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Binkley JM, Gabram S, Finley J, Fowler D, VanHoose L, McCullough LE. Racial disparity in breast cancer survivorship: themes from a series of four national healthcare provider live virtual forums. J Cancer Surviv 2023:10.1007/s11764-023-01373-6. [PMID: 37040001 DOI: 10.1007/s11764-023-01373-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/25/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE Significant disparity exists in the diagnosis, treatment, and survivorship outcomes among Black breast cancer (BC) survivors. Black BC survivors have more significant survivorship issues and a greater burden of illness than White counterparts. Barriers to rehabilitation exist for all BC survivors but are magnified in Black BC survivors. The purpose of this qualitative research was to document patient, clinician, and researchers' perceptions surrounding contributing factors, lived experiences, and potential solutions to racial disparity in BC survivorship. METHODS A narrative approach was utilized to identify themes from a series of four virtual healthcare provider forums that explored lived personal and professional experiences, issues, and potential solutions surrounding racial disparity in BC survivorship. Forums included perspectives of patients, healthcare providers, researchers, and stakeholders in the BC field. An independent thematic analysis was performed by the investigators, all of whom have emic perspectives with respect to race and/or BC. RESULTS Three main themes were identified related to racial disparity in BC survivorship: (1) societal and cultural contributing factors, (2) contribution of healthcare providers and systems, and (3) models of care and research considerations. CONCLUSIONS The findings provide compelling documentation of lived personal and professional experiences of racial disparity in BC survivorship. Potential solutions exist and must be enacted immediately to ensure equitable survivorship outcomes for Black individuals following a BC diagnosis. IMPLICATIONS FOR CANCER SURVIVORS Increased awareness related to racial disparity in BC survivorship among survivors, healthcare providers, and researchers will contribute to health equity and improved outcomes for Black individuals.
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Affiliation(s)
- Jill M Binkley
- TurningPoint Breast Cancer Rehabilitation, Atlanta, GA, USA.
- Global Access to Breast Cancer Rehabilitation Community Partnership Initiative, Atlanta, GA, USA.
| | - Sheryl Gabram
- Global Access to Breast Cancer Rehabilitation Community Partnership Initiative, Atlanta, GA, USA
- Georgia Center for Oncology Research and Education, Atlanta, GA, USA
| | - Janae Finley
- TurningPoint Breast Cancer Rehabilitation, Atlanta, GA, USA
- Global Access to Breast Cancer Rehabilitation Community Partnership Initiative, Atlanta, GA, USA
| | | | - Lisa VanHoose
- Global Access to Breast Cancer Rehabilitation Community Partnership Initiative, Atlanta, GA, USA
- College of Saint Mary, Omaha, NE, USA
- The Ujima Center, Monroe, LA, USA
| | - Lauren E McCullough
- Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Stout NL, Utzman R, Jenkins HH, Burkart M, Swisher AK. Implementing and sustaining a breast cancer prospective surveillance rehabilitation program: an institutional perspective. J Cancer Surviv 2023; 17:509-517. [PMID: 36441392 DOI: 10.1007/s11764-022-01304-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The prospective surveillance model (PSM) is an evidence-based rehabilitation care delivery model that facilitates functional screening and intervention for individuals undergoing cancer treatment. While PSM is empirically validated and feasible in practice, implementation into cancer care delivery has languished. The purpose of this manuscript is to characterize the barriers and facilitators to implementing PSM in a breast cancer center and to share policy and process outcomes that have sustained the model in practice. METHODS The PSM implementation was undertaken as a quality improvement initiative of our cancer center. We retrospectively assessed barriers to implementation and define those according to the Consolidated Framework for Implementation Research (CFIR). Implementation strategies are defined based on the Expert Recommendations for Implementation Change (ERIC) taxonomy. Breast center policy changes and stakeholder-reported process improvement outcomes at the clinic and system level are described. RESULTS PSM implementation facilitation was driven primarily by adapting the model to align with the cancer center workflow, engaging interdisciplinary stakeholders as program champions, enhancing knowledge and awareness among cancer care providers, and changing infrastructure to support the model. System and clinic-level policy and process changes included the development of clinical pathways, EHR order sets and automated referrals, new staffing models, and adapted clinical workflows. CONCLUSION Our report provides insight on implementing the PSM at a single institution in a cancer care delivery setting. Successful implementation strategies addressed individual, clinic, and system-level barriers and facilitated process and policy changes that have enabled PSM sustainment. Improving integration of rehabilitation services into oncology care has significant implications for survivorship care by enhancing proactive management of functional morbidity. IMPLICATIONS FOR CANCER SURVIVORS Improving integration of rehabilitation services into oncology care has significant implications for survivorship care by enhancing proactive management of functional morbidity.
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Affiliation(s)
- Nicole L Stout
- Department of Hematology Oncology, West Virginia University School of Medicine, Morgantown, WV, USA.
- Department of Health Policy, Management, and Leadership, West Virginia University School of Public Health, Morgantown, WV, USA.
- West Virginia University Cancer Institute, Morgantown, WV, USA.
| | - Ralph Utzman
- Division of Physical Therapy, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Hannah Hazard Jenkins
- West Virginia University Cancer Institute, Morgantown, WV, USA
- Department of Surgery, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Megan Burkart
- West Virginia University Cancer Institute, Morgantown, WV, USA
- Division of Physical Therapy, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Anne K Swisher
- West Virginia University Cancer Institute, Morgantown, WV, USA
- Division of Physical Therapy, West Virginia University School of Medicine, Morgantown, WV, USA
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Toohey K, Hunter M, McKinnon K, Casey T, Turner M, Taylor S, Paterson C. A systematic review of multimodal prehabilitation in breast cancer. Breast Cancer Res Treat 2023; 197:1-37. [PMID: 36269525 PMCID: PMC9823038 DOI: 10.1007/s10549-022-06759-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/02/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Breast cancer is the most prevalent malignancy in women. Prehabilitation may offer improvements in physical and psychological wellbeing among participants prior to treatment. This systematic review aimed to determine the efficacy of prehabilitation in participants diagnosed with breast cancer. METHODS A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. Studies exploring the impact of prehabilitation in participants with breast cancer were included. Studies were assessed independently according to pre-eligibility criteria, with data extraction and methodological quality assessed in parallel. RESULTS 3184 records were identified according to our search criteria, and 14 articles were included. Articles comprised of quantitative randomised controlled trials (n = 7), quantitative non-randomised studies (n = 5), a qualitative study (n = 1), and a mixed-method study (n = 1). The majority of selected studies completed exercise programs (n = 4) or had exercise components (n = 2), with two focusing on upper-limb exercise. Five articles reported complementary and alternative therapies (n = 5). Two articles reported smoking cessation (n = 2), with a single study reporting multi-modal prehabilitation (n = 1). Mostly, prehabilitation improved outcomes including physical function, quality of life, and psychosocial variables (P < 0.05). The qualitative data identified preferences for multimodal prehabilitation, compared to unimodal with an interest in receiving support for longer. CONCLUSIONS Prehabilitation for patients with breast cancer is an emerging research area that appears to improve outcomes, however, ensuring that adequate intervention timeframes, follow-up, and population groups should be considered for future investigations. IMPLICATIONS FOR CANCER SURVIVORS The implementation of prehabilitation interventions for individuals diagnosed with breast cancer should be utilised by multidisciplinary teams to provide holistic care to patients as it has the potential to improve outcomes across the cancer care trajectory.
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Affiliation(s)
- Kellie Toohey
- Faculty of Health, University of Canberra, Bruce ACT, 2617, Australia.
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce ACT, Australia.
| | - Maddison Hunter
- Faculty of Health, University of Canberra, Bruce ACT, 2617, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce ACT, Australia
| | - Karen McKinnon
- Australian Capital Territory Breast Care, Calvary Public Hospital, Bruce ACT, Australia
| | - Tamara Casey
- Australian Capital Territory Breast Care, Calvary Public Hospital, Bruce ACT, Australia
| | - Murray Turner
- Faculty of Health, University of Canberra, Bruce ACT, 2617, Australia
| | - Suzanne Taylor
- Australian Capital Territory Breast Care, Calvary Public Hospital, Bruce ACT, Australia
| | - Catherine Paterson
- Faculty of Health, University of Canberra, Bruce ACT, 2617, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce ACT, Australia
- Robert Gordon University, Aberdeen, AB10 7QB, Scotland
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Standardization of upper limb exercises to improve radiation therapy for breast cancer, a conceptual literature review. J Med Imaging Radiat Sci 2022; 53:720-727. [PMID: 35965195 DOI: 10.1016/j.jmir.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/13/2022] [Accepted: 07/22/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Many patients with breast cancer are left with upper arm mobility dysfunction following surgery. Despite the beneficial effects of upper limb exercises on shoulder dysfunction, radiation therapists still do not widely encourage patients to participate in arm exercises after surgery. This conceptual literature review synthesizes evidence on how patients with breast cancer that participate in upper limb exercises after surgery have improved arm mobility which could result in a more consistent arm position during radiation therapy. METHODS A literature search was performed in the PubMed, Athabasca University Library, and Google Scholar databases to identify articles that evaluated the effect of upper limb exercises on patients' arm mobility and range of motion after breast cancer surgery, and the impact of arm position on anatomy during radiation therapy. Sixteen studies were included in the conceptual review synthesis. RESULTS The studies were heterogeneous in terms of the utilized exercise methods and the upper limb related outcomes measured. Twelve studies demonstrated that upper arm exercises are an effective intervention in restoring arm mobility and decreasing pain in women with breast cancer. Additionally, four studies showed that differences in arm rotation affect the breast region's anatomy, which could result in set-up errors during radiation therapy. CONCLUSION The effectiveness of radiation therapy for breast cancer treatment relies on women to reproduce their shoulder position each day. Any inability to replicate the arm position due to mobility issues can affect the accuracy of the dose delivered and, ultimately, the treatment outcome. Therefore, upper limb exercises should be recommended by radiation therapists to their patients before or during radiation therapy to improve patient comfort and the accuracy of treatment. Additionally, upper limb exercise standards need to be developed for patients with breast cancer and implemented by radiation therapists.
