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Carr HM, Patel RA, Beederman MR, Maassen NH, Hanson SE. Risk Factors for Upper Extremity Impairment after Mastectomy: A Single Institution Retrospective Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5684. [PMID: 39050032 PMCID: PMC11268813 DOI: 10.1097/gox.0000000000005684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/31/2024] [Indexed: 07/27/2024]
Abstract
Background Patients with breast cancer treated with mastectomy are more likely to develop upper extremity dysfunction compared with those treated with breast-conserving therapy. This study aimed to identify cancer and treatment characteristics that may be risk factors for development of upper extremity dysfunction in patients treated with mastectomy. Methods The authors performed a retrospective chart review of patients at the University of Chicago who were treated with a unilateral or bilateral mastectomy from 2010 to 2020 and developed upper extremity dysfunction based on International Classification of Disease-10 codes. Patients were analyzed by side of body (left or right). Patient demographics and treatment characteristics were extracted from the electronic medical record. Results In total, 259 patients met criteria and were included in our study. A total of 396 upper extremities were recorded as experiencing dysfunction and were analyzed. Mean age was 60 years (range = 28-96), and mean body mass index was 28.4 (SD = 7.5). An estimated 54% of patients underwent breast reconstruction. After multivariable analysis, chronic upper extremity pain was found to be associated with ipsilateral radiotherapy (P < 0.001) and ipsilateral in situ cancer (0.041). Limited range of motion was found to be associated with ipsilateral invasive cancer (P = 0.01), any ipsilateral mastectomy surgery (P < 0.001), and ipsilateral radiotherapy (P = 0.03). Musculoskeletal dysfunction was found to be associated with no ipsilateral modified radical mastectomy (P = 0.033). No oncological or treatment characteristics were found to be associated with decreased strength or adhesive capsulitis. Furthermore, breast reconstruction (implant or autologous tissue based) was not associated with upper extremity dysfunction. Conclusion Breast cancer characteristics and treatment modalities may predispose patients treated with mastectomy to developing types of upper extremity dysfunction.
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Affiliation(s)
- Hannah M Carr
- From the Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medicine and Biological Sciences Division, Chicago, Ill
| | - Ronak A Patel
- From the Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medicine and Biological Sciences Division, Chicago, Ill
| | - Maureen R Beederman
- From the Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medicine and Biological Sciences Division, Chicago, Ill
| | - Nicholas H Maassen
- Department of Orthopedic Surgery and Rehabilitation, University of Chicago Medicine and Biological Sciences Division, Chicago, Ill
| | - Summer E Hanson
- From the Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medicine and Biological Sciences Division, Chicago, Ill
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Paltrinieri S, Cavuto S, Contri A, Bassi MC, Bravi F, Schiavi M, Fugazzaro S, Guberti M, Costi S. Needs of breast cancer survivors: a systematic review of quantitative data. Crit Rev Oncol Hematol 2024; 201:104432. [PMID: 38955309 DOI: 10.1016/j.critrevonc.2024.104432] [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: 04/19/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/04/2024] Open
Abstract
This systematic review aimed to update the perceived needs of individuals with breast cancer (BC). Databases were searched for studies reporting quantitative data collected through validated assessment tools. Needs of adults with BC were reported by survivorship phase. The post-diagnosis and the post-surgery phases revealed the most needs; health system and information needs represented the greatest concern, with average Supportive Care Needs Survey-Short Form (SCNS-SF34) scores ranging from 62.0 to 75.8 post-diagnosis and from 45.0 to 67.8 post-surgery. Needs then seemed to decrease or remain stable up to within one year from diagnosis, when needs in all domains increased again; health system and information needs remained a priority. Younger age, side effects, type of treatment, and advanced stage were associated with the occurrence of unmet needs. The needs of BC survivors vary over the course of their cancer experience. This knowledge can assist the planning of appropriate assessments.
