Upper‐body morbidity after breast cancer

Abstract

The purpose of this paper is to review the incidence of upper‐body morbidity (arm and breast symptoms, impairments, and lymphedema), methods for diagnosis, and prevention and treatment strategies. It was also the purpose to highlight the evidence base for integration of prospective surveillance for upper‐body morbidity within standard clinical care of women with breast cancer. Between 10% and 64% of women report upper‐body symptoms between 6 months and 3 years after breast cancer, and approximately 20% develop lymphedema. Symptoms remain common into longer‐term survivorship, and although lymphedema may be transient for some, those who present with mild lymphedema are at increased risk of developing moderate to severe lymphedema. The etiology of morbidity seems to be multifactorial, with the most consistent risk factors being those associated with extent of treatment. However, known risk factors cannot reliably distinguish between those who will and will not develop upper‐body morbidity. Upper‐body morbidity may be treatable with physical therapy. There is also evidence in support of integrating regular surveillance for upper‐body morbidity into the routine care provided to women with breast cancer, with early diagnosis potentially contributing to more effective management and prevention of progression of these conditions. Cancer 2012;118(8 suppl). © 2012 American Cancer Society.

Correlação da dor e qualidade de vida de mulheres pós-tratamento cirúrgico de câncer de mama

“…Hayes, et al 25 observaram que 41% das mulheres no período de dezoito meses pós-operatório apresentaram piora da qualidade de vida. Os autores afirmam que as morbidades persistem em longo prazo, influenciando negativamente sobre a qualidade de vida.…”

Self-reported side effects of breast cancer treatment: a cross-sectional study of incidence, associations, and the influence of exercise

“…Upper limb dysfunction, including a reduced range of motion in the shoulder, muscle weakness, and pain and numbness, are common postoperative complications for breast cancer patients [35,37]. These dysfunctions not only impact on physical health, as breast cancer survivors with clinically defined arm/shoulder problems also have significantly poorer QOL than survivors without arm/shoulder pain [9].…”

“…Pain as a result of breast cancer treatment is an ill-defined syndrome ranging from mild pain to significant nociceptive pain and neuromas [38,39]. Upper-body pain is a commonly experienced breast cancer treatment side-effect, and the extent of pain experienced is generally linked to more invasive surgery and aggressive radiation treatments [40,22,37].…”

“…Although evidence is limited, commonly-used clinical approaches to upper-body morbidities such as muscular chest wall pain include gentle exercises, which promote normal muscular recruitment patterns and enhance tissue extensibility [37]. Therefore, it is postulated that women who sufficiently exercise, and particularly promote controlled use of pectoralis, serratus anterior and latissimus dorsi musculature, would also be less likely to experience muscular chest wall pain.…”

“…The risk of arm lymphedema is directly related to the extent of surgery, or radiation treatment or both [2], and it is regarded as a persistent or chronic condition [37]. Even when symptoms appear resolved, a patient remains at an increased risk of redeveloping lymphedema [37].…”