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Cancer; Pathophysiology and Stress Modulation (Cancer, Therapeutic Interventions). Semin Oncol Nurs 2022; 38:151328. [PMID: 35989196 DOI: 10.1016/j.soncn.2022.151328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this review is to describe the myriad complications of cancer and its therapies to emphasize the pathophysiological need for prehabilitation. DATA SOURCES The information presented in this review is from applicable, peer-reviewed scientific articles. CONCLUSION Cancer itself renders negative effects on the body, most notably unintentional weight loss and fatigue. Cancer treatments, especially surgical interventions, can cause detrimental short- and long-term impacts on patients, which translate to suboptimal treatment outcomes. Prehabilitation can be used to improve patient health prior to anticancer therapies to improve treatment tolerance and efficacy. IMPLICATIONS FOR NURSING PRACTICE Nurses play an important role in the treatment of patients with cancer throughout the cancer care continuum. Many nurses are already aiding their patients in cancer prehabilitation through education. By describing common impairments amenable to multimodal prehabilitation, nurses may better advocate for their patients and can become even more involved in this aspect of care.
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Mathieu J, Daneau C, Lemeunier N, Doyon A, Marchand AA, Descarreaux M. Conservative interventions and clinical outcome measures used in the perioperative rehabilitation of breast cancer patients undergoing mastectomy: a scoping review. BMC Womens Health 2022; 22:343. [PMID: 35974334 PMCID: PMC9380320 DOI: 10.1186/s12905-022-01927-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Mastectomy is the first-line treatment approach for more than 90% of breast cancer patients. The numerous physical impairments associated with this surgical procedure negatively impact the patient’s quality of life. To date, rehabilitation resources available for breast cancer patients undergoing mastectomy within the institutions affiliated to the Centre intégré universitaire de soins de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS-MCQ) are lacking and do not always seem to reflect the particularities of breast cancer care pathways. The purpose of this review was to identify and describe the conservative interventions and the clinical outcome measures used in the perioperative physical rehabilitation of women with breast cancer who are awaiting or have undergone mastectomy. We also aimed to report on the barriers and facilitators to study participation and completion. Methods MEDLINE, CINAHL, and the Cochrane Library were searched from inception to January 2021, and we updated the search on July 11, 2022. We included peer-reviewed English and French literature with quantitative designs, describing conservative interventions and clinical outcome measures used within rehabilitation programs designed for women who were awaiting or had undergone mastectomy. Paired reviewers independently reviewed all citations and articles using a two-phase screening process and independently extracted the data. Results Of the 6080 articles identified, 57 met the inclusion criteria. Most interventions were multimodal, which combined exercise with patient education, manual therapy, and/or lymphatic drainage. The most frequently used objective measures of physical function were shoulder range of motion, muscle strength, and signs of lymphedema. In contrast, the primary patient-reported outcome measures were quality of life, shoulder function, and pain. Undergoing another breast surgery, death, and cancer recurrence were the most reported barriers to study completion. Conclusion This scoping review reports on the heterogeneity and wide range of conservative interventions and clinical outcome measures used in the physical rehabilitation of breast cancer patients who had undergone or were scheduled to undergo mastectomy. Tailoring interventions to breast cancer patients’ needs and promoting outpatient rehabilitation interventions appear to be better suited to the particularities of breast cancer care pathways. Further research is needed to better identify barriers and facilitators to study participation and completion. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01927-3.
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Respiratory Physiotherapy Intervention Strategies in the Sequelae of Breast Cancer Treatment: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073800. [PMID: 35409486 PMCID: PMC8997605 DOI: 10.3390/ijerph19073800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/10/2022] [Accepted: 03/19/2022] [Indexed: 02/05/2023]
Abstract
Breast cancer treatments can trigger respiratory sequelae. Respiratory physiotherapy helps to eliminate or mitigate the sequelae by optimizing respiratory function. This systematic review aims to synthesize the scientific evidence and assess its quality regarding the use of respiratory physiotherapy in the sequelae of breast cancer. The Cochrane Library, Physiotherapy Evidence Database, PubMed, Web of Science, Scientific Electronic Library Online, Cumulative Index of Nursing and Allied Literature Complete, and Scopus were searched. Study quality was determined using the PEDro scale, STROBE Statement, and Single-Case Experimental Design Scale. Ten studies, six clinical trials, one case study, and three observational studies were selected. The mean methodological quality of the clinical trials was 5.6, that of the case study was 7, and that of the observational studies was 56%. Respiratory physiotherapy has been observed to improve respiratory capacity, lung function, respiratory muscle strength, effort tolerance, dyspnea, fatigue, thoracic mobility, upper limb volume, sleep quality and quality of life, as well as sensitivity to adverse physiological reactions, nausea, vomiting, and anxiety. However, it is not effective for vasomotor symptoms. More clinical trials are needed. These studies should homogenize the techniques used, as well as improve their methodological quality.
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Risk Reduction Recommendations for Upper Quadrant Side Effects After Breast Cancer Surgery and Treatments: A Delphi Survey to Evaluate Consensus Among Expert Physical Therapists and Alignment With Current Evidence. REHABILITATION ONCOLOGY 2021. [DOI: 10.1097/01.reo.0000000000000274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Min J, Kim JY, Yeon S, Ryu J, Min JJ, Park S, Kim SI, Jeon JY. Change in Shoulder Function in the Early Recovery Phase after Breast Cancer Surgery: A Prospective Observational Study. J Clin Med 2021; 10:jcm10153416. [PMID: 34362199 PMCID: PMC8347494 DOI: 10.3390/jcm10153416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 11/28/2022] Open
Abstract
Breast cancer surgery significantly affects the shoulder’s range of motion (ROM) and strength. However, the extent of shoulder impairment, as well as patterns of recovery immediately after surgery, is not fully understood. Therefore, we aimed to investigate shoulder ROM and strength during the early recovery phase after surgery. Thirty-two breast cancer patients were observed five times: the day before surgery, discharge day (postoperative day 1 (POD1) or (POD2)), first outpatient visit (POD7–10), second outpatient visit (POD14–20), and third outpatient visit (POD21–30). We assessed shoulder passive ROM and strength for both affected and unaffected arms at each observation. ROM decreased in both affected and unaffected sides post-surgery. ROM on the affected side did not recover to the pre-surgery level until the third outpatient visit (POD24). In contrast, the ROM on the unaffected side recovered to the pre-surgery level by the first outpatient visit (POD10). The shoulder strength of both arms declined and did not recover to pre-surgery levels. Shoulder strength in the affected arm significantly decreased immediately after surgery (52.9% of the pre-surgery levels) and did not recover until the third outpatient visit (62.5% of the pre-surgery levels), whereas that in the unaffected arm decreased gradually (83.1 ± 2.3 at POD 1 and 78.9 ± 2.9 at POD 24). Descriptively, patterns of recovery in ROM may vary according to types of surgery while patterns of recovery in shoulder strength did not: shoulder strength significantly decreased and did not recover notably regardless of types of surgery. Both shoulder ROM and strength reduced during the early recovery phase after breast cancer surgery regardless of types of surgery, although the degree of reduction was greater in shoulder strength than ROM. Our findings suggest that rehabilitation exercises should be implemented in both upper limbs.
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Affiliation(s)
- Jihee Min
- Department of Physiology, Yonsei Institute of Sports Science & Exercise Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea; (J.M.); (S.Y.)
- Exercise Medicine and Rehabilitation Laboratory, Department of Sport Industry Studies, Yonsei University, Seoul 03722, Korea; (J.R.); (J.J.M.)
| | - Jee Ye Kim
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul 03722, Korea; (J.Y.K.); (S.P.); (S.I.K.)
| | - Sujin Yeon
- Department of Physiology, Yonsei Institute of Sports Science & Exercise Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea; (J.M.); (S.Y.)
| | - Jiin Ryu
- Exercise Medicine and Rehabilitation Laboratory, Department of Sport Industry Studies, Yonsei University, Seoul 03722, Korea; (J.R.); (J.J.M.)
| | - Jin Joo Min
- Exercise Medicine and Rehabilitation Laboratory, Department of Sport Industry Studies, Yonsei University, Seoul 03722, Korea; (J.R.); (J.J.M.)
| | - Seho Park
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul 03722, Korea; (J.Y.K.); (S.P.); (S.I.K.)
| | - Seung Il Kim
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul 03722, Korea; (J.Y.K.); (S.P.); (S.I.K.)
| | - Justin Y. Jeon
- Exercise Medicine and Rehabilitation Laboratory, Department of Sport Industry Studies, Yonsei University, Seoul 03722, Korea; (J.R.); (J.J.M.)
- Exercise Medicine Center for Diabetes and Cancer Patients, Yonsei University, Seoul 03722, Korea
- Cancer Prevention Center, Yonsei Cancer Center, Shinchon Severance Hospital, Seoul 03722, Korea
- Correspondence: or
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Shoulder Dysfunction in Breast Cancer Survivors: Can Treatment Type or Musculoskeletal Factors Identify Those at Higher Risk? REHABILITATION ONCOLOGY 2021. [DOI: 10.1097/01.reo.0000000000000224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Manfuku M, Nishigami T, Mibu A, Yamashita H, Imai R, Tanaka K, Kitagaki K, Hiroe K, Sumiyoshi K. Effect of perioperative pain neuroscience education in patients with post-mastectomy persistent pain: a retrospective, propensity score-matched study. Support Care Cancer 2021; 29:5351-5359. [PMID: 33677717 DOI: 10.1007/s00520-021-06103-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/23/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Central sensitization (CS)-related symptoms and pain catastrophizing contribute to persistent post-mastectomy pain (PPMP). Pain neuroscience education (PNE) is effective in reducing CS-related symptoms and pain catastrophizing in patients with chronic pain. However, to date, no intervention study of PNE has been conducted to patients with PPMP. This study was aimed to examine whether PNE is more effective than biomedical education (BME) for PPMP. METHODS In this retrospective case-control study, 118 patients were included. We intervened different patients at different times as follows: (1) a BME group (n = 58) of patients who received BME combined with physiotherapy and (2) a PNE group (n = 60) of patients who received PNE combined with physiotherapy. One year after surgery, we assessed pain intensity and interference (brief pain inventory [BPI]), CS-related symptoms (central sensitization inventory [CSI]), and pain catastrophizing (pain catastrophizing scale [PCS]). Propensity score matching was used to reduce or minimize selection bias and confounding biases and to make the number of cases in both groups match 1:1. RESULTS Propensity score matching generated the BME group (n = 51) and the PNE group (n = 51). The BPI score, CSI score, and PCS score were statistically significantly lower in the PNE group than in the BME group (all, p < 0.05). The effect sizes for the BPI intensity (r = 0.31) were moderate. CONCLUSIONS PNE resulted in a better outcome of pain management with less functional disability and CS-related symptoms compared to BME after breast surgery.
