|
45
A PROSPECTIVE STUDY OF PATIENT SENSATIONS AFTER BREAST CANCER SURGERY:
A TWO-YEAR FOLLOW-UP. Roberta H. Baron, RN, MSN, AOCN®, Jane V. Fey,
MPH, and Kimberly J. Van Zee, MS, MD, Memorial Sloan-Kettering Cancer
Center, New York, NY.
Topic: Many breast cancer patients describe distressing postoperative
sensations and question if these feelings are normal. This phenomenon
remains poorly understood. Few studies have evaluated sensations in patients
who had sentinel lymph node biopsy (SLNB) compared to axillary lymph node
dissection (ALND). Our study evaluated sensations over time and with different
surgical procedures.
Purpose: To evaluate prevalence, severity, and level of distress of sensations
at one week (baseline), 3, 6, 12, and 24 months after breast cancer surgery.
Theoretical Framework: This study is based on the University of California
San Francisco Symptom Management Model in which careful symptom assessment
is a prerequisite for effective symptom management.
Methods: Patients completed the Breast Sensation Assessment Scale (BSAS),
an instrument developed by the investigators. The BSAS contains 18 descriptors
of breast/axilla sensations. Patients recorded each sensation as present
or absent, and if present, rated it on severity and level of distress.
The BSAS demonstrated good reliability and validity in our previous studies.
Data Analysis: Prevalence, severity, and distress of sensations in different
populations were compared using Fisher’s Exact Test.
Findings and Implications: 246 patients completed the BSAS at baseline,
3, 6, 12, and 24 months. Surgery included SLNB+Breast Conservation (BCT)(51%),
SLNB+Total Mastectomy (TM)(14%), ALND+BCT (19%), and ALND+TM (16%). At
baseline, tenderness was the most prevalent sensation in SLNB and ALND
and persisted in SLNB through 24 months. At 24 months, tenderness caused
the most distress in both groups. Numbness and tightness became most prevalent
in ALND at 3, 6, 12, and 24 months, and numbness was significantly more
severe (p < .01) at those time points when compared to SLNB. Prevalence
of phantom breast/nipple sensations in the TM population remained constant
at baseline (39%), 3, and 6 months (38%), 12 months (37%), and decreased
at 24 months (27%). In the total population, younger patients (< 50
years) had significantly more sensations at baseline (p < .01) than
older patients (>50), and reported more numbness through 24 months.
Certain sensations remain prevalent, severe, and distressing even two
years after surgery. This information provides nurses with a better understanding
of patients’ experiences over time leading to more accurate patient
education and preoperative preparation.
|
