Longitudinal change of treatment‐related upper limb dysfunction and its impact on late dysfunction in breast cancer survivors: A prospective cohort study

Abstract

Background and Objectives: To investigate the prevalence of upper limb dysfunction (ULD) and subtypes after breast cancer surgery and to identify factors associated with late ULD. Methods: Among 191 enrolled patients, 191 were evaluated at 3 months, 187 at 6 months, and 183 at 12 months after surgery. Pain, shoulder range of motion, muscle strength, and arm circumference were assessed. Based on symptoms and physical examinations, the types of ULD common after breast cancer treatment were diagnosed and categorized. Results: The prevalence of ULD after surgery were 24.6%, 20.9%, and 26.8% at 3, 6, and 12 months, respectively. The most common types of ULD were pectoralis tightness at 3 and 6 months and lymphedema at 12 months. Patients with pectoralis tightness or lymphedema at 3 or 6 months showed a higher prevalence of rotator cuff disease at 12 months compared with those without early pectoralis tightness or lymphedema. Conclusions: The major post-operative ULD were pectoralis tightness at 3 and 6 months and lymphedema at 12 months. Late ULD such as rotator cuff disease were associated with pectoral tightness or lymphedema at earlier stages. Diagnosis and treatment of ULD should take place as soon as possible after surgery.

Associations among baseline variables, treatment-related factors and health-related quality of life 2 years after breast cancer surgery

“…The symptoms of tightness and arm lymphedema perceived in the remaining breast, chest wall, arm and axilla are likely to be caused by ALND, postoperative contracture and radiotherapy. A recent prospective cohort study of upper limb dysfunction (ULD) after surgery for breast cancer determined the incidence, time course and risk factors for various ULD subtypes, including pectoralis tightness, lymphedema and lymphostasia, myofascial pain syndrome, rotator cuff disease, adhesive capsulitis, and post-mastectomy pain syndrome [40]. The highest incidences of ULD were due to pectoralis tightness and lymphedema, which is consistent with our results, and development of these symptoms caused long-term rotator cuff disease, indicating that physical rehabilitation is needed in patients with tightness and lymphedema to improve long-term postoperative physical function.…”

Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies

“…26,35 Whether or not we incorporated missing data for nonsignificant predictors or converted categorical data for age and BMI to continuous data (Appendix 13, available at www.cmaj.ca/lookup/suppl/ doi:10.1503/cmaj.151276/-/DC1) did not appreciably influence the results. 42 Wilson et al, 2013 49 Mejdahl et al, 2013 26 Johansen et al, 2014 52 Lundstedt et al, 2012 41 De Oliveira et al, 2014 37 Steegers et al, 2008 44 Meretoja et al, 2014 58 Yang et al, 2010 51 Tasmuth et al, 1997 46 Shahbazi et al, 2015 60 Husen et al, 2006 40 Bell et al, 2014 59 Swenson et al …”

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

“…There is evidence that it is possible to prevent some complications (or minimize their effect) throughout the acute phase of cancer treatment with oncological therapies through an early rehabilitation program [13][14][15][16][17][18][19] and it is known that physiotherapy and a program with specific exercises can contribute to the improvement in QoL in women with breast cancer throughout the acute phase of survival [20][21][22][23][24][25][26][27][28][29][30][31][32]. However, clinical practice suggests that patients undergoing SLNB surgery are rarely included in a functional rehabilitation program because it is assumed that in this surgery there is an absence of morbidity and consequently a minimal impact in their QoL.…”