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Affiliation(s)
- Masahiro Manfuku
- Department of Rehabilitation, Breast Care Sensyu Clinic, Osaka, Japan
| | - Tomohiko Nishigami
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, Hiroshima, Japan.
| | - Akira Mibu
- Department of Physical Therapy, Konan Women's University, Kobe, Hyogo, Japan
| | - Hirofumi Yamashita
- Department of Rehabilitation, Nozomi Orthopaedic Clinic Saijo, Hiroshima, Japan
| | - Ryota Imai
- Department of Rehabilitation, Osaka Kawasaki Rehabilitation University, Osaka, Japan
| | | | - Kazufumi Kitagaki
- Department of Cardiovascular Rehabilitation, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kanamori Hiroe
- Department of Breast Surgery, Breast Care Sensyu Clinic, Osaka, Japan
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Preliminary Study on the Effect of an Early Physical Therapy Intervention after Sentinel Lymph Node Biopsy: A Multicenter Non-Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031275. [PMID: 33572618 PMCID: PMC7908454 DOI: 10.3390/ijerph18031275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 01/23/2021] [Indexed: 11/17/2022]
Abstract
Selective sentinel lymph node biopsy (SLNB) represents a minimally invasive surgery in patients with breast cancer. The purpose of this study was to explore the possible effect of an early physiotherapy intervention for the recovery of the upper limb and the surgical scars after SLNB in comparison with usual care. A total of 40 patients were enrolled in either the control group (n = 20) or the experimental group (n = 20). The intervention group performed an early physiotherapy program based on functional exercises, scar manual therapy, and educational tips. The control group received usual care. Shoulder range of motion (ROM), grip strength, upper limb pain and disability (SPADI), scar recovery (POSAS), myofascial adhesions (MAP-BC), quality of life (EORTCQLA-BR-23) and the presence of axillary web syndrome (AWS) and lymphoedema were assessed at baseline and immediately after intervention. A follow-up period of 6 months was performed for lymphoedema surveillance. Between groups significant differences in favor of the intervention were found for ROM (r = 0.43), grip strength (r = 0.32), SPADI (d = 0.45), POSAS (d = 1.28), MAP-BC (d = 1.82) and EORTCQLQ-BR 23 general function subscale (d = 0.37) (p < 0.05 for all variables). Our results suggest that an early physical therapy program seems to be more effective than usual care in women after SLNB. However, results should be interpreted with caution and future randomized trial with a larger sample size is needed.
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Stout NL, Brunelle C, Scheiman N, Thawer H. Surveillance Protocols for Survivors at Risk for Lymphedema. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-020-00402-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Stout NL, Fu JB, Silver JK. Prehabilitation is the Gateway to Better Functional Outcomes for Individuals with Cancer. JOURNAL OF CANCER REHABILITATION 2021; 4:283-286. [PMID: 35048084 PMCID: PMC8765744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Prehabilitation is a clinical model that introduces components of rehabilitation to patients prior to undergoing intensive medical interventions, such as surgery, in order to optimize function and improve tolerability to the intervention. Cancer care introduces a continuum of sequential or concurrent intensive anti-neoplastic medical interventions that are known to be detrimental to a patient's function. Prehabilitation evidence has grown across several areas of oncology care delivery demonstrating that a multi-modal rehabilitative intervention, delivered prior to oncology-direct therapies, leads to better functional outcomes and improves important endpoints associated with surgery and cancer treatment. This commentary article provides a brief history of the emergence of prehabilitation in cancer care delivery, reviews the current evidence base and guidelines for prehabilitation, and offers insights for future implementation of this model as a standard in oncology care. A prehabilitation program is an optimal starting point for most patients undergoing anti-neoplastic therapy as it serves as a gateway to improving functional outcomes throughout the cancer continuum. Future research in prehabilitation should aim to reach beyond measuring functional outcomes and to explore the impact of this model on important disease treatment endpoints such as tumor response to oncology-directed treatment, impact on treatment-related toxicities, and disease progression.
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Affiliation(s)
- Nicole L. Stout
- Department of Hematology/Oncology, West Virginia University Cancer Institute, Morgantown, West Virginia, USA
- Department of Health Policy, Management, and Leadership, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | - Jack B. Fu
- Department of Palliative, Rehabilitation & Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Julie K. Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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McLaughlin SA, Stout NL, Schaverien MV. Avoiding the Swell: Advances in Lymphedema Prevention, Detection, and Management. Am Soc Clin Oncol Educ Book 2020; 40:1-10. [PMID: 32315238 DOI: 10.1200/edbk_280471] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Lymphedema is a feared complication of cancer treatments that negatively affects survivors' quality of life. The true incidence of lymphedema is difficult to determine given its long latency period. As the number of survivors of cancer is increasing in the United States, lymphedema is poised to be a major health concern. The most noteworthy risk factor for lymphedema is comprehensive lymph node dissection. The last 2 decades have witnessed a dramatic shift in cancer treatment in an attempt to systematically de-escalate therapeutic interventions, specifically seeking to shift treatment away from routine lymph node dissection in favor of sentinel node biopsy or radiation strategies, thereby reducing the risk for lymphedema while maintaining survival outcomes. A growing body of robust evidence supports prospective screening and thereby a prospective surveillance model (PSM) for early diagnosis and intervention for the prevention and treatment of lymphedema. Finally, investigators are actively evaluating the effectiveness of contemporary surgical procedures in ameliorating the symptoms and disability of patients with lymphedema and reducing the risk of future episodes of cellulitis, with outcomes of surgery significantly better than with conservative therapy alone. In this article, we review the current data surrounding these initiatives.
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Affiliation(s)
| | - Nicole L Stout
- Department of Hematology Oncology, West Virginia University Cancer Institute, Morgantown, WV
| | - Mark V Schaverien
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
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Ostos-Díaz B, Casuso-Holgado MJ, Muñoz-Fernández MJ, Carazo AF, Martín-Valero R, Medrano-Sánchez EM. Early Physical Rehabilitation after Sentinel Lymph Node Biopsy in Breast Cancer: Is It Feasible and Safe? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228382. [PMID: 33198359 PMCID: PMC7697742 DOI: 10.3390/ijerph17228382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/07/2020] [Accepted: 11/09/2020] [Indexed: 12/17/2022]
Abstract
The primary purpose of this research was to investigate the feasibility and safety of delivering an early supervised physical therapy intervention to women after sentinel lymph node biopsy (SLNB); furthermore, we aimed to provide explorative data on its effects. This was a single-site feasibility study. Pre- and post-evaluation was conducted from baseline to follow-up at 6 months. Primary outcomes were participant recruitment, participant retention, compliance with the intervention, and safety. Secondary outcomes were shoulder range of motion, handgrip strength, upper limb pain and disability, scar recovery, quality of life, and the incidence of axillary web syndrome (AWS) and/or lymphoedema. A total of 43 participants (mean age 55.37 years) completed the trial and the follow-up period. A total of 91% of women who met the inclusion criteria agreed to participate, and the adherence rate was 80%. No adverse events were reported. Incidence of AWS was 9.3%, and there was no incidence of lymphoedema at 6 months. Our results support that this intervention is feasible and safe. The results presented in this study also provide preliminary evidence for the use of a rehabilitation program as a supportive intervention after SLNB, but future research on effectiveness is needed.
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Affiliation(s)
- Beatriz Ostos-Díaz
- Department of Physiotherapy, University of Sevilla, 41009 Sevilla, Spain; (B.O.-D.); (M.J.M.-F.)
| | - María Jesús Casuso-Holgado
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, C/Avicena s/n, 41009 Seville, Spain;
- Correspondence: ; Tel.: +34-95-448-65-21; Fax: +34-95-448-65-27
| | | | - Ana F. Carazo
- Department of Economy, Quantitative Methods and Economy History, Pablo de Olavide University, 41013 Sevilla, Spain;
| | - Rocío Martín-Valero
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Málaga, Spain;
| | - Esther M. Medrano-Sánchez
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, C/Avicena s/n, 41009 Seville, Spain;
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17
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Shoulder amplitude movement does not influence postoperative wound complications after breast cancer surgery: a randomized clinical trial. Breast Cancer Res Treat 2020; 184:97-105. [DOI: 10.1007/s10549-020-05826-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/20/2020] [Indexed: 01/18/2023]
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Rafn BS, Midtgaard J, Camp PG, Campbell KL. Shared concern with current breast cancer rehabilitation services: a focus group study of survivors' and professionals' experiences and preferences for rehabilitation care delivery. BMJ Open 2020; 10:e037280. [PMID: 32723743 PMCID: PMC7389511 DOI: 10.1136/bmjopen-2020-037280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Breast cancer survivors experience a wide spectrum of physical sequelae from cancer treatment. National and international guidelines recommend that rehabilitation is offered from the point of diagnosis. However, there is a lack of data on the translation of these recommendations into clinical care. The objective of this study was to explore the experiences of breast cancer survivors, rehabilitation professionals and breast surgeons on current rehabilitation services including preferences for care delivery, specific ways to promote early detection and timely management of upper body issues and attitudes towards self-managed surveillance and rehabilitation. DESIGN Qualitative focus groups. Breast cancer survivors completed a questionnaire about rehabilitation services received and experience of upper body issues. These quantitative data were collected to provide context for the qualitative data and increase transferability. Transcripts were analysed using content analysis. SETTING Five geographically distinct health authorities in British Columbia, Canada. PARTICIPANTS Eleven focus groups were conducted with 35 breast cancer survivors, 29 rehabilitation professionals and 5 breast surgeons. RESULTS Three categories captured participants' concern and wish for improved care: (1) cut the cancer out and goodbye; (2) you have to look out for yourself and (3) in a perfect world. All breast cancer survivors reported chronic upper body issues (mean 4.5 unique issues). Breast cancer survivors expressed worry and uncertainty in their solo management of the rehabilitation. The current services were reported to not enable early detection and timely management. Suggestions included reorganising the timing of patient education and improving the quality of and access to rehabilitation services by elevating the knowledge among healthcare professionals and providing multimodal self-management resources. CONCLUSIONS The results revealed a gap between oncology guidelines and the current clinical reality. The rehabilitation services were reported in need of revamping to increase equity of care. Multiple upper body issues were reported by many breast cancer survivors.
