A longitudinal study of shoulder and arm morbidity in breast cancer survivors 7 years after sentinel lymph node biopsy or axillary lymph node dissection

Abstract

Knowledge about long-term consequences of breast cancer treatment on shoulder and arm function and volume in stages I-II breast cancer survivors is limited. The effects of shoulder-arm function shortly after surgery on long-term function are unknown. One hundred and ninety-four women were examined pre-surgery (T0) and 6 weeks after surgery (T1). Of those, 110 were re-examined 7 years later (T2). Thirty-four women underwent sentinel lymph node biopsy (SLNB) and 76 underwent axillary lymph node dissection (ALND). Differences between affected and unaffected side were calculated for four ranges of motion functions, three strength functions and arm volume. These were used to analyse time and group effects. Differences exceeding 20° in range of motion, 20 % in strength and 200 ml in arm volume were considered clinically relevant. Multivariate regression analyses examined the effect of shoulder-arm function at T1 on shoulder-arm function at T2. Additional predictor variables included were age, follow-up time, Body Mass Index, complications, chemotherapy, radiation, SLNB/ALND and type of breast surgery. At T2, range of motion (except external rotation), abduction strength and arm volume were impaired compared to T0. After ALND, women had significantly more forward flexion impairment, increased arm volume and clinically relevant impairments (70 %) than after SLNB (41 %). T1 external rotation, abduction-external rotation, grip strength and arm volume were the strongest predictors of these variables at T2. Age was the strongest predictor of the remaining four variables. ALND predicted arm volume only. Seven years after breast cancer surgery, two-fifth of the women after SLNB and seven out of ten women after ALND had impairments. Impairments were found in five of eight shoulder-arm functions. After SLNB, women have less forward flexion impairment and less arm volume increase than after ALND. Shoulder-arm function at 6 weeks after surgery and age are the strongest predictors of long-term shoulder-arm function.

Persistent Breast Pain Following Breast Cancer Surgery Is Associated With Persistent Sensory Changes, Pain Interference, and Functional Impairments

“…Differences among the classes did not meet published standards for clinically meaningful differences in grip strength of 6 kg 25 and flexion/abduction of 20°. 18 However, these “standards” are based on cross-sectional studies. Persistent changes of lesser magnitude may be clinically meaningful.…”

Persistent Arm Pain Is Distinct From Persistent Breast Pain Following Breast Cancer Surgery

“…5,7,8,13–15 Many of these studies focused on morbidity after ALND 5,8,14 or evaluated ALND as a risk factor for more severe morbidity. 13,15 In general, sustained mobility impairments and more severe impairments in strength and mobility were found in patients who had a complete ALND. Interestingly, although a similar proportion of patients in the Mild and Moderate Pain classes had an ALND (47% and 51%, respectively), statistically significant differences in the degree of impairment in flexion, abduction, and external rotation, were found.…”

“…The observed differences between the classes did not reach published standards for clinically meaningful differences of 20°. 13 However, a 20° change represents severe physical impairments. 26 The more subtle changes that persist over time may represent clinically meaningful decrements in these patients.…”

Effectiveness of Physiotherapy Intervention on the Quality of Life of Women with Breast Cancer who Underwent Sentinel Lymph Node Biopsy.

“…The modalities of breast cancer surgery which, in addition to breast surgery, recur to Sentinel Lymph Node Biopsy (SLNB) have significantly reduced morbidity of the upper limb and trunk on the surgery side when compared to surgeries in which an Axillary Lymph Node Dissection is performed [1][2][3][4][5][6]. However, in the acute survival phase [7,8], when oncological therapies are performed during the first year following diagnosis, the effect of therapies such as chemotherapy, radiotherapy, hormone therapy, and immunotherapy can overcome the lower aggressiveness of the surgery, leading to no differences in quality of life (QoL) between the two groups of patients [9][10][11][12].…”