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Affiliation(s)
- S Paltrinieri
- Research and EBP Unit, Health Professions Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Public Health Sciences PhD Program, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - S Cavuto
- Statistics Unit, Clinical Trial Center, SOC Infrastructure, Research and Statistics, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - A Contri
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - M C Bassi
- Medical Library, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - F Bravi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - M Schiavi
- Research and EBP Unit, Health Professions Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - S Fugazzaro
- Physical Medicine and Rehabilitation Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Guberti
- Research and EBP Unit, Health Professions Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - S Costi
- Physical Medicine and Rehabilitation Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
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3
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De Groef A, Vets N, Devoogdt N, Smeets A, Van Assche D, Emmerzaal J, Dams L, Verbeelen K, Fieuws S, Baets LD. Prognostic factors for the development of upper limb dysfunctions after breast cancer: the UPLIFT-BC prospective longitudinal cohort study protocol. BMJ Open 2024; 14:e084882. [PMID: 38754876 PMCID: PMC11097819 DOI: 10.1136/bmjopen-2024-084882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Upper limb (UL) dysfunctions are highly prevalent in people after breast cancer and have a great impact on performing activities in daily living. To improve care, a more comprehensive understanding of the development and persistence of UL dysfunctions is needed. Therefore, the UPLIFT-BC study will primarily examine the prognostic value of different factors at the body functions and structures, environmental and personal level of the International Classification of Functioning, Disability and Health (ICF) framework at 1-month post-surgery for persisting UL dysfunctions at 6 months after finishing cancer treatment. METHODS AND ANALYSIS A prospective longitudinal cohort study, running from 1-week pre-surgery to 6 months post-local cancer treatment, is performed in a cohort of 250 women diagnosed with primary breast cancer. Different potentially prognostic factors to UL dysfunctions, covering body functions and structures, environmental and personal factors of the ICF, are assessed pre-surgically and at different time points post-surgery. The primary aim is to investigate the prognostic value of these factors at 1-month post-surgery for subjective UL function (ie, QuickDASH) at 6 months post-cancer treatment, that is, 6 months post-radiotherapy or post-surgery (T3), depending on the individuals' cancer treatment trajectory. In this, factors with relevant prognostic value pre-surgery are considered as well. Similar analyses are performed with an objective measure for UL function (ie, accelerometry) and a composite score of the combination of subjective and objective UL function. Second, in the subgroup of participants who receive radiotherapy, the prognostic value of the same factors is explored at 1-month post-radiotherapy and 6 months post-surgery. A forward stepwise selection strategy is used to obtain these multivariable prognostic models. ETHICS AND DISSEMINATION The study protocol was approved by the Ethics Committee of UZ/KU Leuven (reference number s66248). The results of this study will be published in peer-reviewed journals and will be presented at several research conferences. TRIAL REGISTRATION NUMBER NCT05297591.
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Affiliation(s)
- An De Groef
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Flanders, Belgium
- Department of Rehabilitation Sciences, University of Antwerp, Antwerpen, Belgium
- CarEdOn Research Group, Leuven, Belgium
| | - Nieke Vets
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Flanders, Belgium
- CarEdOn Research Group, Leuven, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Flanders, Belgium
- CarEdOn Research Group, Leuven, Belgium
- Department of Vascular Surgery, Centre for Lymphedema, University Hospitals Leuven, Leuven, Belgium
| | - Ann Smeets
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Dieter Van Assche
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Flanders, Belgium
| | | | - Lore Dams
- Department of Rehabilitation Sciences, University of Antwerp, Antwerpen, Belgium
- CarEdOn Research Group, Leuven, Belgium
| | - Kaat Verbeelen
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Flanders, Belgium
- Department of Rehabilitation Sciences, University of Antwerp, Antwerpen, Belgium
- CarEdOn Research Group, Leuven, Belgium
| | - Steffen Fieuws
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven, Leuven, Belgium
| | - Liesbet De Baets
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium
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De Baets L, Vets N, Emmerzaal J, Devoogdt N, De Groef A. Altered upper limb motor behavior in breast cancer survivors and its relation to pain: A narrative review. Anat Rec (Hoboken) 2024; 307:298-308. [PMID: 36398938 DOI: 10.1002/ar.25120] [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: 07/29/2022] [Revised: 10/24/2022] [Accepted: 11/03/2022] [Indexed: 11/21/2022]
Abstract
Breast cancer is the most commonly diagnosed cancer among women and many women suffer from persistent physical and psychological complaints following their cancer treatment. Altered motor behavior at the shoulder region and upper limb, that is, alterations in movement patterns, spatiotemporal movement characteristics and muscle activation patterns, is a common physical consequence of breast cancer treatment, that can have a clear impact on daily life functioning and quality of life. Furthermore, altered upper limb motor behavior is suggested to relate to upper limb pain, which is very commonly reported in breast cancer survivors (BCS). This review, prepared according to the SANRA guidelines, looks into the current understanding of alterations in motor behavior at shoulder and upper limb in BCS, by discussing the factors related to this altered behavior. In this, we specifically focus on the relation between motor behavior and pain. Results of our search show that cancer treatment modality is predictive for shoulder range of motion. Furthermore, single prospective studies show depressive symptoms, living alone, being non-white and low physical activity levels as predicting factors for reduced shoulder range of motion. Pain as factor related to altered motor behavior is only assessed in cross-sectional research, limiting its interpretation in context of being cause or consequence of motor behavioral adaptations, and on the underlying mechanism explaining their relation. It is concluded that studies which explain the mechanisms how and in which subgroup of BCS motor behavioral alterations are associated with pain at the upper limb, are necessary in future.