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Affiliation(s)
- Bolette Skjødt Rafn
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julie Midtgaard
- The University Hospitals' Centre for Health Research (UCSF), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pat G Camp
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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Vidt ME, Potochny J, Dodge D, Green M, Sturgeon K, Kass R, Schmitz KH. The influence of mastectomy and reconstruction on residual upper limb function in breast cancer survivors. Breast Cancer Res Treat 2020; 182:531-541. [PMID: 32506338 DOI: 10.1007/s10549-020-05717-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/01/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE Breast cancer survivorship is common (90% of women survive 5 or more years), but many women are not able to return to full function and well-being after treatment due to functional limitations, persistent pain, and inability to perform daily activities. Since each surgical reconstructive option (e.g., autologous tissue flaps versus implants) can impact shoulder and arm function differently, it is important to understand how shoulder and upper limb strength, mobility, and function are influenced by the type of surgical intervention. Efforts can then focus on prehabiliation strategies to prevent the onset of limitations and on developing rehabilitation protocols that directly target shortcomings. METHODS The current paper presents a review summarizing how shoulder and upper limb function may be affected by surgical mastectomy and breast reconstruction. RESULTS Mastectomy and breast reconstruction with implants or autologous tissues present different functional outcomes for patients. Each surgical procedure is associated with unique sequelae derived from the tissues and procedures associated with each surgery. Characterizing the specific functional outcomes associated with each surgical approach will promote the development of targeted rehabilitation strategies that can be implemented into a multidisciplinary treatment planning pathway for breast cancer patients. CONCLUSIONS Surgical treatments for breast cancer, including mastectomy and breast reconstruction, can have negative effects. Focused efforts are needed to better understand treatment-specific effects so that targeted rehabilitation can be developed to improve patient function, QoL, and ability to return to work and life activities post-breast cancer.
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Affiliation(s)
- Meghan E Vidt
- Department of Biomedical Engineering, Pennsylvania State University, 331 Chemical and Biomedical Engineering Building, University Park, PA, 16802, USA. .,Department of Physical Medicine and Rehabilitation, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA.
| | - John Potochny
- Department of Plastic Surgery, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA
| | - Daleela Dodge
- Department of Surgery, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA.,Department of Humanities, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA
| | - Michael Green
- Department of Humanities, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA.,Department of Medicine, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA
| | - Kathleen Sturgeon
- Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA
| | - Rena Kass
- Department of Surgery, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA.,Department of Medicine, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA
| | - Kathryn H Schmitz
- Department of Physical Medicine and Rehabilitation, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA.,Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA
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Harrington SE, Stout NL, Hile E, Fisher MI, Eden M, Marchese V, Pfalzer LA. Cancer Rehabilitation Publications (2008-2018) With a Focus on Physical Function: A Scoping Review. Phys Ther 2020; 100:363-415. [PMID: 32043151 PMCID: PMC8204886 DOI: 10.1093/ptj/pzz184] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cancer rehabilitation research has accelerated over the last decade. However, closer examination of the published literature reveals that the majority of this work has focused on psychological interventions and cognitive and behavioral therapies. Recent initiatives have aggregated expert consensus around research priorities, highlighting a dearth in research regarding measurement of and interventions for physical function. Increasingly loud calls for the need to address the myriad of physical functional impairments that develop in people living with and beyond cancer have been published in the literature. A detailed survey of the landscape of published research has not been reported to our knowledge. PURPOSE This scoping review systematically identified literature published between 2008 and 2018 related to the screening, assessment, and interventions associated with physical function in people living with and beyond cancer. DATA SOURCES PubMed and CINAHL were searched up to September 2018. STUDY SELECTION Study selection included articles of all levels of evidence on any disease stage and population. A total of 11,483 articles were screened for eligibility, 2507 full-text articles were reviewed, and 1055 articles were selected for final inclusion and extraction. DATA EXTRACTION Seven reviewers recorded type of cancer, disease stage, age of participants, phase of treatment, time since diagnosis, application to physical function, study design, impairments related to physical function, and measurement instruments used. DATA SYNTHESIS Approximately one-third of the articles included patients with various cancer diagnoses (30.3%), whereas the rest focused on a single cancer, most commonly breast (24.8%). Most articles (77%) measured physical function following the completion of active cancer treatment with 64% representing the assessment domain. The most commonly used measures of physical function were the Medical Outcomes Study 36-Item Health Survey Questionnaire (29%) and the European Organization for Research and Treatment of cancer Quality of Life Questionnaire-Cancer 30 (21.5%). LIMITATIONS Studies not written in English, study protocols, conference abstracts, and unpublished data were excluded. CONCLUSIONS This review elucidated significant inconsistencies in the literature regarding language used to define physical function, measurement tools used to characterize function, and the use of those tools across the cancer treatment and survivorship trajectory. The findings suggested that physical function in cancer research is predominantly measured using general health-related quality-of-life tools rather than more precise functional assessment tools. Interdisciplinary and clinician-researcher collaborative efforts should be directed toward a unified definition and assessment of physical function.
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Affiliation(s)
- Shana E Harrington
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Blatt PE Center, 101G, Columbia, SC 29208 (USA)
| | - Nicole L Stout
- Office of Strategic Research, Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland; Cancer Prevention and Control, Department of Hematology/Oncology, West Virginia University Cancer Institute, Morgantown, West Virginia
| | - Elizabeth Hile
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Mary Insana Fisher
- Department of Physical Therapy, School of Education and Health Sciences, University of Dayton, Dayton, Ohio
| | - Melissa Eden
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix, Arizona
| | - Victoria Marchese
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Lucinda A Pfalzer
- Physical Therapy Department, University of Michigan–Flint, Flint, Michigan
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Abstract
OBJECTIVES To recognize cancer prehabilitation as a pretreatment regimen to increase functional status for patients requiring cancer treatment. This article presents current evidence addressing the efficacy and benefits of prehabilitation regimens in different cancer survivor populations. DATA SOURCES Studies and case reports in the PubMed database. CONCLUSION Cancer prehabilitation may improve outcomes. Prehabilitation may include targeted or whole-body exercise, nutrition, education, psychologic counseling, and smoking cessation. Opportunities exist to further improve access to and delivery of multimodal prehabilitation, and nurses play a critical role in connecting patients to these services. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses who are knowledgeable of cancer treatment-related effects are poised to assess survivors for existing impairments, advocate for prehabilitation for existing and potential morbidities, and monitor functional status over time. As patient educators, they are key to informing cancer survivors about the role of prehabilitation.
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Changes in Pectoral Muscle Volume During Subacute Period after Radiation Therapy for Breast Cancer: A Retrospective up to 4-year Follow-up Study. Sci Rep 2019; 9:7038. [PMID: 31065026 PMCID: PMC6505029 DOI: 10.1038/s41598-019-43163-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 04/17/2019] [Indexed: 11/08/2022] Open
Abstract
Radiotherapy (RT) is an effective treatment for managing breast cancer patients with breast conserving surgery, but patients may experience radiation-induced shoulder problems. Even though the course of shoulder morbidity is unknown, pectoral muscle changes after radiotherapy can be a major cause of shoulder problems. Twenty-two patients treated with RT for unilateral breast cancer were included in the study. All patients underwent serial computed tomography (CT) imaging before and immediately after RT, as well as 2 months, 6 months, 2 years, and 3-4 years after RT. These CT scans were used to compare muscle volume changes. The pectoral muscle volume and muscle volume surrounding the scapular measurement was performed using 3D modelling after segmentation of the CT scans. In all patients, the pectoral muscle volume increased during the 2 months after RT, and there was continuous volume reduction from 2-48 months after RT. Changes in muscle volume ratio over time were analysed by repeated measure ANOVA and it was found that there was a significant change in the pectoral muscle volume (p < 0.001) from Just before RT and Immediately after RT at 2 month after RT. On the other hand, the changes in the muscle volume of the surrounding scapular were not significant.
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The effect of preoperative exercise on upper extremity recovery following breast cancer surgery: a systematic review. Int J Rehabil Res 2018; 41:189-196. [PMID: 29683834 DOI: 10.1097/mrr.0000000000000288] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Prehabilitation benefits among patients undergoing various oncological surgeries have been demonstrated. However, the effects of presurgical exercise and fitness on postoperative ipsilateral upper extremity recovery outcomes in patients with breast cancer surgery are less evident. A systematic review was performed to assess the effects of preoperative exercise and fitness on postmastectomy recovery. Systematic literature search was performed in 12 electronic databases. Study eligibility was accessed using the PICOS (Participants, Interventions, Comparison, Outcome and Study Design) criteria. Six eligible studies were found: three cohort-control and three prospective observational studies. One randomized-controlled trial showed that prehabilitation was beneficial in shoulder range of motion (ROM) and upper extremity functional recovery. One cohort-control study demonstrated that preoperative exercises reduced postoperative pain without increasing the risk of developing a seroma. A prospective cohort study showed that preoperatively active individuals had a significantly better chance of feeling recovered physically at 3 weeks after surgery. Baseline ipsilateral grip strength, shoulder flexion, and abduction ROM were reliable predictors of shoulder flexion and abduction ROM and grip strength improvements at 1 month following breast cancer surgery. One study showed that preoperative conditioning alone without postoperative rehabilitation was insufficient to aid recovery. Implementing exercise program and optimizing preoperative fitness, especially shoulder ROM, before breast cancer surgery in conjunction with individualized rehabilitation program may benefit postmastectomy ipsilateral upper extremity recovery.
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Ibrahim M, Lau GJ, Smirnow N, Buono AT, Cooke A, Gartshore K, Loiselle CG, Johnson K. A Multidisciplinary Preoperative Teaching Session for Women Awaiting Breast Cancer Surgery: A Quality Improvement Initiative. Rehabil Process Outcome 2018. [DOI: 10.1177/1179572718790937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: Most of the breast cancer diagnoses are recommended for breast surgery. Unfortunately, many patients report preoperative anxiety, which can affect postoperative recovery. Preoperative teaching sessions have been shown to reduce anxiety and improve recovery for the patients with breast cancer. To better support the patients at our cancer center, a multidisciplinary preoperative teaching session was developed and delivered as a quality improvement initiative. Methods: Participants scheduled for breast surgery were invited to attend a group-delivered preoperative teaching session, either for breast-conserving surgery or mastectomy. The sessions were presented by a nurse, occupational therapist, and physiotherapist. Data were collected through a researcher-developed 2-item questionnaire administered before and after sessions to compare self-reported anxiety and knowledge levels, along with qualitative feedback. Results: A total of 94 participants attended the preoperative sessions, piloted over a year. The majority were scheduled for breast-conserving surgery. Wilcoxon signed rank tests showed that after session, self-reported levels of anxiety decreased, whereas levels of knowledge increased. Most participants found the session to be very helpful and would recommend it to other patients/families awaiting surgery. Conclusions: Patients awaiting surgery for breast cancer may be better supported through a multidisciplinary group teaching session by decreasing anxiety and improving knowledge related to the procedure. Future directions could explore the effect of specific session elements on anxiety, knowledge, and postoperative complications using psychometrically sound instruments and additional time points. Implications for cancer survivors: Standardization of these preoperative teaching sessions may enhance breast cancer care, reduce postoperative complications, and improve patient recovery.
