Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: Patient perceptions and precautionary behaviors

Sarah A. McLaughlin, Mary J. Wright, Katherine T. Morris, Michelle R. Sampson, Julia P. Brockway, Karen E. Hurley, Elyn R. Riedel, Kimberly J. Van Zee

Research output: Contribution to journalArticle

136 Citations (Scopus)

Abstract

Purpose: Sentinel lymph node (SLN) biopsy was adopted for the staging of the axilla with the assumption that it would reduce the risk of lymphedema in women with breast cancer. This study was undertaken to examine patient perceptions of lymphedema and use of precautionary behaviors several years after axillary surgery. Patients and Methods: Nine hundred thirty-six women who underwent SLN biopsy (SLNB) alone or SLNB followed by axillary lymph node dissection (SLNB/ALND) between June 1, 1999, and May 30, 2003, were evaluated at a median of 5 years after surgery. Patient-perceived lymphedema and avoidant behaviors were assessed through interview and administered a validated instrument, and compared with arm measurements. Results: Current arm swelling was reported in 3% of patients who received SLNB alone versus 27% of patients who received SLNB/ALND (P < .0001), as compared with 5% and 16%, respectively, with measured lymphedema. Only 41% of patients reporting arm swelling had measured lymphedema, and 5% of patients reporting no arm swelling had measured lymphedema. Risk factors associated with reported arm swelling were greater body weight (P < .0001), higher body mass index (P < .0001), infection (P < .0001), and injury (P < .007) in the ipsilateral arm since surgery. Patients followed more precautions if they had measured or perceived lymphedema. Conclusion: Body weight, infection, and injury are significant risk factors for perceiving lymphedema. There is significant discordance between the presence of measured and patient-perceived lymphedema. When compared to SLNB/ALND, SLNB-alone results in a significantly lower rate of patient-perceived arm swelling 5 years postoperatively, and is perceived by fewer women than are measured to have it.

Original languageEnglish (US)
Pages (from-to)5220-5226
Number of pages7
JournalJournal of Clinical Oncology
Volume26
Issue number32
DOIs
StatePublished - Nov 10 2008
Externally publishedYes

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Sentinel Lymph Node Biopsy
Lymphedema
Dissection
Breast Neoplasms
Arm
Biopsy
Body Weight
Axilla
Wounds and Injuries
Infection
Lymph Node Excision
Body Mass Index
Interviews

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection : Patient perceptions and precautionary behaviors. / McLaughlin, Sarah A.; Wright, Mary J.; Morris, Katherine T.; Sampson, Michelle R.; Brockway, Julia P.; Hurley, Karen E.; Riedel, Elyn R.; Van Zee, Kimberly J.

In: Journal of Clinical Oncology, Vol. 26, No. 32, 10.11.2008, p. 5220-5226.

Research output: Contribution to journalArticle

McLaughlin, Sarah A. ; Wright, Mary J. ; Morris, Katherine T. ; Sampson, Michelle R. ; Brockway, Julia P. ; Hurley, Karen E. ; Riedel, Elyn R. ; Van Zee, Kimberly J. / Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection : Patient perceptions and precautionary behaviors. In: Journal of Clinical Oncology. 2008 ; Vol. 26, No. 32. pp. 5220-5226.
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abstract = "Purpose: Sentinel lymph node (SLN) biopsy was adopted for the staging of the axilla with the assumption that it would reduce the risk of lymphedema in women with breast cancer. This study was undertaken to examine patient perceptions of lymphedema and use of precautionary behaviors several years after axillary surgery. Patients and Methods: Nine hundred thirty-six women who underwent SLN biopsy (SLNB) alone or SLNB followed by axillary lymph node dissection (SLNB/ALND) between June 1, 1999, and May 30, 2003, were evaluated at a median of 5 years after surgery. Patient-perceived lymphedema and avoidant behaviors were assessed through interview and administered a validated instrument, and compared with arm measurements. Results: Current arm swelling was reported in 3{\%} of patients who received SLNB alone versus 27{\%} of patients who received SLNB/ALND (P < .0001), as compared with 5{\%} and 16{\%}, respectively, with measured lymphedema. Only 41{\%} of patients reporting arm swelling had measured lymphedema, and 5{\%} of patients reporting no arm swelling had measured lymphedema. Risk factors associated with reported arm swelling were greater body weight (P < .0001), higher body mass index (P < .0001), infection (P < .0001), and injury (P < .007) in the ipsilateral arm since surgery. Patients followed more precautions if they had measured or perceived lymphedema. Conclusion: Body weight, infection, and injury are significant risk factors for perceiving lymphedema. There is significant discordance between the presence of measured and patient-perceived lymphedema. When compared to SLNB/ALND, SLNB-alone results in a significantly lower rate of patient-perceived arm swelling 5 years postoperatively, and is perceived by fewer women than are measured to have it.",
author = "McLaughlin, {Sarah A.} and Wright, {Mary J.} and Morris, {Katherine T.} and Sampson, {Michelle R.} and Brockway, {Julia P.} and Hurley, {Karen E.} and Riedel, {Elyn R.} and {Van Zee}, {Kimberly J.}",
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T1 - Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection