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Affiliation(s)
- Liesbet De Baets
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nieke Vets
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Jill Emmerzaal
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
- Department of Vascular Surgery, Center for Lymphedema, University Hospitals Leuven, Leuven, Belgium
| | - An De Groef
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
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5
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McNeely ML, Courneya KS, Al Onazi MM, Wharton S, Wang Q, Dickau L, Vallance JK, Culos-Reed SN, Matthews CE, Yang L, Friedenreich CM. Upper Limb Morbidity in Newly Diagnosed Individuals After Unilateral Surgery for Breast Cancer: Baseline Results from the AMBER Cohort Study. Ann Surg Oncol 2023; 30:8389-8397. [PMID: 37755568 DOI: 10.1245/s10434-023-14316-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE We aimed to examine potential associations between post-surgical upper limb morbidity and demographic, medical, surgical, and health-related fitness variables in newly diagnosed individuals with breast cancer. METHODS Participants were recruited between 2012 and 2019. Objective measures of health-related fitness, body composition, shoulder range of motion, axillary web syndrome, and lymphedema were performed within 3 months of breast cancer surgery, and prior to or at the start of adjuvant cancer treatment. RESULTS Upper limb morbidity was identified in 54% of participants and was associated with poorer upper limb function and higher pain. Multivariable logistic regression analysis identified mastectomy versus breast-conserving surgery (odds ratio [OR] 3.51, 95% confidence interval [CI] 2.65-4.65), axillary lymph node dissection versus sentinel lymph node dissection (OR 2.67, 95% CI 1.73-4.10), earlier versus later time from surgery (OR 1.58, 95% CI 1.15-2.18), and younger versus older age (OR 1.01, 95% CI 1.00-1.03) as significantly associated with a higher odds of upper limb morbidity, while mastectomy (OR 1.57, 95% CI 1.10-2.25), axillary lymph node dissection (OR 2.20, 95% CI 1.34-3.60), lower muscular endurance (OR 1.10, 95% CI 1.01-1.16) and higher percentage body fat (OR 1.04, 95% CI 1.00-1.07) were significantly associated with higher odds of moderate or greater morbidity severity. CONCLUSIONS Upper limb morbidity is common in individuals after breast cancer surgery prior to adjuvant cancer treatment. Health-related fitness variables were associated with severity of upper limb morbidity. Findings may facilitate prospective surveillance of individuals at higher risk of developing upper limb morbidity.
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Affiliation(s)
- Margaret L McNeely
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.
- Supportive Care Services, Cancer Care Alberta, Edmonton, AB, Canada.
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Mona M Al Onazi
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Stephanie Wharton
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Qinggang Wang
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Leanne Dickau
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Jeffrey K Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, AB, Canada
| | - S Nicole Culos-Reed
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Charles E Matthews
- Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Rockville, MD, USA
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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6
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Klein I, Friger M, David MB, Shahar D. Risk factors for long-term arm morbidities following breast cancer treatments: A systematic review. Oncotarget 2023; 14:921-942. [PMID: 38039404 PMCID: PMC10691815 DOI: 10.18632/oncotarget.28539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/16/2023] [Indexed: 12/03/2023] Open
Abstract
PURPOSE To examine the risk factors for arm morbidity following breast cancer treatments, taking a broad view of all types of physical morbidity, including prolonged pain, lymphedema, decreased range of motion, and functional limitations. METHODS A systematic literature review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. Studies exploring the risk factors for prolonged arm morbidity following breast cancer surgery and treatments were included. The studies were assessed independently according to pre-eligibility criteria, following data extraction and methodological quality assessment. RESULTS 1,242 articles were identified. After removing duplicates, the full texts of 1,153 articles were examined. Sixty-nine of these articles met the criteria and were included in the review. These 69 articles identified 29 risk factors for arm morbidity following treatments for breast cancer. The risk of bias was evaluated using NIH study quality assessment tools. The studies reviewed were published between 2001 and 2021 and included a total of 22,886 patients who were followed up for between three months and 10 years. CONCLUSIONS The main risk factors for long-term morbidity are removal of lymph nodes from the axilla, body mass index >30, having undergone a mastectomy, the stage of the disease, radiation therapy, chemotherapy, infection and trauma to the affected arm after surgery. An understanding of the risk factors for prolonged arm morbidity after surgery can help doctors and therapists in making personalized decisions about the need and timing of rehabilitation treatments.
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Affiliation(s)
- Ifat Klein
- Department of Physical Therapy, Assuta Medical Center, Ramat Hahayal, Tel Aviv 6971028, Israel
- Department of Epidemiology, Biostatistics and Community Health Sciences, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Michael Friger
- Department of Epidemiology, Biostatistics and Community Health Sciences, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Merav Ben David
- Department of Physical Therapy, Assuta Medical Center, Ramat Hahayal, Tel Aviv 6971028, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Danit Shahar
- Department of Epidemiology, Biostatistics and Community Health Sciences, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
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7
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Chen D, Li L, Jiang LY, Jia J. The prevalence and risk factors for physical impairments in Chinese post-cancer treated breast cancer survivors: a 4 years' cross-sectional study at a single center. Sci Rep 2023; 13:18458. [PMID: 37891422 PMCID: PMC10611789 DOI: 10.1038/s41598-023-45731-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/23/2023] [Indexed: 10/29/2023] Open
Abstract
The incidence of breast cancer in China was 19.2% in 2018, with a five-year survival rate of up to 80%. The impairments that may result from breast cancer treatment, such as lymphedema, pain, and symptoms related to nerve damage, could have long-term side effects. Its prevalence and symptom profile have been commonly reported in various countries, but such data are rarely available for China. Physical function was assessed in 138 breast cancer survivors (BCSs) in the study. The prevalence of lymphedema (65.9%) was higher than that of pain (31.2%), shoulder range of motion (ROM) restriction (20.3%), grip strength restriction (GSR) (21.7%) and paresthesia (11.6%). These impairments mainly appeared within 28 months after breast cancer diagnosis, but could happen in 10 years. Carcinoma in situ and radiotherapy (RT) were related to the occurrence of lymphedema (respectively B = -1.8, p = 0.003; B = 1.3, p = 0.001). RT and delayed rehabilitation time (DRT) may increase the severity of lymphedema (respectively p = 0.003, p = 0.010). Breast conserving surgery (B = -2.1, p = 0.002) and the occurrence of AWS (B = 3.1, p = 0.006) were related to the occurrence of pain. The occurrence of brachial plexus injury (BPI) (B = 3.1, p < 0.001) and pain (B = 1.9, p = 0.002) improved the occurrence of shoulder ROM restriction. The occurrence of BPI (B = 3.6, p < 0.001) improved the occurrence of GSR. The occurrence of pain (B = 2.1, p = 0.001) improved the occurrence of paresthesia. These findings prompt us to further investigate the actual rehabilitation needs of survivors and the specific barriers to rehabilitation in the following research.
