Physical and psychological morbidity after axillary lymph node dissection for breast cancer

Purpose: Alternatives to axillary lymph node dissection (ALND) are being de veloped amid controversy surrounding the therapeutic benefit and overall ut ility of this routine surgical procedure. Although potential negative side effects associated with ALND are known, we set out to examine whether these side effects contribute significantly to patient reports of quality of lif e and mental health. Patients and Methods: We surveyed 222 women who had received an ALND as par t of breast cancer surgery. All women underwent a physical therapy assessme nt of range of arm/shoulder motion and completed the Modified Post-operativ e Pain Questionnaire, the Pain Disability Index, the McGill Pain Questionna ire (short form), the European Organization for Research and Treatment of C ancer Quality of Life Questionnaire, and the Mental Health Inventory, Results: Seventy-two percent of the women experienced arm/shoulder pain, we akness, or numbness in the week before the interview, and range of motion o f the affected arm/shoulder was impaired in 73% of the women. Severity of p ain was reported to be low to moderate, and younger patients experienced gr eater pain than older patients. Pain severity correlated positively with th e number of lymph nodes removed and receipt of chemotherapy and was not sig nificantly related to length of time since surgery or receipt of radiation therapy. Generally high levels of cancer-specific quality of life and menta l health were reported, Quality of life was significantly predicted by the McGill Pain Questionnaire, and mental health was significantly predicted by the Pain Disability Index and the physical therapy assessment. Conclusion: Surgery-related symptoms after ALND persist for a majority of w omen with breast cancer and are not significantly related to time since sur gery or receipt of radiation therapy These symptoms and associated disabili ty are significantly predictive of cancer-specific quality of life and ment al health. J Clin Oncol 17:143-149, (C) 1999 by American Society of Clinical Oncology.