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Affiliation(s)
- Marize Ibrahim
- Rehabilitation & Exercise Oncology Program, Hope & Cope, Jewish General Hospital, Montréal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montréal, QC, Canada
- Department of Oncology, McGill University, Montréal, QC, Canada
- Breast & Bone Health Program, Hope & Cope, Jewish General Hospital, Montréal, QC, Canada
| | - Garnet J Lau
- Breast & Bone Health Program, Hope & Cope, Jewish General Hospital, Montréal, QC, Canada
| | - Nadia Smirnow
- Rehabilitation & Exercise Oncology Program, Hope & Cope, Jewish General Hospital, Montréal, QC, Canada
| | - Anna T Buono
- Segal Cancer Centre, Jewish General Hospital, Montréal, QC, Canada
| | - Andrea Cooke
- Segal Cancer Centre, Jewish General Hospital, Montréal, QC, Canada
- Ingram School of Nursing, McGill University, Montréal, QC, Canada
| | - Kimberley Gartshore
- Segal Cancer Centre, Jewish General Hospital, Montréal, QC, Canada
- Ingram School of Nursing, McGill University, Montréal, QC, Canada
| | - Carmen G Loiselle
- Department of Oncology and Ingram School of Nursing, McGill University, Montréal, QC, Canada
- Hope & Cope, Jewish General Hospital, Montréal, QC, Canada
| | - Kyla Johnson
- Occupational Therapy Department, Segal Cancer Centre, Jewish General Hospital, Montréal, QC, Canada
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Gerber LH, Hodsdon B, Comis LE, Chan L, Gallin JI, McGarvey CL. A Brief Historical Perspective of Cancer Rehabilitation and Contributions From the National Institutes of Health. PM R 2018; 9:S297-S304. [PMID: 28942904 DOI: 10.1016/j.pmrj.2017.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 11/17/2022]
Abstract
People who have cancer diagnoses often need care throughout their lives through all stages of their illness. These stages include diagnosis, primary treatment, survivorship, and end of life. The management of people with cancer, now a common and chronic illness with long-term survival improving, is complex, challenging, and rapidly changing. Rehabilitation for people with cancer diagnoses is a new specialty and is charged with providing care throughout the trajectory of illness and wellness to maximize potential for function and mitigate disability. Rehabilitation interventions include the application of physical and occupational therapeutics, speech and language interventions, and physical medicine in order to help patients reach their individual goals and to promote life satisfaction. The Department of Rehabilitation in the Clinical Center of the National Institutes of Health has pioneered this field through research and clinical care models over the past 40 years. Staff of this department has supported clinical research investigators at the National Institutes of Health in their exploration of new treatments using chemotherapies, surgery, radiation, and psychosocial interventions. They have also engaged in research specific to rehabilitation to devise and improve functional outcome measures, design exercise interventions, devise orthotics, and prosthetic devices for adaptation to functional loss. Collectively, the staff has published widely in oncology textbooks and professional journals in order to share findings and improve the quality of cancer rehabilitation treatment across the continuum of care.
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Affiliation(s)
- Lynn H Gerber
- Department of Medicine, Inova Fairfax Medical Campus, Inova Health System, Fairfax, VA; 4400 University Dr., MS 2G7, George Mason University, Fairfax, VA 22030(∗).
| | - Bonnie Hodsdon
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD(†)
| | - Leora Ellen Comis
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD(‡)
| | - Leighton Chan
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD(§)
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Rafn BS, Hung S, Hoens AM, McNeely ML, Singh CA, Kwan W, Dingee C, McKevitt EC, Kuusk U, Pao J, Van Laeken N, Goldsmith CH, Campbell KL. Prospective surveillance and targeted physiotherapy for arm morbidity after breast cancer surgery: a pilot randomized controlled trial. Clin Rehabil 2018; 32:811-826. [PMID: 29473482 DOI: 10.1177/0269215518757292] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate prospective surveillance and targeted physiotherapy (PSTP) compared to education (EDU) on the prevalence of arm morbidity and describe the associated program cost. DESIGN Pilot randomized single-blinded controlled trial. SETTING Urban with assessments and treatment delivered in hospitals. PARTICIPANTS Women scheduled for breast cancer surgery. INTERVENTIONS Participants were randomly assigned (1:1) to PSTP ( n = 21) or EDU ( n = 20) and assessed presurgery and 12 months postsurgery. All participants received usual care, namely, preoperative education and provision of an education booklet with postsurgical exercises. The PSTP group was monitored for arm morbidity every three months and referred for physiotherapy if arm morbidity was identified. The EDU group received three education sessions on nutrition, stress and fatigue management. MAIN OUTCOME MEASURES Arm morbidity was based on changes in the surgical arm(s) from presurgery in four domains: (1) shoulder range of motion, (2) strength, (3) volume, and (4) upper body function. Complex arm morbidity indicated ≥2 domains impaired. Second, the cost of the PSTP program was described. RESULTS At 12 months, 18 (49%) participants (10 PSTP and 8 EDU) had arm morbidity, with EDU participants presenting more complex arm morbidity compared to PSTP participants. PSTP participants attended 4.4 of 5 assessments with 90% retention. The PSTP program cost was $150 covered by the Health Care Provider and the Patient Out-of-Pocket Travel cost was CAN$40. CONCLUSION Our results suggest that PSTP is feasible among women with breast cancer for early identification of arm morbidity. A larger study is needed to determine the cost and effectiveness benefits.
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Affiliation(s)
- Bolette S Rafn
- 1 Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada
| | - Stanley Hung
- 1 Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada
| | - Alison M Hoens
- 1 Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada
| | - Margaret L McNeely
- 2 Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | | | - Winkle Kwan
- 4 Fraser Valley Centre, BC Cancer Agency, Vancouver, BC, Canada
| | - Carol Dingee
- 5 Department of Surgery, The University of British Columbia, Vancouver, BC, Canada
| | - Elaine C McKevitt
- 5 Department of Surgery, The University of British Columbia, Vancouver, BC, Canada
| | - Urve Kuusk
- 5 Department of Surgery, The University of British Columbia, Vancouver, BC, Canada
| | - Jinsi Pao
- 5 Department of Surgery, The University of British Columbia, Vancouver, BC, Canada
| | - Nancy Van Laeken
- 5 Department of Surgery, The University of British Columbia, Vancouver, BC, Canada
| | - Charlie H Goldsmith
- 6 Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.,7 Department of Occupational Science & Occupational Therapy, The University of British Columbia, Vancouver, BC, Canada
| | - Kristin L Campbell
- 1 Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada
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Fu MR, Wang Y, Li C, Qiu Z, Axelrod D, Guth AA, Scagliola J, Conley Y, Aouizerat BE, Qiu JM, Yu G, Van Cleave JH, Haber J, Cheung YK. Machine learning for detection of lymphedema among breast cancer survivors. Mhealth 2018; 4:17. [PMID: 29963562 PMCID: PMC5994440 DOI: 10.21037/mhealth.2018.04.02] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/10/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In the digital era when mHealth has emerged as an important venue for health care, the application of computer science, such as machine learning, has proven to be a powerful tool for health care in detecting or predicting various medical conditions by providing improved accuracy over conventional statistical or expert-based systems. Symptoms are often indicators for abnormal changes in body functioning due to illness or side effects from medical treatment. Real-time symptom report refers to the report of symptoms that patients are experiencing at the time of reporting. The use of machine learning integrating real-time patient-centered symptom report and real-time clinical analytics to develop real-time precision prediction may improve early detection of lymphedema and long term clinical decision support for breast cancer survivors who face lifelong risk of lymphedema. Lymphedema, which is associated with more than 20 distressing symptoms, is one of the most distressing and dreaded late adverse effects from breast cancer treatment. Currently there is no cure for lymphedema, but early detection can help patients to receive timely intervention to effectively manage lymphedema. Because lymphedema can occur immediately after cancer surgery or as late as 20 years after surgery, real-time detection of lymphedema using machine learning is paramount to achieve timely detection that can reduce the risk of lymphedema progression to chronic or severe stages. This study appraised the accuracy, sensitivity, and specificity to detect lymphedema status using machine learning algorithms based on real-time symptom report. METHODS A web-based study was conducted to collect patients' real-time report of symptoms using a mHealth system. Data regarding demographic and clinical information, lymphedema status, and symptom features were collected. A total of 355 patients from 45 states in the US completed the study. Statistical and machine learning procedures were performed for data analysis. The performance of five renowned classification algorithms of machine learning were compared: Decision Tree of C4.5, Decision Tree of C5.0, gradient boosting model (GBM), artificial neural network (ANN), and support vector machine (SVM). Each classification algorithm has certain user-definable hyper parameters. Five-fold cross validation was used to optimize these hyper parameters and to choose the parameters that led to the highest average cross validation accuracy. RESULTS Using machine leaning procedures comparing different algorithms is feasible. The ANN achieved the best performance for detecting lymphedema with accuracy of 93.75%, sensitivity of 95.65%, and specificity of 91.03%. CONCLUSIONS A well-trained ANN classifier using real-time symptom report can provide highly accurate detection of lymphedema. Such detection accuracy is significantly higher than that achievable by current and often used clinical methods such as bio-impedance analysis. Use of a well-trained classification algorithm to detect lymphedema based on symptom features is a highly promising tool that may improve lymphedema outcomes.
