title: Early self-reported impairments in arm functioning of primary breast cancer patients predict late side effects of axillary lymph node dissection: results from a population-based cohort study.
abstract: OBJECTIVE
  Improvements in the life expectancy of women with breast cancer raise important questions how to improve quality of life (QoL) for women sustaining complications and side effects of cancer treatment. The presented study examined the prevalence of arm morbidity in a cohort of primary breast cancer patients over time as a result of the extent of axillary lymph node dissection. Of particular interest is the question of using a recognized QoL assessment instrument at defined assessment points as an endpoint criteria of oncological treatment.
  
  
  METHODS
  A prospective, population-based, longitudinal cohort study of patients with primary breast cancer was performed (n = 389). QoL data (EORTC QLQ C30 + BR23) and clinical data were assessed at designated time points. Primary endpoint of this analysis was patient reported arm morbidity assessed with the three-idem scale in the BR 23 (swelling, moving, pain).
  
  
  RESULTS
  20% of the patients evidenced considerable impairments in arm functioning. Arm morbidity was significantly related to the number of lymph nodes dissected (P < 0.002 entire cohort, P < 0.001 lymph node negatives) and was independent of age, stage of the disease, kind of breast surgery and radiation treatment. Early impairments in arm functioning (below 50 score values) assessed within 6 months after axillary surgery was a good predictor for late arm morbidity at 12 months RR 11.5 (CI 95% 4.7-28.4), 24 months RR 6.0 (CI95% 2.8-13.3) and 36 months RR 3.8 (CI 95% 1.8-7.9).
  
  
  CONCLUSIONS
  Arm morbidity after axillary surgery is a severe and chronic condition affecting many breast cancer patients. The recognized QoL assessment instrument depict patients with severe impairments in arm functioning after axillary lymph node dissection and predict late arm morbidity. To increase patients' quality of life it thus may serve as a valid assessment tool for screening, allowing early referral for treatment and monitoring.
authors.affiliation: Gynecology, Gynecological Endocrinology and Oncology, University of Marburg, Faculty of Medicine, Pilgrimstein 3, Marburg, D-35037, Germany. albertu@med.uni-marburg.de
authors.forename: Ute S
authors.initials: US
authors.lastname: Albert
authors.forename: Michael
authors.initials: M
authors.lastname: Koller
authors.forename: Ina
authors.initials: I
authors.lastname: Kopp
authors.forename: Wilfried
authors.initials: W
authors.lastname: Lorenz
authors.forename: Klaus D
authors.initials: KD
authors.lastname: Schulz
authors.forename: Uwe
authors.initials: U
authors.lastname: Wagner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000503:physiopathology*; D001365:Axilla; D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D004487:Edema / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision / Q000009:adverse effects*; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D010146:Pain / Q000209:etiology / Q000503:physiopathology; D011159:Population Surveillance; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome