title: The relationship between morbidity after axillary surgery and long-term quality of life in breast cancer patients: the role of anxiety.
abstract: OBJECTIVE
  Although arm/shoulder morbidity after sentinel lymph node biopsy (SLNB) and/or axillary lymph node dissection (ALND) has been studied before, information is lacking concerning self-imposed restrictions in activities and long-term consequences of both surgical procedures in relationship to quality of life (QoL) and anxiety.
  
  
  METHODS
  Eighty-nine disease-free breast cancer survivors completed a set of questionnaires assessing arm/shoulder symptoms, limitations in daily life, anxiety and QoL. Also, the ipsi- and contra lateral arm circumference and the range of shoulder motion were measured.
  
  
  RESULTS
  Fifty-one women had SLNB, 25 had SLNB followed by ALND and 13 had ALND. Although ALND patients experienced more shoulder symptoms, limitations in daily life and imposed more restrictions on themselves than SLNB patients, no significant differences during physical examination were found. A decreased range of motion and a higher score on trait anxiety resulted in a lower QoL. Trait anxiety and perceived limitations in daily life predicted long-term quality of life.
  
  
  CONCLUSIONS
  There is a discrepancy between experienced and measured limitations in range of shoulder motion. Anxiety and self-imposed restrictions play an important role in predicting long-term QoL and should get the necessary attention when addressing shoulder symptoms in breast cancer patients.
authors.affiliation: Department of Surgery, St. Elisabeth Hospital, P.O. Box 90151, 5000 LC Tilburg, The Netherlands. p.aerts@elisabeth.nl
authors.forename: P D M
authors.initials: PD
authors.lastname: Aerts
authors.forename: J
authors.initials: J
authors.lastname: De Vries
authors.forename: A F W
authors.initials: AF
authors.lastname: Van der Steeg
authors.forename: J A
authors.initials: JA
authors.lastname: Roukema
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology*; D001132:Arm / Q000503:physiopathology; D001365:Axilla / Q000601:surgery; D001943:Breast Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000523:psychology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects / Q000523:psychology*; D008875:Middle Aged; D009017:Morbidity; D009426:Netherlands; D011788:Quality of Life; D016059:Range of Motion, Articular; D012785:Shoulder Joint / Q000503:physiopathology; D011795:Surveys and Questionnaires