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Affiliation(s)
- Mei R. Fu
- Rory Meyers College of Nursing, Tandon School of Engineering of NYU, New York University, New York, NY, USA
| | - Yao Wang
- Electrical and Computer Engineering, Tandon School of Engineering of NYU, New York University, New York, NY, USA
| | - Chenge Li
- Electrical and Computer Engineering, Tandon School of Engineering of NYU, New York University, New York, NY, USA
| | - Zeyuan Qiu
- Department of Chemistry and Environmental Science, New Jersey Institute of Technology, Newark, NJ, USA
| | - Deborah Axelrod
- Department of Surgery, New York University School of Medicine, New York, NY, USA
- NYU Perlmutter Cancer Center, New York, NY, USA
| | - Amber A. Guth
- Department of Surgery, New York University School of Medicine, New York, NY, USA
- NYU Perlmutter Cancer Center, New York, NY, USA
| | | | - Yvette Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bradley E. Aouizerat
- Bluestone Center for Clinical Research, Department of Oral and Maxillofacial Surgery, College of Dentistry, New York University, New York, NY, USA
| | - Jeanna M. Qiu
- Chemical and Physical Biology Concentration, Harvard University, Cambridge, MA, USA
| | - Gary Yu
- Rory Meyers College of Nursing, Tandon School of Engineering of NYU, New York University, New York, NY, USA
| | - Janet H. Van Cleave
- Rory Meyers College of Nursing, Tandon School of Engineering of NYU, New York University, New York, NY, USA
| | - Judith Haber
- Rory Meyers College of Nursing, Tandon School of Engineering of NYU, New York University, New York, NY, USA
| | - Ying Kuen Cheung
- Mailman School of Public Health, Columbia University, New York, NY, USA
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Hidding JT, Beurskens CHG, van der Wees PJ, Bos WCAM, Nijhuis-van der Sanden MWG, van Laarhoven HWM. Changes in volume and incidence of lymphedema during and after treatment with docetaxel, doxorubicin, and cyclophosphamide (TAC) in patients with breast cancer. Support Care Cancer 2017; 26:1383-1392. [PMID: 29127528 PMCID: PMC5876252 DOI: 10.1007/s00520-017-3907-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 09/25/2017] [Indexed: 01/18/2023]
Abstract
Purposes The purposes of this study were to investigate the incidence of lymphedema in patients with breast cancer during and after adjuvant treatment with docetaxel, doxorubicin, and cyclophosphamide (TAC), to identify predictors for development of lymphedema, and to describe consequences in daily life in relation to lymphedema. Methods This is a prospective study with measurements before chemotherapy (T0), during chemotherapy before cycle 2 (T1), cycle 4 (T2), and 1 month after completion of treatment (T3). Volume change was monitored using tape measurements. Lymphedema was defined as ≥ 10% volume difference. Linear mixed-effect models were estimated to analyze differences in arm volume and consequences in daily life (total score and domain scores of the Lymph-International Classification of Functioning (ICF) questionnaire) over time and to identify treatment and patient characteristics as predictors for changes in volume. Results Forty-eight patients completed all measurements. Volume did not change during TAC treatment. One month after treatment, volume was significantly increased compared to T0-T2, and 12 patients (25%) had developed lymphedema. Axillary lymph node dissection was associated with lymphedema (ES 2.9, 95% CI 0.02–5.7; p < 0.05). In patients with and without lymphedema, 1 month after completion (T3), the Lymph-ICF questionnaire showed significant limitations in physical function compared to T0-T2. In patients with lymphedema at T3, a significant association between volume and total score on the Lymph-ICF questionnaire on physical function and mobility activities was observed. Conclusions One month after treatment in 12 patients (25%), volume difference increased over 10%. Axillary lymph node dissection was predictive for development of lymphedema. All patients, but more patients with lymphedema, perceived difficulties in activities in daily life after treatment.
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Affiliation(s)
- Janine T Hidding
- Department of Orthopedics, Section of Physical Therapy, Radboud University Medical Center, Nijmegen, The Netherlands. .,Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Geert Grooteplein Noord 21, 6525 EZ, Nijmegen, The Netherlands.
| | - Carien H G Beurskens
- Department of Orthopedics, Section of Physical Therapy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Philip J van der Wees
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Geert Grooteplein Noord 21, 6525 EZ, Nijmegen, The Netherlands
| | - Wilmy C A M Bos
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Department of Orthopedics, Section of Physical Therapy, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Geert Grooteplein Noord 21, 6525 EZ, Nijmegen, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.,Academic Medical Center, Department of Medical Oncology, University of Amsterdam, Amsterdam, The Netherlands
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Predictors of Altered Upper Extremity Function During the First Year After Breast Cancer Treatment. Am J Phys Med Rehabil 2017; 95:639-55. [PMID: 26829093 DOI: 10.1097/phm.0000000000000455] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate trajectories of and predictors for changes in upper extremity (UE) function in women (n = 396) during the first year after breast cancer treatment. DESIGN Prospective, longitudinal assessments of shoulder range of motion (ROM), grip strength, and perceived interference of function were performed before and for 1 year after surgery. Demographic, clinical, and treatment characteristics were evaluated as predictors of postoperative function. RESULTS Women had a mean (SD) age of 54.9 (11.6) years, and 64% were white. Small but statistically significant reductions in shoulder ROM were found on the affected side over 12 months (P < 0.001). Predictors of interindividual differences in ROM at the 1-month assessment were ethnicity, neoadjuvant chemotherapy, type of surgery, axillary lymph node dissection, and preoperative ROM. Predictors of interindividual differences in changes over time in postoperative ROM were living alone, type of surgery, axillary lymph node dissection, and adjuvant chemotherapy. Declines in mean grip strength from before through 1 month after surgery were small and not clinically meaningful. Women with greater preoperative breast pain interference scores had higher postoperative interference scores at all postoperative assessments. CONCLUSION Some of the modifiable risk factors identified in this study can be targeted for intervention to improve UE function in these women.
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31
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Lang AE, Kim S, Dickerson CR, Milosavljevic S. Measurement of objective shoulder function following breast cancer surgery: a scoping review protocol. PHYSICAL THERAPY REVIEWS 2017. [DOI: 10.1080/10833196.2017.1343539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Angelica E. Lang
- Department of Health Sciences, University of Saskatchewan , Saskatoon, Canada
| | - Soo Kim
- School of Physical Therapy, University of Saskatchewan , Saskatoon, Canada
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Baima J, Reynolds SG, Edmiston K, Larkin A, Ward BM, O'Connor A. Teaching of Independent Exercises for Prehabilitation in Breast Cancer. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:252-256. [PMID: 26541465 DOI: 10.1007/s13187-015-0940-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We attempted to determine the feasibility of studying prehabilitation exercises to improve shoulder pain and abduction range of motion (ROM) after breast cancer surgery. We evaluated methods of exercise teaching and assessed effect on postsurgical seroma formation. This was a feasibility study with two non-blinded groups of subjects randomized by timing of appointment. This single-site study was performed at an academic tertiary medical center. Sixty cancer patients were randomly assigned to either group 1, in-person teaching arm, n = 36, or group 2, video-only teaching arm, n = 24. Forty-five patients completed the study. Shoulder exercises were assigned to both groups 1 month prior to surgery during evaluation. Group 1 received in-person instruction on exercises, plus an information sheet with exercises and a link to an online video. Group 2 received only the information sheet with exercises and a link to the online video. The primary outcomes considered are as follows: exercise compliance, shoulder pain (via visual analog scale), shoulder abduction ROM (via goniometer), and presence or absence of seroma. Seventy-six percent of study patients chose to exercise. There was no difference in exercise compliance between in-person teaching versus video teaching (75 %, 24/32 vs. 77 %, 10/13, OR = 1.03). Sixty-six of patients (20/30) lost greater than 10° shoulder abduction ROM at 1 month post surgery. Twenty-nine of patients (9/31) had worse shoulder pain than baseline at 1 month post surgery (24 %, 6/25 exercisers, and 50 %, 3/6 non-exercisers). Fifteen percent of patients (4/27) had worse shoulder pain than baseline at 3 months post surgery (8 %, 2/23 exercisers, and 100 %, 2/2 non-exercisers). Prehabilitation exercise program inferred no additional risk of seroma formation (Exercisers 21 %, 7/33 vs. non-exercisers 22 %, 2/9, OR = 0.94). Our subjects were able to perform three exercises independently in the preoperative period. A high-quality randomized controlled trial is necessary to assess the appropriate timing and efficacy of this intervention.
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Affiliation(s)
- Jennifer Baima
- University of Massachusetts Medical School, Worcester, MA, USA.
| | | | | | - Anne Larkin
- University of Massachusetts Medical School, Worcester, MA, USA
| | - B Marie Ward
- University of Massachusetts Medical School, Worcester, MA, USA
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Cheville AL, Mustian K, Winters-Stone K, Zucker DS, Gamble GL, Alfano CM. Cancer Rehabilitation. Phys Med Rehabil Clin N Am 2017; 28:1-17. [DOI: 10.1016/j.pmr.2016.08.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Carli F, Silver JK, Feldman LS, McKee A, Gilman S, Gillis C, Scheede-Bergdahl C, Gamsa A, Stout N, Hirsch B. Surgical Prehabilitation in Patients with Cancer. Phys Med Rehabil Clin N Am 2017; 28:49-64. [DOI: 10.1016/j.pmr.2016.09.002] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Włoch A, Żak M, Opuchlik A, Biskup M, Fabiś J. Assessment of shoulder mobility in women over 60 years of age after one-sided mastectomy. REHABILITACJA MEDYCZNA 2017. [DOI: 10.5604/01.3001.0009.5480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The overall risk of contracting various diseases, including breast cancer, increases with age. An on-going process of population ageing challenges modern physiotherapy with the need to have functional capacity in older people appreciably enhanced. The issue of anthropometric assessment of the range of motion and shoulder muscle strength is presently much underrated in the physical rehabilitation management of women patients after radical one-sided mastectomy.
The study aimed to assess the functional mobility of a shoulder expressed as a range of motion, in conjunction with the assessment of shoulder muscle strength, in women patients over 60 years of age after radical one-sided mastectomy.
The study comprised 24 patients (mean age 65 years) recruited from the Department of Rehabilitation, Holy Cross Cancer Centre, Kielce. All patients had undergone modifi ed radical mastectomy using the Madden technique, and an adjuvant therapy. The shoulder range of motion, i.e. flexion, abduction, internal and external rotation, was evaluated by a goniometer. Elevation, protraction and retraction movements were evaluated using an anthropometric device. A dynamometer was applied to assess the strength of select muscle groups within the shoulder during elevation, protraction and retraction motions. Statistical analysis was made with the aid of STATISTICA 12.0 software, having adopted a 0.05 alpha level as statistically signifi cant.
The movements of fl exion, abduction and external rotation of the upper extremity were signifi cantly reduced on the mastectomy side. The range of motion and muscle strength during shoulder elevation, protraction and retraction were significantly diminished on the operated side (12% - 14%), compared to the non-operated one.
1. Functional mobility of the shoulder was signifi cantly reduced on the mastectomy side. 2. Results of the present study highlight the need to extend the scope of rehabilitation regimens offered to older women after radical one-sided mastectomy.
