PONTE VEDRA BEACH, FlaNurses frequently tell breast cancer
patients that they can expect less pain and discomfort following a sentinel
lymph node dissection (SLND) than an axillary lymph node dissection (ALND).
Two groups of oncology nurses have done studies to find out
what "less" means in terms of sensations reported by patients after
the two procedures. Both researchers said that such information could be used
to help prepare SLND patients for what to expect postoperatively.
Preliminary findings from both studies were presented at the
Oncology Nursing Society’s Sixth National Conference on Cancer Nursing
Research. The results confirmed that side effects of the newer, less invasive
SLND are less severe for women who have lumpectomies. One study found no
immediate difference for patients who have mastectomies, however, and both
report that most women can expect some discomfort 6 months after either SLND or
"We’ve been telling people, ‘SLND is a much less
invasive procedure, so you’re not going to have discomfort afterward.’ That’s
not completely true," Roberta H. Baron, RN, MSN, AOCN, a clinical nurse
specialist at Memorial Sloan-Kettering Cancer Center, told ONI in an
Ms. Baron and her colleagues developed the Breast Sensation
Assessment Scale, which includes 18 descriptions of breast sensations. In the
ongoing study, women use the scale to record whether these sensations are
present or absent at baseline (1 week) and at 3, 6, 12, and 24 months after
surgery. If a sensation is present, the patient rates the severity and the
level of distress.
Thus far, Ms. Baron has collected data on 211 women at 6
months. Of these, 141 had SLND (109 with breast-conserving treatment and 32
with total mastectomy) while 70 had SLND followed by ALND (37 with
breast-conserving treatment and 33 with total mastectomy).
Tenderness was the most prevalent sensation 3 to 15 days after
ALND and SLND. Next was soreness. At 3 and 6 months, tenderness was still the
most prevalent sensation for those who had SLND. Among ALND patients, however,
numbness was most common at 3 and 6 months. The ALND patients reported
"significantly more pulling, tightness, and numbness" than their SLND
counterparts even at baseline, Ms. Baron said.
The contrast in side effects became more pronounced when the
researchers averaged severity and distress scores for all the sensations. For
women who received breast-conserving therapy, SLND produced significantly lower
scores at baseline and at 3 and 6 months, compared with ALND. "This was
not evident in the mastectomy group, and further investigation is
warranted," Ms. Baron said.
The trial stopped accrual in Nov. 2000, and she forecast that
the last patient would complete the study in Nov. 2002.
A group led by Karen K. Swenson, RN, MS, AOCN, oncology
research manager, Park Nicollet Institute, Minneapolis, has enrolled about 235
patients at Park Nicollet Health Services in Minneapolis and United Center for
Breast Care in St. Paul. All the patients had SLND, but 162 had SLND alone and
73 had both procedures, undergoing ALND if SLND found cancer cells or a surgeon
requested ALND. The initial analysis did not separate lumpectomy and mastectomy
At 1 month after surgery, SLND patients had significantly less
pain, numbness, arm swelling, and limitation in arm and shoulder movement, Ms.
Swenson reported. They also showed less pain, arm numbness, and arm swelling at
6 months. About 20% of the ALND group, but only 4% of the SLND group, had some
degree of arm swelling at 6 months when arm swelling is more likely to develop.
At 6 months, side effects interfered more with the daily life of the ALND
patients, and at 1 month, ALND patients lost more days from work due to