Long-term follow-up on shoulder and arm morbidity in patients treated for early breast cancer

Abstract

Background: A prospective study on shoulder and arm morbidity was conducted in Denmark in 2003–2005. This study demonstrated that sentinel lymph node biopsy was associated with better outcomes than axillary lymph node dissection 18 months after surgery. We here aimed to describe subjective symptoms and objective findings in these patients 10+ years after they underwent breast cancer surgery and to assess how symptoms and findings developed during this period.

Material and methods: Participants in the prospective study completed a questionnaire and underwent an objective, bilateral examination of their shoulder and arm morbidity, which included measurement of arm volume, range of motion, and sensibility.

Results: Seventy participants completed follow-up. Thirty-four (49%) had one or more functional impairments, and 64% had one or more subjective loco regional symptoms like pain, swelling of the arm, and decreased shoulder mobility. Objective evaluation showed 34 ml’s of increased arm volumes and 3–25% had severe reduced shoulder mobility on the operated side. Compared to the findings at 18 months postoperatively, small but significant differences in occurrence of subjective findings were observed. A significant progression regarding most objective findings was revealed.

Conclusion: More than 11 years after breast cancer surgery, the majority of participants complained of one or more subjective symptoms of shoulder and arm morbidity. Objective findings were mild or modest in most cases. During the prolonged follow-up period of 10 years, a worsening in symptoms and objective findings was observed.

HIGHLIGHTS

• Shoulder and arm morbidity in relation to breast cancer treatment seems to progress beyond 10 years.

• The most frequent symptoms were pain, swelling or heaviness of the arm, and decreased shoulder mobility.

• The objective evaluation showed higher arm volumes and reduced shoulder mobility on the operated side.

• Objective findings are mild and modest but may affect activities of daily living, and most participants with late symptoms stated that this was a daily problem.