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Affiliation(s)
- Dan Chen
- Department of Rehabilitation Medicine, Shanghai Jing'an District Central Hospital, Shanghai, China
| | - Li Li
- Department of Rehabilitation Medicine, Shanghai Jing'an District Central Hospital, Shanghai, China
| | - Liu-Ya Jiang
- Department of Rehabilitation Medicine, Shanghai Jing'an District Central Hospital, Shanghai, China
| | - Jie Jia
- Department of Rehabilitation Medicine, Shanghai Jing'an District Central Hospital, Shanghai, China.
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8
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Boisbouvier S, Underwood T, McNamara J, Probst H. Upright patient positioning for gantry-free breast radiotherapy: feasibility tests using a robotic chair and specialised bras. Front Oncol 2023; 13:1250678. [PMID: 37810987 PMCID: PMC10556698 DOI: 10.3389/fonc.2023.1250678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/18/2023] [Indexed: 10/10/2023] Open
Abstract
For external beam radiotherapy using photons or particles, upright patient positioning on a rotating, robotic chair (a gantry-less system) could offer substantial cost savings. In this study, we considered the feasibility of upright breast radiotherapy using a robotic radiotherapy chair, for (i) a cohort of 9 patients who received conventional supine radiotherapy using photons for a diagnosis of primary breast cancer, plus (ii) 7 healthy volunteers, selected to have relatively large bra cup sizes. We studied: overall body positioning, arm positioning, beam access, breast reproducibility, and comfort. Amongst the healthy volunteer cohort, the impact of specialised radiotherapy bras upon inframammary skinfolds (ISF) was also determined, for upright treatment positions. In conclusion, upright body positioning for breast radiotherapy appears to be comfortable and feasible. Of the 9 patients who received conventional, supine radiotherapy (mean age 63.5 years, maximum age 90 years), 7 reported that they preferred upright positioning. Radiotherapy bras were effective in reducing/eliminating ISF for upright body positions, including for very large breasted volunteers. For upright proton radiotherapy to the breast, beam access should be straightforward, even for arms-down treatments, as en-face field directions are typically used. For photon radiotherapy, additional research is now required to investigate beam paths and whether, for certain patients, additional immobilisation will be required to keep the contralateral breast free from exposure. Future research should also investigate arm supports custom-designed for upright radiotherapy.
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Affiliation(s)
- Sophie Boisbouvier
- Radiation Oncology Department, Centre Léon Bérard, Lyon, France
- Université Sorbonne Paris Nord, Laboratoire Educations et Promotion de la santé (LEPS), Bobigny, France
| | - Tracy Underwood
- Research Depatment, Leo Cancer Care Ltd, Horley, United Kingdom
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Joanna McNamara
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, United Kingdom
| | - Heidi Probst
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, United Kingdom
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9
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Wills RAM, Maciukiewicz JM, Mourtzakis M, Dickerson CR. Examining the Effect of Time-From-Treatment on Activities of Daily Living Kinematics in Breast Cancer Survivors. J Appl Biomech 2023:1-6. [PMID: 37225172 DOI: 10.1123/jab.2022-0245] [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: 10/24/2022] [Revised: 03/23/2023] [Accepted: 04/02/2023] [Indexed: 05/26/2023]
Abstract
Breast cancer affects one in 8 females with a 5-year survival rate of 89%. Up to 72% of breast cancer survivors have trouble with activities of daily living (ADL) following treatment. Increased time-from-treatment improves some measures of function, yet ADL limitations persist. Therefore, this study assessed the effect of time-from-treatment on upper extremity kinematics during ADLs in breast cancer survivors. Twenty-nine female breast cancer survivors were divided into 2 groups: <1 year (n = 12) and 1-2 years (n = 17) from treatment. Kinematics were collected during 6 ADL tasks, and humerothoracic joint angles were quantified. A 2-way mixed analysis of variance assessed the effects of time-from-treatment and arm on maximum angles for each ADL. Decreased maximum angle existed for breast cancer survivors with increased time-from-treatment during all ADLs. Breast cancer survivors in the 1-2 years group used ∼28° to 32° lower elevation, ∼14° to 28° lower axial rotation, and ∼10° to 14° lower plane of elevation range across tasks. Decreased ranges of arm movement during ADLs with increased time-from-treatment may reflect compensatory movement strategies. Recognizing this shift in strategies and accompanying underlying disease progression can help inform responses to functional performance limitations in breast cancer survivors as delayed effects are present posttreatment.