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Affiliation(s)
- Anna Włoch
- Rehabilitation Department, Holy Cross Cancer Center, Kielce, Poland
| | - Marek Żak
- Department of Physical Rehabilitation in Rheumatology and Geriatrics, Chair of Clinical Rehabilitation, University of Physical Education in Krakow, Poland
| | - Anna Opuchlik
- Rehabilitation Department, Holy Cross Cancer Center, Kielce, Poland
| | | | - Jarosław Fabiś
- Clinic of Arthroscopy, Minimally Invasive Surgery and Sports Traumatology, University Clinical Hospital, Lodz, Poland
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Stout NL, Silver JK, Raj VS, Rowland J, Gerber L, Cheville A, Ness KK, Radomski M, Nitkin R, Stubblefield MD, Morris GS, Acevedo A, Brandon Z, Braveman B, Cunningham S, Gilchrist L, Jones L, Padgett L, Wolf T, Winters-Stone K, Campbell G, Hendricks J, Perkin K, Chan L. Toward a National Initiative in Cancer Rehabilitation: Recommendations From a Subject Matter Expert Group. Arch Phys Med Rehabil 2016; 97:2006-2015. [DOI: 10.1016/j.apmr.2016.05.002] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 05/17/2016] [Accepted: 05/18/2016] [Indexed: 11/29/2022]
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Yang EJ, Ahn S, Kim EK, Kang E, Park Y, Lim JY, Kim SW. Use of a prospective surveillance model to prevent breast cancer treatment-related lymphedema: a single-center experience. Breast Cancer Res Treat 2016; 160:269-276. [PMID: 27665585 PMCID: PMC5065580 DOI: 10.1007/s10549-016-3993-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 09/19/2016] [Indexed: 11/26/2022]
Abstract
Purpose Breast cancer patients undergoing axillary lymph node dissection (ALND) are at risk of lymphedema (LE). Successful management of LE relies on early diagnosis using sensitive modalities. In the current study, we explored the effectiveness of a surveillance program for lymphedema management (SLYM) compared to standard care. Methods
Breast cancer patients who underwent ALND in Seoul National University Bundang Hospital from January 2008 to December 2015 were included in this prospective study. The SLYM commenced in May 2011. The LE outcomes of patients treated prior to initiation of the SLYM were compared with those of patients after SLYM implementation. Results
A total of 707 patients were included, 390 in the SLYM group and 317 in the historical control (HC) group. A total of 203 patients (28.7 %) had episodes of all-stage LE during follow-up. Of these, 126 (19.7 %) were in the surveillance group and 77 (24.3 %) in the HC group. The overall 5-year cumulative incidence of LE (greater than stage 3) was 25 (95 % CI 15.4–34.6) (6.4 %) in the SLYM group and 48 (95 % CI, 15.4–34.6) (15.1 %) in the HC group. In the SLYM group, poor compliance had a significant impact on LE incidence (OR = 2.98, P = 0.002). Low level of self-monitoring and insight scores were significantly related to LE incidence (OR = 1.31, P = 0.025) after adjusting for age, body mass index, the type of surgery chosen, radiation therapy, and chemotherapy. With a cut-off of 29.5 days from operation to the first visit to the LE clinic, the sensitivity was 60 % and the specificity 61 % in terms of predicting a LE event. Conclusions Surveillance improves LE prevention compared to clinical evaluation. The first visit to the LE clinic should be made within 1 month after surgery. In the first year, visits should be made at intervals of less than 3 months. Electronic supplementary material The online version of this article (doi:10.1007/s10549-016-3993-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eun Joo Yang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea.
| | - Soyeon Ahn
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam-si, Korea
| | - Eun-Kyu Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Korea
| | - Eunyoung Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Korea
| | - Youngmi Park
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam-si, Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea
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Shoulder Strength Changes One Year After Axillary Lymph Node Dissection or Sentinel Lymph Node Biopsy in Patients With Breast Cancer. Arch Phys Med Rehabil 2016; 97:953-63. [DOI: 10.1016/j.apmr.2015.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 12/05/2015] [Accepted: 12/10/2015] [Indexed: 11/20/2022]
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Yao C, Xu Y, Chen L, Jiang H, Ki CS, Byun JS, Bian W. Effects of warm acupuncture on breast cancer-related chronic lymphedema: a randomized controlled trial. ACTA ACUST UNITED AC 2016; 23:e27-34. [PMID: 26966410 DOI: 10.3747/co.23.2788] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Effective treatment for breast cancer-related chronic lymphedema (bcrl) remains a clinical challenge. Acupuncture and moxibustion treatments have been shown to be beneficial and safe for treating bcrl. In the present randomized controlled trial, we compared the effectiveness of combined acupuncture and moxibustion ("warm acupuncture") with that of diosmin in bcrl. METHODS Breast cancer patients who met the inclusion and exclusion criteria (n = 30) were randomized to experimental and control groups (15 per group). On alternate days, patients in the experimental group received 30 minutes of acupuncture at 6 acupoints, with 3 of the needles each being topped by a 3-cm moxa stick. The control treatment was diosmin 900 mg 3 times daily. The control and experimental treatments were administered for 30 days. Outcome measures included arm circumferences (index of effectiveness), range of motion [rom (shoulder joint function)], quality of life, clinical safety, and adverse events. RESULTS Measured by the index of effectiveness, bcrl improved by 51.46% in the experimental group and by 26.27% in the control group (p < 0.00001). Effects were greatest at 10 cm above the elbow and at the wrist, where the warm needling was provided. Impairments in shoulder joint rom were minimal at baseline in both treatment groups. However, the roms of rear protraction, abduction, intorsion, and extorsion in the experimental group improved significantly; they did not change in the control group. Self-reported quality of life was significantly better with warm acupuncture than with diosmin. No adverse effects were reported during the treatment period, and laboratory examinations for clinical safety fell within the normal ranges. CONCLUSIONS Compared with diosmin, warm acupuncture treatment can effectively reduce the degree of bcrl at the specific acupoints treated and can promote quality of life. Warm acupuncture showed good clinical safety, without any adverse effects on blood or the cardiovascular system.
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Affiliation(s)
- C Yao
- Department of Breast Disease, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, P.R.C
| | - Y Xu
- Department of Breast Disease, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, P.R.C
| | - L Chen
- Department of Breast Disease, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, P.R.C
| | - H Jiang
- Department of Breast Disease, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, P.R.C
| | - C S Ki
- Hospital of the Catholic University of Daegu, Daegu, South Korea
| | - J S Byun
- Department of Internal Medicine, College of Korean Medicine, Daegu Haany University, Daegu, South Korea
| | - W Bian
- Department of Breast Disease, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, P.R.C
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Movement, Function, Pain, and Postoperative Edema in Axillary Web Syndrome. Phys Ther 2015; 95:1345-53. [PMID: 25977305 PMCID: PMC4595809 DOI: 10.2522/ptj.20140377] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 05/01/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Axillary web syndrome (AWS) is a condition that may develop following breast cancer surgery and that presents as a palpable axillary cord of tissue. OBJECTIVE The purposes of this study were: (1) to determine the clinical characteristics of AWS related to movement, function, pain, and postoperative edema and (2) to define the incidence of and risk factors for AWS within the first 3 months following breast cancer surgery. DESIGN This was a prospective cohort study with a repeated-measures design. METHODS Women who underwent breast cancer surgery with sentinel node biopsy or axillary lymph node dissection (N=36) were assessed for AWS, shoulder range of motion, function, pain, and postoperative edema (using girth measurements, bioimpedance, and tissue dielectric constant) at 2, 4, and 12 weeks. Demographic characteristics were used for risk analysis. RESULTS Seventeen women (47.2%) developed AWS, and AWS persisted in 10 participants (27.8%) at 12 weeks. Abduction range of motion was significantly lower in the AWS group compared with the non-AWS group at 2 and 4 weeks. There were no differences between groups in measurements of function, pain, or edema at any time point. Trunk edema measured by dielectric constant was present in both groups, with an incidence of 55%. Multivariate analysis determined lower body mass index as being significantly associated with AWS (odds ratio=0.86; 95% confidence interval=0.74, 1.00). LIMITATIONS Limitations included a short follow-up time and a small sample size. CONCLUSION Axillary web syndrome is prevalent following breast/axilla surgery for early-stage breast cancer and may persist beyond 12 weeks. The early consequences include movement restriction, but the long-term effects of persistent AWS cords are yet unknown. Low body mass index is considered a risk factor for AWS.
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Breast Cancer Rehabilitation. TOPICS IN GERIATRIC REHABILITATION 2015. [DOI: 10.1097/tgr.0000000000000082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Measurement Issues in Anthropometric Measures of Limb Volume Change in Persons at Risk for and Living with Lymphedema: A Reliability Study. J Pers Med 2015; 5:341-53. [PMID: 26437431 PMCID: PMC4695859 DOI: 10.3390/jpm5040341] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/05/2015] [Accepted: 09/17/2015] [Indexed: 11/29/2022] Open
Abstract
Understanding whether a true change has occurred during the process of care is of utmost importance in lymphedema management secondary to cancer treatments. Decisions about when to order a garment, start an exercise program, and begin or end therapy are based primarily on measurements of limb volume, based on circumferences taken by physiotherapists using a flexible tape. This study aimed to assess intra-rater and inter-rater reliability of measurements taken by physiotherapists of legs and arms with and without lymphedema and to evaluate whether there is a difference in reliability when measuring a healthy versus a lymphedematous limb. The intra-rater reliability of arm and leg measurements by trained physiotherapist were very high (scaled standard error of measurements (SEMs) for an arm and a leg volume were 0.82% and 0.64%, respectively) and a cut-point of 1% scaled SEM may be recommended as a threshold for acceptable reliability. Physiotherapists can rely on the same error when assessing lymphedematous or healthy limbs. For those who work in teams and share patients, practice is needed in synchronizing the measurements and regularly monitoring their inter-rater reliability.
