Annals of Surgical Oncology

, Volume 15, Issue 12, pp 3342–3349 | Cite as

Implications of a Postoperative Rehabilitation Program on Quality of Life in Women with Primary Breast Cancer Treated with Sentinel Lymph Node Biopsy or Complete Axillary Lymph Node Dissection

  • Marcela Ponzio Pinto e Silva
  • Luis Otávio Sarian
  • Sirlei Siani Morais
  • Maria Teresa Pace do Amaral
  • Mariana Maia Freire de Oliveira
  • Sophie Derchain
Breast Oncology



The aim of this clinical study was to evaluate quality of life (QoL) in early-stage breast cancer patients and to investigate the effects of a comprehensive rehabilitation program comparing women undergoing sentinel node biopsy (SNB) versus complete axillary lymph node dissection (ALND). QoL was assessed with the Functional Assessment of Cancer Therapy—General and Functional Assessment of Cancer Therapy—Breast (FACT-B) questionnaire.


Eighty-nine women with histologically confirmed primary breast cancer stages I–II were enrolled. Recruitment began on May 2006 and ended on December 2007. According to current standards of care, 58 women were found clinically fit to undergo SNB, and the other 31 were elected for ALND. Thirty women who underwent SNB were randomly allocated to participate in a comprehensive postoperative rehabilitation program, and the 28 remaining were dismissed and scheduled to return for clinical follow-up.


Women undergoing ALND had a better QoL within 30 days of surgery on the FACT-B, FACT-G, Trial Outcome Index (TOI), emotional well-being (EWB), and breast concern subscale (BCS) (P < .005) and at 6 months after surgery on the EWB subscale only. Women undergoing SNB had a significant improvement in QoL only on the EWB subscale 6 months after surgery in the group with rehabilitation and 30 days after surgery in the group without rehabilitation.


Women undergoing ALND benefited from a rehabilitation program and had a better QoL. Women undergoing BLS, regardless of rehabilitation, showed improvement in QoL for the emotional well-being subscale only.


