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

Abstract

RESUMO | Após cirurgia por câncer de mama, as mulheres estão sujeitas a desenvolver algumas complicações físicas. Os objetivos deste trabalho foram: investigar o desfecho dessas mulheres, que, durante o primeiro mês pós-operatório, foram submetidas a um programa de reabilitação e identificar ao longo de dois anos as complicações mais frequentes e as condutas fisioterapêuticas mais adotadas. Foi um estudo descritivo, retrospectivo, com dados de 707 prontuários de mulheres operadas por câncer de mama no Hospital da Mulher Professor Doutor José Aristodemo Pinotti da Universidade Estadual de Campinas, entre janeiro de 2006 e dezembro de 2007, atendidas pelo Setor de Fisioterapia. A análise foi feita por meio de médias, desvio padrão e frequências absolutas e relativas. Ao final do programa, 55% das mulheres receberam alta, 17% necessitaram de atendimento adicional e 26% não aderiram a ele. As complicações mais frequentes foram: aderência pericicatricial (26%), restrição da amplitude de movimento (24%) e deiscência cicatricial (17%). No primeiro ano após a cirurgia (n=460), foram relatados dor (28,5%), sensação de peso (21,5%) e restrição da amplitude de movimento do ombro (16, 7%); já no segundo (n=168), houve dor (48,2%), sensação de peso (42,8%) e linfedema (23,2%). Concluiu-se que, ao final do programa, a maioria das mulheres recebeu alta. Ao longo dos anos, houve redução da frequência de restrição da amplitude de movimento do ombro com aumento de linfedema. Cuidados com o braço, exercícios domiciliares e autodrenagem foram as condutas mais adotadas.Descritores | fisioterapia; terapia por exercício; reabilitação; complicações pós-operatórias; câncer de mama.ABSTRACT | After breast cancer surgery, women may develop some physical complications. Thus, the aims of this study were to investigate the outcome of these women, who participated in a rehabilitation program for one month, as well to identify along two years the most frequent complications and adopted physical therapy conducts. It was a descriptive and retrospective study with 707 medical records of women treated for breast cancer at the Women's Hospital Professor Doutor José Aristodemo Pinotti, Universidade Estadual de Campinas, between January 2006 and December 2007, admitted in the Division of Physical Therapy. Analysis was performed by means, standard deviation, absolute and relative frequencies. By the end of the program, 55% of women were discharged, 17% required additional treatment, and 26% did not join it. The most frequent complications were: pericicatricial adherence (26%), range of motion (ROM) restriction (24%), and scar dehiscence (17%). In the first year after surgery (n=460), the main complaints were: pain (28.5%), heaviness (21.5%), and restriction of shoulder range of motion (16.7%); in the second year (n=168), they were pain (48.2%), heaviness (42.8%), and lymphedema (23.2%). It was concluded that most women were discharged in the end of the program and, over the years, they presented reduction of shoulder range of motion frequency and lymp...

Late locoregional complications associated with adjuvant radiotherapy in the treatment of breast cancer: Systematic review and meta‐analysis

“…36,38 Other complications are frequently reported in association with lymphedema, such as restriction of ipsilateral should mobility in about 16.7% of women treated with breast cancer. 39 It has also been reported that the incidence of skeletal muscle complications is an age-related phenomenon, being higher in women over the age of 50 years submitted to lymphadenectomy. 40 Other reported morbidities related to breast cancer treatment are neuropathy, rotator cuff disease, adhesive capsulitis, postmastectomy pain syndrome, and intercostobrachial neuralgia.…”

“…There is considerable variation in the incidence, ranging from 3.5% to 44.8%, probably due to the diversity of methods used in making the diagnosis, and the fact that it is a time‐dependent phenomenon, with the RR increasing over time . Other complications are frequently reported in association with lymphedema, such as restriction of ipsilateral should mobility in about 16.7% of women treated with breast cancer . It has also been reported that the incidence of skeletal muscle complications is an age‐related phenomenon, being higher in women over the age of 50 years submitted to lymphadenectomy .…”

Dor, função pulmonar e força muscular respiratória no pré e pós-operatório de mulher mastectomizada

“…Esta dor geralmente está associada com a neoplasia devido à invasão ou a compressão das estruturas, devido ao tratamento que inclui a radioterapia, fibrose, neuropatia, quimioterapia e o pós-operatório 3 . A dor também pode estar associada à presença do dreno aspirativo 10 .…”

Upper Limb Functionality and Quality of Life in Women with Five-Year Survival after Breast Cancer Surgery

“…6 The main complications related to surgery are sensitivity impairment, seroma production, altered ventilatory capacity, lymphedema, axillary cording, reduced strength on the upper limb, reduced range of motion (ROM) of the arm and shoulder, and pain. 7,8 Pain itself is the main physical/functional impairment reported by patients, 9 with a prevalence of up to 60%. 9,10 Functionality involves the interrelation of the personal aspects of an individual (physical and emotional) with the surroundings (the environment and the engagement on activities).…”