Barriers to rehabilitation following surgery for primary breast cancer

Abstract

Surgery is a mainstay of primary breast cancer therapy. Alterations in surgical technique have reduced normal tissue injury, yet pain and functional compromise continue to occur following treatment. A tenuous evidence base bolstered by considerable expert opinion suggests that early intervention with conventional rehabilitative modalities can reduce surgery-associated pain and dysfunction. Barriers to the timely rehabilitation of functionally morbid sequelae are discussed at length in this article. Barriers arise from a wide range of academic, human, logistic, and financial sources. Despite obstacles, expeditious and effective post-surgical rehabilitation is being regularly delivered to breast cancer patients at many institutions. This experience has given rise to anecdotal information on the management of common sequelae that may undermine function. The epidemiology, pathophysiology, and management of these sequelae are outlined in this article with an emphasis on the caliber of supporting evidence. Myofascial dysfunction, axillary web syndrome, frozen shoulder, lymphostasis, post-mastectomy syndrome, and donor site morbidity following breast reconstruction are addressed. A critical need for more definitive evidence to guide patient management characterizes the current treatment algorithms for surgical sequelae.

Characterization of pain in women after breast cancer treatment

“…These movements are described as abrupt and which stretch the upper limb 10,12,14 . The neuropathic pain is the factor responsible for increasing the complaint of pain when undertaking these movements, as it can lead to the development of the mechanical situation of restriction of shoulder movement 3,4,10,[12][13][14] . As the women in the sample studied were periodically undertaking exercises for rehabilitation of the range of movement of the upper limb, they were asked whether the pain increased when undertaking these exercises and 56.7% stated that it did not, while 23.3% reported that it sometimes increased and 20% said that the pain always increased with physical exercise.…”

“…Knowledge about the pain relief measures is extremely important for the teams who work with these women 4,18 . Appropriate pain management must be implemented, avoiding self-treatment, since this can further compromise the symptom of pain in women with breast cancer 11,13 . …”

Hyperthyroidism is a Risk Factor for Developing Adhesive Capsulitis of the Shoulder: A Nationwide Longitudinal Population-Based Study

“…Pathogenesis mechanisms have been proposed, such as endocrine, immunological, and inflammatory processes4. In addition, thyroid diseases, diabetes mellitus, Dupuytren contractures, breast cancer treatment, and autoimmune diseases have been associated with adhesive capsulitis in previous studies56789. Furthermore, patients diagnosed with myocardial infarctions and cerebral vascular diseases are reportedly at risk of adhesive capsulitis1011.…”

Complicações e condutas fisioterapêuticas após cirurgia por câncer de mama: estudo retrospectivo

“…As cirurgias por câncer de mama, bem como as terapias adjuvantes, podem resultar em algumas complicações físicas, dentre elas: infecção, necrose de pele, seroma, aderência e deiscência cicatriciais, limitação da amplitude de movimento (ADM) do ombro, cordão axilar, dor, alteração sensorial, lesão de nervos motor e/ou sensitivo, fraqueza muscular e linfedema [1][2][3][4][5][6][7] .…”

“…Vários são os recursos fisioterapêuticos utilizados no pós-operatório de câncer de mama, entre eles a cinesioterapia, a terapia manual e o complexo descongestivo fisioterápico 7,12,13 .…”