Predictors of functional shoulder recovery at 1 and 12 months after breast cancer surgery

Abstract

The objective of this study are (1) to determine if upper extremity function, as represented by shoulder ROM, self-reported symptoms and upper extremity functional limitations in activities of daily living could be predictively related to demographic and cancer characteristics post-surgery for breast cancer. And (2) to examine if variables related to early onset impairment contribute to late onset impairments in women after breast cancer surgery. Subjects were assessed preoperatively and 1, 3, 6, 9, and 12+ months post breast cancer surgery for impairments and symptoms and at 12+ months for shoulder functional limitations using a physical therapy surveillance model. Body weight, shoulder ROM, manual muscle testing, and upper limb volume were recorded. At 12+ months, the Harvard Alumni Health Study Physical Activity Questionnaire, and an Upper Limb Disability Questionnaire were administered. Symptoms and ROM impairments were compared by functional limitations. Characteristics significantly associated with early ROM impairment (but not later impairment) were axillary lymph node dissection, removal of ≥15 nodes, mastectomy surgery and stage II breast cancer. Positive nodes, older age, and BMI≥25 were significantly associated with reduced shoulder ROM at 12+ months. At 12+ months, only 10 % of the patients experienced ROM impairments while rates of self-reported symptoms in the affected upper extremity at 12+ months were as follows: pain-49%, weakness-47.1%, numbness-55.9%, feeling tired-42.5%. The majority of patients used the affected upper extremity for reaching without limitation, but ≥35% reported limitation with household chores, carrying and lifting. Difficulty carrying and lifting could be predicted by BMI≥25 and use of the dominant affected upper limb. Different factors are associated with early versus later ROM loss. Symptoms reported by breast cancer survivors are frequently associated with functional limitations in upper extremity tasks and warrant intervention. Physical therapy using a prospective surveillance model of care may reduce severity of ROM loss, symptoms and functional upper extremity limitations 1 year after breast cancer surgery.

The impact of breast cancer-related lymphedema on the ability to perform upper extremity activities of daily living

“…Consistent with our results, reports that include clinical confirmation of lymphedema do not show significant impact of BCRL on function [11,20,38]. Hayes et al assessed upper-body morbidity in a cohort of 287 women who had CI confidence interval, BMI body mass index, SLNB sentinel lymph node biopsy, ALND axillary lymph node dissection, RLNR regional lymph node radiation, RVC relative volume change ''-'' indicates the specified variable/comparison was not analyzed [20]. In this cohort, shoulder range of motion and strength was used to assess shoulder function, while arm function was evaluated using a self-reported questionnaire [20].…”

“…Consequently, assessing BCRL by clinical quantification using arm volume measurements is the preferred method to assure reliability. Consistent with our results, reports that include clinical confirmation of lymphedema do not show significant impact of BCRL on function [11,20,38]. Hayes et al assessed upper-body morbidity in a cohort of 287 women who had CI confidence interval, BMI body mass index, SLNB sentinel lymph node biopsy, ALND axillary lymph node dissection, RLNR regional lymph node radiation, RVC relative volume change ''-'' indicates the specified variable/comparison was not analyzed [20].…”

“…Other treatment-related factors including fatigue, pain, loss of upper extremity range of motion and strength, anxiety, changes in weight, unemployment, and neuropathy have also been suggested to compromise function and QOL [8,[15][16][17][18][19][20][21][22][23].…”

A longitudinal analysis of chronic arm morbidity following breast cancer surgery

“…Correlational analyses were conducted between continuous demographic (age, BMI) and clinical variables (number of nodes removed, number of positive nodes, time since surgery). These clinical variables have been shown to be significant predictors of AM [58,59] and quality of life [60] in BC patients. Demographic and/or clinical variables showing significant group differences or positive associations with negative affect were included in the mediation analyses.…”

Assessment of the status of A National Action Plan for Cancer Survivorship in the USA

“…Survivors encounter many issues that fall outside the immediate scope and responsibility of their cancer treatment team-often years after treatment [7][8][9][10]. Survivors may face needs associated with rehabilitation [11][12][13], information [14,15], psychological functioning [16,17], finances [18], and aging [19,20].…”