Magnitude of late effects of breast cancer treatments on shoulder function: a systematic review

Abstract

Late effects of treatment for breast cancer on shoulder function have been documented by a number of investigators; however, many studies include only prevalence data. When comparisons are provided that assess differences between treatment groups, only P-values without magnitudes of effect are often reported. The purpose of this systematic review was to identify literature that could be used to examine the magnitude of late effects of breast cancer treatments on shoulder function with a particular focus on axillary lymph node dissection (ALND) and on radiotherapy. A comprehensive search of online databases was performed for research papers published between 1980 and 2008 that provided comparison data between treatment groups, between the affected and unaffected side of individuals, or between pre-operative and subsequent assessments 12 months or more after diagnosis of breast cancer. Papers that met inclusion criteria were reviewed using a methodological checklist. Standardized effect sizes were computed for continuous data; odds ratios and 95% confidence intervals were computed for dichotomous data if not already available. Twenty-two papers met the inclusion criteria. With a few exceptions, most analyses showed excess shoulder morbidity with breast cancer treatment, ALND, or radiotherapy. Although effect sizes varied, moderate to large effects predominated across the different outcomes. There is sufficient evidence of late effects of ALND or radiotherapy post-breast cancer to warrant careful attention to shoulder function across time in individuals who have had breast cancer. Implications for future shoulder dysfunction are discussed.

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

“…5,[10][11][12][13][14] We assessed the risk of bias in individual studies and used the GRADE approach to appraise the quality of evidence. We converted the intensity of persistent postsurgical pain to a 10-cm visual analogue scale across studies to optimize the interpretation of our findings.…”

“…[10][11][12][13] Systematic reviews summarizing proposed risk factors for persistent pain after breast cancer surgery -including demographic, intraoperative and postoperative factors -have had several limitations, including outdated searches, inadequate attention to risk-of-bias assessment, lack of statistical pooling of measures of association and failure to evaluate the quality of evidence. 5,[10][11][12][13][14] We conducted a systematic review and meta-analysis of observational studies to identify risk factors for persistent pain after breast cancer surgery, addressing the limitations of previous reviews.…”

Computer Simulation of Pectoralis Major Muscle Strain to Guide Exercise Protocols for Patients After Breast Cancer Surgery

“…33 Loss of flexibility of the muscle suggests the need to start stretching exercises as early as possible; however, exercise programs that start in the first days after surgery have been associated with an increased risk of seroma formation. 2,15,16,34,43 There is no available information that provides absolute parameters for safe stretching for patients after mastectomy or breast reconstruction.…”

“…Motions that were found to be restricted after treatment were flexion, abduction, and external rotation, and combinations of abduction and external rotation. 26,28,30,31,33,36 Commonly applied exercises, such as the corner stretch, abduction and external rotation combined, and the overhead stretch, include these motions. Extension of the shoulder beyond neutral is only sporadically part of clinical trials, so extension and extension combined with external rotation were included, based on the description of PM anatomy and that, with contraction, shortening of the PM muscle moves the shoulder into flexion.…”

“…8 Up to 50% of survivors have a loss of shoulder motion after completion of their treatments, 28,46 which often extends into a long-term impairment. 33,48 This loss of motion has been found to be predictive of reduced capability to perform functional activities 28 and has been shown to be related to depressive symptoms in a group of 183 older women. …”