename: Jutta
authors.initials: J
authors.lastname: Engel
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Kerr
authors.forename: Anne
authors.initials: A
authors.lastname: Schlesinger-Raab
authors.forename: Hansjörg
authors.initials: H
authors.lastname: Sauer
authors.forename: Dieter
authors.initials: D
authors.lastname: Hölzel
mesh_terms: D000328:Adult; D000368:Aged; D001132:Arm; D001365:Axilla / Q000601:surgery; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000523:psychology / Q000601:surgery*; D015897:Comorbidity; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000523:psychology / Q000706:statistics & numerical data*; D008209:Lymphedema / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D008875:Middle Aged; D009069:Movement Disorders / Q000453:epidemiology / Q000209:etiology; D016017:Odds Ratio; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012042:Registries