Sentinel Lymph Node Sentinel Node Biopsy Lymphedema Axillary Lymph Node Dissection Sentinel Lymph Node Identification 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Rietman JS, Geertzen JHB, Hoekstra HJ, et al. Long term treatment related upper limb morbidity and quality of life after sentinel lymph node biopsy for stage I or II breast cancer. Eur J Surg 2006; 32:148–52Google Scholar
  2. 2.
    Mansel RE, Fallowfield L, Kissin M, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: The ALMANAC Trial. J Natl Cancer Inst 2006; 98:599–609PubMedCrossRefGoogle Scholar
  3. 3.
    Fleissig A, Fallowfield LJ, Langridge CI, et al. Post-operative arm morbidity and quality of life. Results of the ALMANAC randomized trial comparing sentinel node biopsy with standard axillary treatment in the management of patients with early breast cancer. Breast Cancer Res Treat 2006; 95:279–93PubMedCrossRefGoogle Scholar
  4. 4.
    Leidenius M, Leivonen M, Vironen J, et al. The consequences of long-time arm morbidity in node-negative breast cancer patients with sentinel node biopsy or axillary clearance. J Surg Oncol 2005; 92:23–31PubMedCrossRefGoogle Scholar
  5. 5.
    Swenson KK, Nissen MJ, Ceronsky C, et al. Comparison of side effects between sentinel lymph node and axillary lymph node dissection for breast cancer. Ann Surg Oncol 2002; 9:745–53PubMedCrossRefGoogle Scholar
  6. 6.
    Cho OH, Yoo YS, Kim NC. Efficacy of comprehensive group rehabilitation for women with early breast cancer in South Korea. Nurs Health Sci 2006; 8:140–6PubMedCrossRefGoogle Scholar
  7. 7.
    De Rezende LF, Franco RL, de Rezende MF, et al. Two exercise schemes in postoperative breast cancer: comparison of effects on shoulder movement and lymphatic disturbance. Tumori 2006; 92:55–61PubMedGoogle Scholar
  8. 8.
    Silva MPP, Derchain SFM, Rezende L, et al. Movimento do ombro após cirurgia por carcinoma invasor da mama: estudo randomizado controlado de exercícios livres versus limitados a 90° no pós-operatório. Rev Bras Ginecol Obstet, 2004; 26:125–30Google Scholar
  9. 9.
    Brady MJ, Cella DF, Mo F, et al. Reliability and validity of the Functional Assessment of Cancer Therapy-Breast quality-of-life instrument. J Clin Oncol 1997; 15:974–86PubMedGoogle Scholar
  10. 10.
    Torresan RZ, Cabello CS, Conde DM, et al. Impact of the preservation of the intercostobrachial nerve in axillary lymphadenectomy due to breast cancer. Breast J 2003; 9:389–92Google Scholar
  11. 11.
    Schulze T, Mucke J, Markwardt J, et al. Long-term morbidity of patients with early breast cancer after sentinel lymph node biopsy compared to axillary lymph node dissection. J Surg Oncol 2006; 93:109–19PubMedCrossRefGoogle Scholar
  12. 12.
    Leidenius M, Leppänen E, Krogerus L, et al. Motion restriction and axillary web syndrome after sentinel node biopsy and axillary clearance in breast cancer. Am J Surg 2003; 185:127–30PubMedCrossRefGoogle Scholar
  13. 13.
    Golshan M, Martin WJ, Dowlatshahi K. Sentinel lymph node biopsy lowers the rate of lymphedema when compared with standard axillary lymph node dissection. Am Sur 2003; 69):209–11Google Scholar
  14. 14.
    Silberman AW, McVay C, Cohen JS, et al. Comparative morbidity of axillary lymph node dissection and the sentinel lymph node technique: implications for patients with breast cancer. Ann Surg 2004; 240:7–8CrossRefGoogle Scholar
  15. 15.
    Rietman JS, Dijkstra PU, Hoekstra HJ, et al. Late morbidity after treatment of breast cancer in relation to daily activities and quality of life: a systematic review. Eur J Surg 2003; 29:229–38Google Scholar
  16. 16.
    Wilke LG, McCall LM, Posther KE, et al. Surgical complications associated with sentinel lymph node biopsy: results from a prospective international cooperative group trial. Ann Surg Oncol 2006; 13:491–500PubMedCrossRefGoogle Scholar
  17. 17.
    Krynyckyi BR, Kim CK. Short-term morbidity of the upper limb after sentinel lymph node biopsy or axillary lymph node dissection for Stage I or II breast carcinoma. Cancer 2004; 101:2367–8PubMedCrossRefGoogle Scholar
  18. 18.
    Dubernard G, Sideris L, Delaloge S, et al. Quality of life after sentinel lymph node biopsy in early breast cancer. Eur J Surg 2004; 30:728–34Google Scholar
  19. 19.
    Burnet K, Chapman D, Wishart G, et al. Nurse specialists in breast care: a developing role. Nurs Stand 2004; 18:38–42PubMedGoogle Scholar
  20. 20.
    The WHOQOL Group. The World Health Organization quality of life assessment (WHOQOL): development and general psychometric properties. Soc Sci Med 1998; 46:1569–85Google Scholar
  21. 21.
    Stanton AL, Danoff-Burg S, Huggins ME. The first year after breast cancer diagnosis: hope and coping strategies as predictors of adjustment. Psychooncology 2002; 11:93–102PubMedCrossRefGoogle Scholar
  22. 22.
    Knobf MT. Psychosocial responses in breast cancer survivors. Semin Oncol Nurs 2007; 23:71–83PubMedCrossRefGoogle Scholar
  23. 23.
    Rubin SE; Chan F; Thomas DL. Assessing changes in life skills and quality of life resulting from rehabilitation services. J Rehabil 2003; 69:4–8Google Scholar

Copyright information

© Society of Surgical Oncology 2008

Authors and Affiliations

  • Marcela Ponzio Pinto e Silva
    • 1
  • Luis Otávio Sarian
    • 2
  • Sirlei Siani Morais
    • 3
  • Maria Teresa Pace do Amaral
    • 1
  • Mariana Maia Freire de Oliveira
    • 1
  • Sophie Derchain
    • 2
  1. 1.Physical Therapy Service, Department of Obstetrics and GynecologyUniversity of Campinas, UnicampSão PauloBrazil
  2. 2.Department of Obstetrics and GynecologyUniversity of Campinas, UnicampSão PauloBrazil
  3. 3.Statistics Division, Department of Obstetrics and GynecologyUniversity of Campinas, UnicampSão PauloBrazil

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