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Affiliation(s)
- Rebecca A M Wills
- Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON,Canada
| | - Jacquelyn M Maciukiewicz
- Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON,Canada
| | - Marina Mourtzakis
- Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON,Canada
| | - Clark R Dickerson
- Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON,Canada
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10
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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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11
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Improving Evidence-Based Methods of Characterizing Shoulder-Related Quality of Life for Survivors of Breast Cancer. REHABILITATION ONCOLOGY 2023. [DOI: 10.1097/01.reo.0000000000000332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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12
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Rasmussen GHF, Kristiansen M, Arroyo-Morales M, Voigt M, Madeleine P. The Analgesic Effect of Resistance Training after Breast Cancer (ANTRAC): A Randomized Controlled Trial. Med Sci Sports Exerc 2023; 55:167-176. [PMID: 36084228 DOI: 10.1249/mss.0000000000003034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The objective of this blinded parallel-arm randomized controlled trial was to investigate the effect of resistance training (RT) on pain, maximal strength, and shoulder function in breast cancer survivors (BCS) with persistent pain after treatment. METHODS Twenty BCS with self-reported pain ≥1.5 yr after treatment were randomized to an experimental group (EXP, n = 10), who performed a supervised progressive total body heavy RT program 2 times per week for 12 wk, or a control group (CON, n = 10), who was instructed to continue their everyday life. Perceived pain intensity, pressure pain threshold (PPT) levels, one-repetition maximum (1RM), and active range of motion were collected pre- and postintervention and at 3 months follow-up. RESULTS There was a significant 11% decrease in peak pain intensity ( P < 0.05) for both groups, a significant 48% increase in 1RM ( P < 0.05), and a significant 35% increase in PPT levels ( P < 0.001) for EXP, but not for CON. For EXP, maximal strength at follow-up was still significantly greater than at preintervention ( P < 0.05), whereas PPT levels had reverted to baseline levels. There was no change in active range of motion ( P < 0.05) and no change in arm circumference ( P < 0.05). CONCLUSIONS RT had a significant effect on 1RM and PPT of BCS with persistent pain after treatment, demonstrating both a functional and analgesic effect of progressive RT in this population. Strength was largely maintained after detraining, whereas PPT levels were not, indicating that the process of RT rather than the gain in strength may be associated with analgesia.
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Affiliation(s)
- Gorm Henrik Fogh Rasmussen
- Sport Sciences-Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, DENMARK
| | - Mathias Kristiansen
- Sport Sciences-Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, DENMARK
| | | | - Michael Voigt
- Sport Sciences-Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, DENMARK
| | - Pascal Madeleine
- Sport Sciences-Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, DENMARK
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13
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Rasmussen GHF, Madeleine P, Arroyo-Morales M, Voigt M, Kristiansen M. Pain sensitivity and shoulder function among breast cancer survivors compared to matched controls: a case-control study. J Cancer Surviv 2023; 17:150-159. [PMID: 33495914 PMCID: PMC9970942 DOI: 10.1007/s11764-021-00995-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Persistent pain and loss of shoulder function are common adverse effects to breast cancer treatment, but the extent of these issues in comparison with healthy controls is unclear for survivors beyond 1.5 years after treatment. The purpose of this study was to benchmark differences in pressure pain thresholds (PPT), maximal isokinetic muscle strength (MIMS), and active range of motion (ROM) of females with persistent pain ≥1.5 years after breast cancer treatment (BCS) compared with pain-free matched controls (CON), and examine the presence of movement-evoked pain (MEP) during assessment of MIMS. METHODS The PPTs of 18 locations were assessed using a pressure algometer and a numeric rating scale was used to assess intensity of MEP. Active ROM and MIMS were measured using a universal goniometer and an isokinetic dynamometer, respectively. RESULTS A two-way analysis of variance revealed that PPTs across all locations, MIMS for horizontal shoulder extension/flexion and shoulder adduction, active ROM for shoulder flexion, horizontal shoulder extension, shoulder abduction, and external shoulder rotation were significantly lower for BCS compared with CON (P < 0.05). MEP was significantly higher for BCS and MEP intensity had a significant, negative correlation with PPTs (P < 0.01). DISCUSSION/CONCLUSION BCS with persistent pain ≥1.5 years after treatment demonstrates widespread reductions in PPTs and movement-specific reductions in MIMS and active ROM of the affected shoulder, along with MEP during physical performance assessment. IMPLICATIONS FOR CANCER SURVIVORS BCS with persistent pain ≥1.5 years after treatment shows signs of central sensitization and may benefit from individualized rehabilitation.
