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 ALND.
"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 interview.
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 patients.
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 surgery.