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Atanes Mendes Peres AC, Dias de Oliveira Latorre MDR, Yugo Maesaka J, Filassi JR, Chada Baracat E, Alves Gonçalves Ferreira E. Body Posture After Mastectomy: Comparison Between Immediate Breast Reconstruction Versus Mastectomy Alone. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2015; 22. [PMID: 26375989 DOI: 10.1002/pri.1642] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 02/28/2015] [Accepted: 05/06/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Immediate breast reconstruction has been increasingly incorporated as part of breast cancer treatment, especially for the psychological benefits. Currently, there are many options for breast reconstruction surgery, but the impact of the different techniques on body posture has not been widely studied. One study demonstrated that immediate breast reconstruction with a Beker-25 prosthesis could help to preserve body posture after mastectomy; however, there is no evidence regarding the effect of surgery on the body posture of women after breast reconstruction when using autologous tissue. PURPOSE The purpose of this paper is to compare the body postures of women who underwent immediate breast reconstruction using an abdominal flap with those of women who underwent mastectomy alone. DESIGN This is a cross-sectional study. SUBJECTS Seventy-six women diagnosed with breast cancer underwent mastectomy, between 1 and 5 years after the diagnosis, are the participants of the study. Two groups were defined: women who underwent mastectomy and immediate breast reconstruction (n = 38) and women who underwent mastectomy alone (n = 38). PROCEDURE To assess body posture, specific anatomical points for obtaining photographs were located and marked in anterior, posterior and right-side and left-side views. The photographs were analysed using Postural Analysis Software/Software de Análise Postural (PAS/SAPO). RESULTS In the left lateral view, there was a significant difference in the vertical alignment of the trunk (4.2 vs 3.1; p = 0.05). There were no significant differences between the two groups for the variables in the anterior, posterior or right-side views. CONCLUSION Women who underwent mastectomy alone, compared with women who underwent immediate breast reconstruction with abdominal flaps, showed differences in the vertical alignment of the trunk, with greater asymmetry between the acromion and greater trochanter, which can mean trunk rotation. No significant differences were found between the two groups in the alignment of the head, shoulders, scapula, or pelvis. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | - Jonathan Yugo Maesaka
- Mastology Service, Department of Gynecology, Medical School, University of São Paulo, São Paulo, Brazil
| | - José Roberto Filassi
- Department of Gynecology, Medical School, University of São Paulo, São Paulo, Brazil
| | - Edmund Chada Baracat
- Department of Gynecology, Medical School, University of São Paulo, São Paulo, Brazil
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Fukushima KFP, Carmo LA, Borinelli AC, Ferreira CWS. Frequency and associated factors of axillary web syndrome in women who had undergone breast cancer surgery: a transversal and retrospective study. SPRINGERPLUS 2015; 4:112. [PMID: 25793151 PMCID: PMC4359189 DOI: 10.1186/s40064-015-0889-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 02/13/2015] [Indexed: 11/10/2022]
Abstract
Background Breast cancer is the most common malignancy among women. Surgical treatment is an essential part of therapy, which still includes chemotherapy, radiotherapy and hormone therapy. The increase in early cancer detection and less aggressive treatment has made longer survival rates possible for women with this neoplasia. Morbidities after treatment have subsequently aroused particular interest in the scientific community in order to minimize their effects and provide increased quality-of-life for these patients. The present study aimed at investigating one of these morbidities: axillary web syndrome, which occurs after axillary surgical management. Methods From December 2011 to September 2012, according to the inclusion and exclusion criteria, 97 patients, who had been surgically treated for breast cancer, were enrolled, interviewed, and submitted to a specific physical exam. An investigation of the axillary cords, characteristic of this syndrome, was performed in all patients. Results The axillary web syndrome was diagnosed in 28.86% of the women. Higher risk of triggering the syndrome has been associated with younger age (21.7%), longer time between first treatment and data collection (29.3%), greater number of resected lymph nodes (149.7%) and surgical management medical teams (113.2%). Conclusions One can conclude that axillary web syndrome was associated with younger age, greater time elapsed since surgery, surgical management of medical staff and number of resected lymph nodes. Further studies are needed to review prior-to-surgery and post-operative follow-up, to properly assess the effects of surgery in the axilla on homeostatic balance, not only in the ipsilateral upper limb, but also assess their compensatory consequences throughout the body.
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Affiliation(s)
- Kassandra Ferreira Pessoa Fukushima
- Departamento de Patologia, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Avenida Professor Moraes Rego, 1235, Cidade Universitária, Recife, PE CEP: 50670-901 Brazil
| | - Luana Aroucha Carmo
- Departamento de Patologia, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Avenida Professor Moraes Rego, 1235, Cidade Universitária, Recife, PE CEP: 50670-901 Brazil
| | - Adriana Carvalho Borinelli
- Departamento de Patologia, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Avenida Professor Moraes Rego, 1235, Cidade Universitária, Recife, PE CEP: 50670-901 Brazil
| | - Caroline Wanderley Souto Ferreira
- Departamento de Patologia, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Avenida Professor Moraes Rego, 1235, Cidade Universitária, Recife, PE CEP: 50670-901 Brazil
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A systematic review of axillary web syndrome (AWS). J Cancer Surviv 2015; 9:576-98. [PMID: 25682072 DOI: 10.1007/s11764-015-0435-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 01/27/2015] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Axillary web syndrome (AWS) can result in early post-operative and long-term difficulties following lymphadenectomy for cancer and should be recognised by clinicians. This systematic review was conducted to synthesise information on AWS clinical presentation and diagnosis, frequency, natural progression, grading, pathoaetiology, risk factors, symptoms, interventions and outcomes. METHODS Electronic searches were conducted using Cochrane, Pubmed, MEDLINE, CINAHL, EMBASE, AMED, PEDro and Google Scholar until June 2013. The methodological quality of included studies was determined using the Downs and Black checklist. Narrative synthesis of results was undertaken. RESULTS Thirty-seven studies with methodological quality scores ranging from 11 to 26 on a 28-point scale were included. AWS diagnosis relies on inspection and palpation; grading has not been validated. AWS frequency was reported in up to 85.4 % of patients. Biopsies identified venous and lymphatic pathoaetiology with five studies suggesting lymphatic involvement. Twenty-one studies reported AWS occurrence within eight post-operative weeks, but late occurrence of greater than 3 months is possible. Pain was commonly reported with shoulder abduction more restricted than flexion. AWS symptoms usually resolve within 3 months but may persist. Risk factors may include extensiveness of surgery, younger age, lower body mass index, ethnicity and healing complications. Low-quality studies suggest that conservative approaches including analgesics, non-steroidal anti-inflammatory drugs and/or physiotherapy may be safe and effective for early symptom reduction. CONCLUSIONS AWS appears common. Current evidence for the treatment of AWS is insufficient to provide clear guidance for clinical practice. IMPLICATIONS FOR CANCER SURVIVORS Cancer survivors should be informed about AWS. Further investigation is needed into pathoaetiology, long-term outcomes and to determine effective treatment using standardised outcomes.
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Shaitelman SF, Cromwell KD, Rasmussen JC, Stout NL, Armer JM, Lasinski BB, Cormier JN. Recent progress in the treatment and prevention of cancer-related lymphedema. CA Cancer J Clin 2015; 65:55-81. [PMID: 25410402 PMCID: PMC4808814 DOI: 10.3322/caac.21253] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This article provides an overview of the recent developments in the diagnosis, treatment, and prevention of cancer-related lymphedema. Lymphedema incidence by tumor site is evaluated. Measurement techniques and trends in patient education and treatment are also summarized to include current trends in therapeutic and surgical treatment options as well as longer-term management. Finally, an overview of the policies related to insurance coverage and reimbursement will give the clinician an overview of important trends in the diagnosis, treatment, and management of cancer-related lymphedema.
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Johnson KC, Kennedy AG, Henry SM. Clinical Measurements of Lymphedema. Lymphat Res Biol 2014; 12:216-21. [DOI: 10.1089/lrb.2014.0019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kristine C. Johnson
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont
| | - Amanda G. Kennedy
- Department of Clinical and Translational Science, University of Vermont, Burlington, Vermont
| | - Sharon M. Henry
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont
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Evaluation of cross-cultural adaptation and measurement properties of breast cancer-specific quality-of-life questionnaires: a systematic review. Qual Life Res 2014; 24:1179-95. [PMID: 25391488 DOI: 10.1007/s11136-014-0840-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess the procedures of translation, cross-cultural adaptation, and measurement properties of breast cancer-specific quality-of-life questionnaires. METHODS Searches were conducted in the databases MEDLINE, EMBASE, CINAHL, and SciELO using the keywords: "Questionnaires," "Quality of life," and "Breast cancer." The studies were analyzed in terms of methodological quality according to the guidelines for the procedure of cross-cultural adaptation and the quality criteria for measurement properties of questionnaires. RESULTS We found 24 eligible studies. Most of the articles assessed the translation and measurement properties of the instrument EORTC QLQ-BR23. Description about translation and cross-cultural adaptation was incomplete in 11 studies. Translation and back translation were the most tested phases, and synthesis of the translation was the most omitted phase in the articles. Information on assessing measurement properties was provided incompletely in 23 articles. Internal consistency was the most tested property in all of the eligible articles, but none of them provided information on agreement. Construct validity was adequately tested in only three studies that used the FACT-B and QLQ-BR23. Eight articles provided information on reliability; however, only four found positive classification. Responsiveness was tested in four articles, and ceiling and floor effects were tested in only three articles. None of the instruments showed fully adequate quality. CONCLUSION There is limited evidence on cross-cultural adaptations and measurement properties; therefore, it is recommended that caution be exercised when using breast cancer-specific quality-of-life questionnaires that have been translated, adapted, and tested.
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Exploring aspects of physiotherapy care valued by breast cancer patients. Physiotherapy 2014; 100:156-61. [DOI: 10.1016/j.physio.2014.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 03/26/2014] [Indexed: 11/20/2022]
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de Oliveira MMF, de Rezende LF, do Amaral MTP, Pinto e Silva MP, Morais SS, Gurgel MSC. Manual lymphatic drainage versus exercise in the early postoperative period for breast cancer. Physiother Theory Pract 2014; 30:384-9. [PMID: 24410411 DOI: 10.3109/09593985.2013.876695] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare the effect of active exercise and manual lymphatic drainage (MLD) on postoperative wound healing complications, shoulder range of motion (ROM) and upper limb (UL) perimetry in women undergoing radical mastectomy for breast cancer. METHODS Controlled non-randomized clinical trial with 89 women undergoing breast cancer surgery with axillary lymph node dissection (Brazilian Registry of Clinical Trials: 906). Women were matched for staging, age and body mass index, with 46 women allocated to the exercise group and 43 in the MLD group, receiving 2 weekly sessions during one month. Assessments were performed in the preoperative and 60 d after surgery, including inspection, palpation, goniometry and perimetry. RESULTS No significant difference existed between groups relative to individual and clinical surgical characteristics. The incidence of seroma, number of punctures performed, dehiscence and infection was similar in both groups. A comparison of shoulder ROM and UL perimetry between groups, obtained in the preoperative and postoperative period, did not show any significant difference. CONCLUSION The performance of active exercise or MLD did not demonstrate difference in wound healing complications, shoulder ROM and UL perimetry at 60 d after surgery, suggesting that these techniques may be employed, according to the complaints or symptoms of each woman and physical therapist experience.
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Affiliation(s)
- Mariana Maia Freire de Oliveira
- Physical Therapy Section-Prof. Dr. José Arostodemo Pinotti Women's Hospital-Integral Healthcare Center (CAISM), Universidade Estadual de Campinas (Unicamp) , Campinas , Brazil
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