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Affiliation(s)
- G H F Rasmussen
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
| | - P Madeleine
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - M Arroyo-Morales
- Department of Physical Therapy, Faculty of Health Sciences, Sport and Health Research Institute, Biohealth Research Institute Granada, University of Granada, Granada, Spain
| | - M Voigt
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - M Kristiansen
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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14
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Fuentes-Abolafio IJ, Roldán-Jiménez C, Campos MI, Pajares-Hachero BI, Alba-Conejo E, Cuesta-Vargas A. Forearm Muscle Activity During the Handgrip Test in Breast Cancer Survivors: A Cross-Sectional Study. Clin Breast Cancer 2023; 23:e175-e181. [PMID: 36803839 DOI: 10.1016/j.clbc.2023.01.008] [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: 09/27/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023]
Abstract
INTRODUCTION/BACKGROUND Breast cancer survivors (BCS) frequently show upper limb dysfunctions. The forearm muscle activity measured by surface electromyography (sEMG) in this population has not been studied. This study aimed to describe forearm muscle activity in BCS, as well as to assess its possible relationship with other variables related to upper limb functionality and cancer-related fatigue (CRF). MATERIALS AND METHODS A cross-sectional study was carried out including 102 BCS as volunteers at a secondary care in Malaga, Spain. BCS were included if they were aged between 32 and 70 years old, without evidence of cancer recurrence at the time of recruitment. The forearm muscle activity (microvolts, µV) was assessed by sEMG during the handgrip test. The handgrip strength was assessed by dynamometry (kg), the upper limb functionality (%) was measured by the upper limb functional index (ULFI) questionnaire and the CRF was also assessed by revised Piper Fatigue Scale (0-10 points). RESULTS BCS reported reduced forearm muscle activity (287.88 µV) and reduced handgrip strength (21.31 Kg), a good upper limb functionality (68.85%), and a moderate cancer-related fatigue (4.74). Forearm muscle activity showed a poor significant correlation (r = -0.223, P = .038) with the CRF. Handgrip strength showed a poor correlation with the upper limb functionality (r = 0.387, P < .001) and age (r=-0.200, P = .047). CONCLUSION BCS showed a reduced forearm muscle activity. BCS also presented a poor correlation between forearm muscle activity and handgrip strength. Both outcomes tended to lower values with higher levels of CRF, while preserving a good upper limb functionality.
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Affiliation(s)
- Iván José Fuentes-Abolafio
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Andalucia Tech, Málaga, España; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Málaga, España
| | - Cristina Roldán-Jiménez
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Andalucia Tech, Málaga, España; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Málaga, España.
| | - Marcos Iglesias Campos
- UGCI Oncología Médica Hospitales Universitarios Regional y Virgen de la Victoria Campus de Teatinos, S/N, 29010. Málaga, España
| | - Bella I Pajares-Hachero
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Málaga, España; UGCI Oncología Médica Hospitales Universitarios Regional y Virgen de la Victoria Campus de Teatinos, S/N, 29010. Málaga, España
| | - Emilio Alba-Conejo
- UGCI Oncología Médica Hospitales Universitarios Regional y Virgen de la Victoria Campus de Teatinos, S/N, 29010. Málaga, España
| | - Antonio Cuesta-Vargas
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Andalucia Tech, Málaga, España; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Málaga, España; School of Clinical Science, Faculty of Health Science, Queensland University Technology, Brisbrane, Queensland,Australia
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15
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Maciukiewicz JM, Hussein ATS, Mourtzakis M, Dickerson CR. An evaluation of upper limb strength and range of motion of breast cancer survivors immediately following treatment. Clin Biomech (Bristol, Avon) 2022; 96:105666. [PMID: 35636306 DOI: 10.1016/j.clinbiomech.2022.105666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 04/11/2022] [Accepted: 05/11/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is a growing number of breast cancer survivors from improved cancer treatments. However, treatments often impair upper limb function, specifically range of motion and strength, reducing quality of life and function. The primary purpose of this study was to quantify differences in strength and range of motion following treatment. The secondary purpose aimed to measure the activation of each upper limb muscle in the completion of tasks. METHODS 29 breast cancer survivors were categorized into two groups based on time-since-treatment: 1) up to 1-year post-treatment, and 2) 1 to 2 years post-treatment. Participants completed maximal strength and range of motion tasks. During trials eight muscles were monitored bilaterally. Maximal force output was taken during strength trials, and kinematics were monitored during range of motion trials. A 2 by 2 mixed ANOVA (limb (affected, unaffected) x time-since-treatment) examined interaction and main effects of these factors on task peak force, angle and mean activation. FINDINGS Time-since-treatment influenced strength (flexion, extension, internal and external rotation) and range of motion (flexion, scapular abduction), wherein the group further from treatment had 11.5-15.5° less range of motion and 27.7-43.6 N less force production. A main effect of time-since-treatment influenced muscular behaviours during both tasks, where activation was higher in the group 1-2 years from treatment. INTERPRETATION Effects of treatment may manifest in a delayed manner whereby strength and range of motion are reduced in breast cancer survivors to a greater extent in those who are past 1 year of treatment cessation.
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Affiliation(s)
| | - Ayah T S Hussein
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Marina Mourtzakis
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Clark R Dickerson
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada.
