Longitudinal change of treatment-related upper limb dysfunction and its impact on late dysfunction in breast cancer survivors: A prospective cohort study (original) (raw)
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Medical Hypotheses, 2011
Over 2.6 million breast cancer survivors currently reside in the United States. While improvements in the medical management of women diagnosed with breast cancer have resulted in a 5-year survival rate of 89%, curative treatments are associated with a high prevalence of shoulder and arm morbidity, which, in turn, can negatively impact a woman's quality of life. Breast cancer survivors frequently experience shoulder and arm pain, decreased range of motion, muscle weakness, and lymphedema. These symptoms can lead to difficulties with daily activities ranging from overhead reaching and carrying objects to caring for family and returning to work.
Supportive Care in Cancer, 2018
Objective: Determine the changes in shoulder strength, shoulder range of motion and arm volume in breast cancer patients treated with sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND). Method: 68 SLNB and 44 ALND patients were followed-up from pre-surgery to 5 years after surgery. Primary outcomes were the differences between affected and non-affected sides for: shoulder strength measured by dynamometry, shoulder range of motion measured by goniometry and lymphedema measured by volume. As a secondary outcome, health related quality of life (HRQL) was assessed by the Short Form-36 Health Survey (SF-36) and the Functional Assessment of Cancer Therapy for breast cancer (FACT-B+4) questionnaires. Changes over time were tested for SLNB and ALND using univariate repeated measures analysis of variance. GEE models were constructed to assess the effect of SLNB and ALND over time. Results: After 5 years, the ALND group had significant loss of strength for internal rotators (1.39 kg, p=0.001) and significant arm volume increase (132.45 mL, p=0.031). The ALND group had a greater number of patients with clinically relevant internal rotators strength loss (38.7% vs. 13.6%, p=0.012) and a greater number of lymphedema requiring treatment (33.3% vs. 3.4%, p<0.001) than the SLNB group. A loss of strength for shoulder external rotators, shoulder range of motion, and HRQL in Physical and Arm domains persisted at 5 years in both SLNB and ALND groups. Conclusion: These results could help understand and plan the prevention, needs, and long term care of breast cancer patients.
Effects of Breast Cancer Treatment on Shoulder Function: What to Expect and How to Treat?
International Journal of Physical Therapy & Rehabilitation, 2018
Breast cancer treatment may lead to side effects such as shoulder pain, restricted shoulder mobility, fibrosis, breast cancer-related lymphedema, and anatomical and biomechanical changes of the shoulder, which will contribute to functional status limitations. Function of the upper limb requires adequate mobility of the shoulder, including the scapula, and an efficient neuromuscular coordination. Movement deviation patterns in women following surgery for breast cancer are similar to those seen in other known shoulder conditions. Exercise therapy and scapular stabilization exercises were found to be an effective approach for controlling pain, promote normal motor control and decreasing disability. The main purpose of the present paper is to review the shoulder movement dysfunctions after breast cancer treatment and to briefly characterize the main physical therapy intervention strategies to treat or prevent these dysfunctions.
Breast Cancer Research and Treatment, 2010
Purpose-To determine the extent and time course of upper limb impairment and dysfunction in women being treated for breast cancer, and followed prospectively, using a novel physical therapy surveillance model post-treatment. Patients and Methods-Subjects included adult women with newly diagnosed, untreated, unilateral, Stage I to III BC and normal physiological and biomechanical shoulder function. Subjects were excluded if they had a previous history of BC, or prior injury or surgery of the affected upper limb. Measurements included body weight, shoulder ranges of motion (ROM), manual muscle tests, pain levels, upper limb volume, and an upper limb disability questionnaire (ULDQ). Measurements were taken at baseline (pre surgery), and one, three-six, and 12 months post surgery. All subjects received pre-operative education and exercise instruction and specific physical therapy (PT) protocol after surgery including ROM and strengthening exercises. Results-All measures of function were significantly reduced one month post surgery, but most recovered to baseline levels by one year post surgery. Some subjects developed signs of lymphedema 3-12 months post surgery, but this did not compromise function. Shoulder abduction, flexion, and external rotation, but not internal rotation ROM, were associated with the ULDQ. Conclusion-Most women in this cohort undergoing surgery for BC who receive PT intervention may expect a return to baseline ROM and strength by three months. Those who do not reach baseline, often continue to improve and reach their pre-operative levels by one year post surgery. Lymphedema develops independently of shoulder function three to 12 months post surgery, necessitating continued monitoring. A prospective physical therapy model of surveillance allows for detection of early and later onset of impairment following surgery for BC in this specific cohort of patients.
BMC Cancer, 2021
Background Breast cancer surgery frequently causes deficiencies in shoulder functioning. The study pourpode is to identify risk factors for prolonged pain, reduction in function, and decrease in range of motion (ROM) in BC patients. Methods A prospective cohort study was designed in a private hospital; between October 2018 and April 2019 with a follow-up of 6 months. Patients following BC surgery, were divided by arm morbidities, and the different risk facrors were evaluated using univariate analysis and logistic regression. Results A total of 157 patients were included in the study. Risk factors for functional disabilities included; pain levels during hospitalization NPRS 1.2 (±0.8) compared to patients with no disabilities 0.5 ± 0.7 (p = .006), the size of tumors more than 1.4 ± 0.8 cm. compared with no morbidities 0.8 ± 0.9 cm. (p = .046), and breast reconstructions (p = .030). Risk factors for prolonged pain includes mastectomy (p = .006), breast reconstruction (p = .011), more ...
