Treatment related morbidity in breast cancer patients

Background Sentinel lymph node biopsy (SLNB) was introduced for staging of the axilla to reduce the number of unnecessary axillary lymph node dissections (ALND’s) and proved to be an accurate and safe procedure to predict metastatic disease in clinically negative axillary lymph nodes. SLNB was expected to have less treatment related morbidity in comparison to ALND. In a multicenter prospective cohort study, long term upper-limb morbidity, perceived disabilities in activities of daily life (ADL) and quality of life (QOL) were assessed before and six weeks, 12 month and 24 month after SLNB or ALND for breast cancer. Methods 204 patients with stage I/II breast cancer, mean age 55.6 years (sd: 11.6) entered the study and 181 patients (89%) could be evaluated after two years. Sixty-six patients (32%) underwent SLNB only, and 138 (68%) underwent a level I-II ALND. Reliable and valid assessment instruments were used for assessment of upper limb morbidity, ADL and QOL. Assessment included evaluation of shoulder range of motion, muscle strength, grip strength, pain, upper/forearm circumference, shoulder disability and activities of daily life (ADL) and Quality of Live. Results Considerable treatment related upper-limb morbidity was observed. Significant (p