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16
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Assessing the content based on ICF and quality based on COSMIN criteria of patient-reported outcome measures of functioning in breast cancer survivors: a systematic review. Breast Cancer 2022; 29:377-393. [PMID: 35233732 DOI: 10.1007/s12282-022-01340-6] [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: 10/21/2021] [Accepted: 02/03/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To identify currently used patient-reported outcome measures (PROMs) to evaluate disability in breast cancer survivors (BC) and critically evaluate their content and measurement properties. METHODS Four electronic databases (PubMed, EMBASE, CINAHL, Scopus and Google Scholar) were searched from 2001 to February 2021. PRISMA guidelines were followed. The content of the included PROM was evaluated by linking the items of the questionnaires to the International Classification of Functioning, Disability and Health (ICF) Core Set for BC using standard linking rules. Methodological quality and measurement properties were assessed using the COSMIN checklist. Qualitative synthesis was used to summarize the evidence on content validity and measurement properties. The overall quality of evidence on each measurement property was provided using GRADE principles. RESULTS Ten eligible studies reported measurement properties of seven PROMs. The content of included PROMs mostly focused on disability (70% of items), and less on body function and structure (23%) or environmental factors (6%). There was high linkage to The Comprehensive Core Set for BC, Q-DASH (100%), UEFI (95%) and DASH (92%). The Core Set Unique Disability Representation for DASH, and WHODAS2 was 39% and BCSQ-BC, Lymph-ICF was 34%. BCSQ-BC, and Lymph-ICF represented 32, and 20% of the content of the Core Set for BC, respectively, however, the other questionnaires covered less than 20% of the content of the Core Set. High quality of evidence supports sufficient results for internal consistency, testretest, and measurement error for BCSQ-BC, Lymph-ICF, DASH and WHODAS2. CONCLUSIONS Despite a lack of evidence on all-important clinical measurement, two generic (DASH and WHODAS2) and two disease-specific (BCSQ-BC, Lymph-ICF) PROM demonstrated emerging evidence of adequate measurement properties. The stronger alignment of the BCSQ-BC to the breast cancer ICF core set makes it preferable is a disease-specific measure. The Lymph-ICF is recommended where lymphedema is a specific focus. The DASH and WHODAS2 might be most useful where patients with a variety of upper extremity conditions, including breast cancer survivors, are being evaluated in the clinic or research study.
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17
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Klein I, Kalichman L, Chen N, Susmallian S. A comprehensive approach to risk factors for upper arm morbidities following breast cancer treatment: a prospective study. BMC Cancer 2021; 21:1251. [PMID: 34800988 PMCID: PMC8605604 DOI: 10.1186/s12885-021-08891-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/19/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Breast cancer surgery frequently causes deficiencies in shoulder functioning. The study pourpode is to identify risk factors for prolonged pain, reduction in function, and decrease in range of motion (ROM) in BC patients. METHODS A prospective cohort study was designed in a private hospital; between October 2018 and April 2019 with a follow-up of 6 months. Patients following BC surgery, were divided by arm morbidities, and the different risk facrors were evaluated using univariate analysis and logistic regression. RESULTS A total of 157 patients were included in the study. Risk factors for functional disabilities included; pain levels during hospitalization NPRS 1.2 (±0.8) compared to patients with no disabilities 0.5 ± 0.7 (p = .006), the size of tumors more than 1.4 ± 0.8 cm. compared with no morbidities 0.8 ± 0.9 cm. (p = .046), and breast reconstructions (p = .030). Risk factors for prolonged pain includes mastectomy (p = .006), breast reconstruction (p = .011), more than three dissected lymph nodes (p = .002), the presence of preoperative pain (p < .001), in-hospital pain (p < .001), axillary web syndrome (p < .001) and lymphedema (p < .001). Risk factors for decreased ROM were more than three dissected lymph nodes (p = .027), radiation (p = .018), and the size of dissected tissue (p = .035). Postoperative physical therapy appears to reduce the incidence of prolonged pain (p = .013) and regular physical activity may reduce long term functional disabilities (p = .021). CONCLUSIONS Upper arm morbidity following BC treatments affect up to 70% of the patients. Identifying the different risk and beneficial factors may improve awareness among physicians to refer patients to early rehabilitation programs and thus avoid chronic morbidity and improve the course of recovery. TRIAL REGISTRATION The study was registered in Clinical trial with the ID number: NCT03389204 .
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Affiliation(s)
- Ifat Klein
- Department of Physical Therapy, Assuta Medical Center, Tel Aviv, Israel.,Department of physical therapy, Faculty of Health Sciences, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Leonid Kalichman
- Department of physical therapy, Faculty of Health Sciences, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Noy Chen
- Department of Physical Therapy, Assuta Medical Center, Tel Aviv, Israel
| | - Sergio Susmallian
- Department of Surgery, Assuta Medical Center, 20 Habarzel Street, 69710, Tel Aviv, Israel. .,Faculty of Medicine, Ben Gurion University of the Negev, Beer Sheva, Israel.
