Arm Symptoms and Swelling Following Axillary Surgery for Breast Cancer

Abstract

The aim of this thesis was to determine how best to measure, express, analyse and compare the effects of different operations on how women feel, what symptoms they experience, their dysfunction, disability and their cancer related outcomes after axillary surgery for early breast cancer. Participant-rated outcome measures of arm symptoms, function and disability collected from 1088 women participating in a trial of Sentinel Node biopsy compared to Axillary Clearance in early breast cancer were compared with Clinicians’ measurements of arm swelling, sensation and range of motion. Participant-rated outcome measures were more able to detect a difference between treatment groups than clinician-rated outcome measures but not as reproducible on repeated testing. Participants’ ratings of arm symptoms, disability and dysfunction did not vary predictably with clinicians’ ratings of arm swelling implying that arm swelling should not be used in isolation, as a marker of arm symptoms, dysfunction and disability. Clinician-rated outcome measures and outcome measures rated by participants both had their strengths and weaknesses. The use of participant-rated outcome measures in addition to clinicians’ assessments provided valuable complementary information and improved the statistical efficiency of the trial at detecting differences between treatment groups.