P11. Patient-reported upper extremity dysfunction following axillary surgery for breast cancer

Upper extremity (UE) morbidity after breast cancer (BC) surgery is common, with up to 1/3 of patients experiencing notable postoperative impairment. The aim of this study was to assess patient-reported trends in upper extremity dysfunction (UED) after axillary surgery for BC in a large, contemporary cohort of patients using the QuickDASH questionnaire, a validated 11-item survey measuring UE function, symptoms, and impact on daily life.


Methods:

From 9/2022 to 1/2025, the QuickDASH was given to patients undergoing axillary surgery for BC preoperatively, and then 2 weeks, 6 months and 1 year postoperatively. Those who completed at least 1 survey were included. Scores range from 0 (no impairment) to 100 (complete impairment), with a 12 point change considered clinically meaningful. Multivariable linear regression models were used to assess associations between clinicopathologic variables and UED.


Results:

Of 4,378 patients, 442 (10.1%) underwent axillary lymph node dissection (ALND) and 3,936 (89.9%) sentinel lymph node biopsy (SLNB). Compared to SLNB, ALND patients were younger (p< 0.024) and more often treated with mastectomy (p< 0.001), chemotherapy (p< 0.001) and radiation therapy (RT) (< 0.001). ALND patients had greater UED compared to SLNB patients at 2 weeks (p=0.022) and 6 months postoperatively (p< 0.001). This difference was no longer clinically apparent at 1 year after surgery (Table 1). From baseline to 6 months, ALND patients who had RT reported the greatest increase in UED [12 (ALND+RT) vs. 4 (SLNB+RT), p=0.015]. Findings were similar on multivariable analysis, with worse UED among ALND patients at 6-months compared to SLNB (β = 7.4; CI: 4.4, 11, p< 0.001). ALND was associated with greater UED after mastectomy vs. lumpectomy (β = 8.8; CI: 4.5, 13, p< 0.001vs β = 4.7; CI: 0.32, 9.2, p=0.036), respectively. Mastectomy alone increased UED compared to mastectomy with reconstruction (β = 12; CI: 4.4, 19, p=0.002). At 1 year postoperatively, there was no clinically significant difference in UED from baseline after SLNB or ALND.


Conclusions:

UED varied based on type of breast and axillary surgery and use of adjuvant RT. Patients undergoing ALND and mastectomy had more severe and prolonged UED compared to those treated with SLNB and lumpectomy. RT further exacerbated postoperative UED, whereas reconstruction appeared to mitigate impairment. Although UED largely resolved by 1 year, targeted rehabilitation and early intervention should be prioritized for patients at highest risk—particularly those undergoing ALND, mastectomy, or RT—to optimize long-term functional recovery and quality of life.