T2 - Patient perceptions and precautionary behaviors

AU - McLaughlin, Sarah A.

AU - Wright, Mary J.

AU - Morris, Katherine T.

AU - Sampson, Michelle R.

AU - Brockway, Julia P.

AU - Hurley, Karen E.

AU - Riedel, Elyn R.

AU - Van Zee, Kimberly J.

PY - 2008/11/10

Y1 - 2008/11/10

N2 - Purpose: Sentinel lymph node (SLN) biopsy was adopted for the staging of the axilla with the assumption that it would reduce the risk of lymphedema in women with breast cancer. This study was undertaken to examine patient perceptions of lymphedema and use of precautionary behaviors several years after axillary surgery. Patients and Methods: Nine hundred thirty-six women who underwent SLN biopsy (SLNB) alone or SLNB followed by axillary lymph node dissection (SLNB/ALND) between June 1, 1999, and May 30, 2003, were evaluated at a median of 5 years after surgery. Patient-perceived lymphedema and avoidant behaviors were assessed through interview and administered a validated instrument, and compared with arm measurements. Results: Current arm swelling was reported in 3% of patients who received SLNB alone versus 27% of patients who received SLNB/ALND (P < .0001), as compared with 5% and 16%, respectively, with measured lymphedema. Only 41% of patients reporting arm swelling had measured lymphedema, and 5% of patients reporting no arm swelling had measured lymphedema. Risk factors associated with reported arm swelling were greater body weight (P < .0001), higher body mass index (P < .0001), infection (P < .0001), and injury (P < .007) in the ipsilateral arm since surgery. Patients followed more precautions if they had measured or perceived lymphedema. Conclusion: Body weight, infection, and injury are significant risk factors for perceiving lymphedema. There is significant discordance between the presence of measured and patient-perceived lymphedema. When compared to SLNB/ALND, SLNB-alone results in a significantly lower rate of patient-perceived arm swelling 5 years postoperatively, and is perceived by fewer women than are measured to have it.

AB - Purpose: Sentinel lymph node (SLN) biopsy was adopted for the staging of the axilla with the assumption that it would reduce the risk of lymphedema in women with breast cancer. This study was undertaken to examine patient perceptions of lymphedema and use of precautionary behaviors several years after axillary surgery. Patients and Methods: Nine hundred thirty-six women who underwent SLN biopsy (SLNB) alone or SLNB followed by axillary lymph node dissection (SLNB/ALND) between June 1, 1999, and May 30, 2003, were evaluated at a median of 5 years after surgery. Patient-perceived lymphedema and avoidant behaviors were assessed through interview and administered a validated instrument, and compared with arm measurements. Results: Current arm swelling was reported in 3% of patients who received SLNB alone versus 27% of patients who received SLNB/ALND (P < .0001), as compared with 5% and 16%, respectively, with measured lymphedema. Only 41% of patients reporting arm swelling had measured lymphedema, and 5% of patients reporting no arm swelling had measured lymphedema. Risk factors associated with reported arm swelling were greater body weight (P < .0001), higher body mass index (P < .0001), infection (P < .0001), and injury (P < .007) in the ipsilateral arm since surgery. Patients followed more precautions if they had measured or perceived lymphedema. Conclusion: Body weight, infection, and injury are significant risk factors for perceiving lymphedema. There is significant discordance between the presence of measured and patient-perceived lymphedema. When compared to SLNB/ALND, SLNB-alone results in a significantly lower rate of patient-perceived arm swelling 5 years postoperatively, and is perceived by fewer women than are measured to have it.

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