Exercise Interventions for upper limb dysfunction due to breast cancer surgery
Protocols, 1996
highlights the findings and application of Cochrane reviews and other evidence pertinent to the practice of physical therapy. The Cochrane Library is a respected source of reliable evidence related to health care. Cochrane systematic reviews explore the evidence for and against the effectiveness and appropriateness of interventions-medication, surgery, education, nutrition, exercise-and the evidence for and against the use of diagnostic tests for specific conditions. Cochrane reviews are designed to facilitate the decisions of clinicians, patients, and others in health care by providing a careful review and interpretation of research studies published in the scientific literature. 1 Each article in this PTJ series summarizes a Cochrane review or other scientific evidence on a single topic and presents clinical scenarios based on real patients or programs to illustrate how the results of the review can be used to directly inform clinical decisions. This article focuses on a woman with a diagnosis of breast cancer who underwent a modified radical mastectomy with a sentinel lymph node biopsy. She subsequently received chemotherapy and radiation therapy and required episodic physical therapy to decrease impairments and improve functional limitations. Could an exercise program for the upper limb delivered preoperatively and postoperatively and along the trajectory of adjuvant chemotherapy and radiation therapy help reduce shoulder and upper extremity impairments? Available With This Article at ptjournal.apta.org • Discussion Podcast with Amy Litterini and authors Mary Lou Galantino and Nichole Stout. Moderated by Diane Jette.
PLoS ONE, 2014
Background: Breast cancer is the most common type of cancer in women in the developed world. As a result of breast cancer treatment, many patients suffer from serious complaints in their arm and shoulder, leading to limitations in activities of daily living and participation. In this systematic literature review we present an overview of the adverse effects of the integrated breast cancer treatment related to impairment in functions and structures in the upper extremity and upper body and limitations in daily activities. Patients at highest risk were defined.
https://www.ijhsr.org/IJHSR\_Vol.12\_Issue.3\_March2022/IJHSR-Abstract.018.html, 2022
Early breast cancer treatment can cause shoulder dysfunction, which is a well-known and prevalent adverse effect (1). In individuals treated surgically for breast cancer, physiotherapy was found to enhance shoulder function considerably (1). Breast cancer is the most common type of cancer in women and the leading cause of death and morbidity (2). Every year, 1.67 million new instances of breast cancer are identified worldwide, with 458,000 fatalities (2). Although 89 percent of breast cancer survivors live for at least five years after treatment, side symptoms can continue for months or even years(2). The most common upper-limb side effects are pain and joint dysfunction, with prevalence rates ranging from 12% to 51% for pain and 1.5 percent to 50% for joint dysfunction. Surgery is the most common treatment for primary breast cancer. Shoulder exercises are commonly advised to reduce mobility and strength loss as well as prevent lymphedema. Several clinical services have been developed to help with shoulder range of motion rehabilitation and secondary lymphedema prevention(3). The goal of this study was to see how additional postoperative physiotherapy affected shoulder function after the initial postoperative healing period, especially when given for a longer period. Patients who have had a mastectomy are always at risk of getting shoulder pain and adhesive capsulitis, and they must take precautions (3).
Shoulder movement after the treatment of early stage breast cancer
Clinical Oncology, 1998
At 18 months after surgery and postoperative radiotherapy, the function of the ipsilateral shoulder joint was assessed both subjectively and objectively in 141 patients with early stage breast cancer. Half of the patients said that function was reduced compared with before (any) treatment. Overall, 48% had measured limitation of at least one shoulder movement. Mastectomy patients had more problems than those who had a wide local excision (79% versus 35%) as did those (node positive patients) who had axillary irradiation (73%) compared with those who did not (35%). Patients with dysfunction of shoulder movement before radiotherapy had a 60% chance of persistent movement problems at 18 months, compared with 24% of those with normal postoperative function. Informal exercise did not appear to have had any impact on the development of movement limitation.
Exercise to prevent shoulder problems after breast cancer surgery: the PROSPER RCT
Health Technology Assessment
Background Upper limb problems are common after breast cancer treatment. Objectives To investigate the clinical effectiveness and cost-effectiveness of a structured exercise programme compared with usual care on upper limb function, health-related outcomes and costs in women undergoing breast cancer surgery. Design This was a two-arm, pragmatic, randomised controlled trial with embedded qualitative research, process evaluation and parallel economic analysis; the unit of randomisation was the individual (allocated ratio 1 : 1). Setting Breast cancer centres, secondary care. Participants Women aged ≥ 18 years who had been diagnosed with breast cancer and were at higher risk of developing shoulder problems. Women were screened to identify their risk status. Interventions All participants received usual-care information leaflets. Those randomised to exercise were referred to physiotherapy for an early, structured exercise programme (three to six face-to-face appointments that included s...