Measuring upper limb function and patient reported outcomes after major breast cancer surgery: a pilot study in an Asian cohort

Abstract

Background Breast cancer is the most common cancer in women worldwide. Major breast cancer surgery especially with axillary lymph node dissection (ALND), is associated with upper limb functional decline. Majority of studies are conducted in Western population and may not be applicable to Asians. This pilot study aims to evaluate whether major breast surgery results in upper limb functional impairment in a cohort of Asian women with breast cancer. Methods This is a prospective cohort study of 41 patients who underwent 44 major breast surgeries from April 2018 to August 2019. Main inclusion criteria were patients over 21 years of age undergoing major breast surgery for breast cancer. Major breast surgery was defined as wide local excision (WLE) or mastectomy. Main exclusion criteria were patients with pre-existing neurological or rheumatological co-morbidities affecting upper limb function or previous trauma with resulting deformities to the upper limbs. Patients underwent early rehabilitation from post-operative day 1. Shoulder flexion and abduction active range of motion (AROM) and QuickDASH disability score were assessed 1 week before surgery, post-operative week 2 and week 6. Baseline demographics and peri-operative data were also collected. Results Median age was 62.5 years. There were 16 (36.4%) wide local excisions and 28 (63.6%) simple mastectomies. Two (4.5%) cases had neoadjuvant chemotherapy. Fifteen (34.1%) cases had ALND. At post-operative week 6, shoulder flexion was comparable to baseline (p = 0.775), while abduction improved from baseline (p = 0.016). However, QuickDASH disability score was significantly worse at post-operative week 6 compared to baseline (median score 2.5 vs 0, p = 0.027). Subgroup analysis of patients with ALND demonstrated significantly worse QuickDASH disability score at post-operative week 6 (p = 0.010) but not for patients with only sentinel lymph node biopsy (p = 0.396). Conclusion This pilot study in an Asian cohort found that patients were able to regain AROM of shoulder after major breast surgery at post-operative week 6 but had a worse QuickDASH disability score, especially in the subgroup with ALND. Aggressive and early rehabilitation should be encouraged. However, a longer follow-up is required to evaluate long term functional outcomes.

Advanced Rehabilitation Strategies for Post-Operative Breast Cancer: A Study on the Effectiveness of Training using Virtual Reality (Preprint)

“…However, the detailed evaluation of the date might be promising because the mean difference of the reported median values pre and post treatment in the VR groups was higher than in the PNF group (MD= 15.5 and 11, respectively). These findings were further supported by Chan's work [35] where the function measured by Quick-DASH scale were not significant after 2 or 6 weeks of intervention. The current study findings were on contrary to those reported in previous studies where the patients in the VR group demonstrated better functional scores in contrast to the control group.…”

“…Although there were significant improvements reported after treatment, there was no significant difference between groups regarding muscle strength, ROM, and function. In the other study that was performed by Chan and colleagues, no between groups comparison yet there was significant improvement in shoulder abduction and flexion active ROM after VR training [35].…”

“…Five recent studies investigated the function after using VR in patients having BC [16,[33][34][35][36]. No between groups significant differences were reported in two studies [16,33] where both the VR and the comparator groups demonstrated similar improvement.…”

“…Less number of participants (n=6) was included in another study [36]. Weak design that lack a control group was also implemented in many occasions [16,[35][36][37]. Finally, short duration of intervention was evident in many studies where it ranged from single session [30] to two weeks [16] while other researchers applied the interventions during the chemotherapy session [17,37].…”

Contributions of a Rehabilitation Nursing Program in the Self-Care of Women Undergoing Breast Surgery

“…A woman undergoing breast surgery with ALND has a higher risk of developing alterations in the upper limb. Rehabilitation is the best option to prevent complications, recover shoulder range of motion and prevent shoulder, arm and hand disability [ 18 ], maintain functional capacity, and decrease the risk of losing important skills or independence [ 19 ]. Evidence indicates that rehabilitation is beneficial in these women’s recovery, mostly after 3 months [ 20 , 21 , 22 ].…”