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18
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Klein I, Kalichman L, Chen N, Susmallian S. A pilot study evaluating the effect of early physical therapy on pain and disabilities after breast cancer surgery: Prospective randomized control trail. Breast 2021; 59:286-293. [PMID: 34340163 PMCID: PMC8342784 DOI: 10.1016/j.breast.2021.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/08/2021] [Accepted: 07/16/2021] [Indexed: 12/24/2022] Open
Abstract
Background Morbidity of the shoulders after breast cancer (BC) surgery is a common side effect that includes; persistent pain, function limitation, and decreased range of motion (ROM). This study examines the effect of early physical therapy (PT) and patient's education on these morbidities. Methods A prospective, randomized clinical trial was conducted at a single medical center from October 2018 until April 2019. Women scheduled for breast cancer surgery were divided into intervention or control as standard care. The intervention included a PT treatment that included exercise instructions from the first postoperative day. Pain levels, upper limb function, ROM, and complications were measured. Results The study includes 157 women (mean age, 52.2 ± 12.9). Early PT reduced pain levels at the first month (NPRS 1.5 ± 1.2) and six months (NPRS 0.5 ± 0.8), compared with control (NPRS 2.1 ± 1.4, 1.0 ± 1.2), p = 0.019 and p = 0.011, respectively. Subdivision of the sample into small and extensive surgeries revealed additional positive effect for the intervention six months postoperatively on functional disabilities, p = 0.004 and p = 0.032 respectively. No complications attributable to the intervention were recorded. Conclusions Early PT and patient education reduces pain levels, and may improve function disabilities, without causing postoperative complications, although a larger study is needed to achieve unequivocal results. In breast cancer surgeries frequently delay the start of physical activities, arguing that it involves complications. The shoulder after breast surgery may provoke prolonged pain, disabilities, and prolongs recovery time. Physical therapy given the day after surgery, does not cause postoperative complications. Early onset of exercise regarding function and pain during recovery, may help reduce pain levels.
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Affiliation(s)
- Ifat Klein
- Department of Physical Therapy, Assuta Medical Center, Tel Aviv, Israel; Department of Physical Therapy. Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Leonid Kalichman
- Department of Physical Therapy. Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Noy Chen
- Department of Physical Therapy, Assuta Medical Center, Tel Aviv, Israel
| | - Sergio Susmallian
- Department of Surgery, Assuta Medical Center, Tel Aviv, Israel; Faculty of Medicine, Ben Gurion University of the Negev, Beer Sheva, Israel.
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Effect of physical activity levels on oncological breast surgery recovery: a prospective cohort study. Sci Rep 2021; 11:10432. [PMID: 34002007 PMCID: PMC8129134 DOI: 10.1038/s41598-021-89908-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/04/2021] [Indexed: 01/03/2023] Open
Abstract
After breast cancer (BC) surgery, women may experience a physical decline. The effect of physical activity (PA) on the course of recovery after BC surgery has not yet been thoroughly examined. To analyze the impact of physical activity performed by women undergoing breast cancer surgery on measures of function, range of motion, and self-efficacy. A prospective study was carried out in 157 patients who underwent surgery for BC between October 2018 and April 2019, divided into four groups according to the intensity of PA with 6 months follow-up. 50 sedentary patients and 107 active patients were enrolled; the mean age was 52.6. Women who performed physical activity, moderate to vigorous, demonstrated lower function disabilities (QuickDASH 2.22) compared with inactivity or light physical activity (QuickDASH 7.0, p < 0.001), with better shoulder flexion (159.0° vs. 150.7°, p = 0.007) and abduction (159.5° vs. 152.2°, p = 0.008). Higher PA levels, displayed in higher self-efficacy reports (9.5 vs. 8.8, p = 0.002), and return to prior job status (0.005). The PA level does not influence pain at one, three and 6 months postoperatively (p = 0.278, p = 0.304 and p = 0.304 respectively). High PA levels increase the risk of axillary web syndrome (p = 0.041), although, it reduces the incidence of chronic pain (p = 0.007). Women who practice physical activity recover better from BC surgery than sedentary women. The higher the intensity and frequency of training, the better the results. Vigorous activity cause axillary web syndrome, despite, it has a beneficial effect on lowering the rate of chronic pain.
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Lang AE, Kim SY, Dickerson CR, Milosavljevic S. Measurement of objective shoulder function following breast cancer surgery: a scoping review. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1851439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Angelica E. Lang
- School of Rehabilitation Sciences, University of Saskatchewan, Saskatoon, Canada
| | - Soo Y. Kim
- School of Rehabilitation Sciences, University of Saskatchewan, Saskatoon, Canada
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21
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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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Wong CJ, Tay MRJ, Aw HZ. Prevalence and Risk Factors of Adhesive Capsulitis in Asian Breast Cancer Patients Undergoing an Outpatient Community Cancer Rehabilitation Program. Arch Phys Med Rehabil 2020; 102:843-848. [PMID: 33203512 DOI: 10.1016/j.apmr.2020.10.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To investigate the prevalence and risk factors for adhesive capsulitis in postoperative breast cancer patients up to 5 years after surgery who were attending an outpatient community cancer rehabilitation program, and to determine whether any significant relationship exists between arm lymphedema and adhesive capsulitis. DESIGN Cross-sectional observational study. SETTING National cancer rehabilitation center. PARTICIPANTS Asian women (N=135) who underwent breast surgery and were referred for an outpatient community cancer rehabilitation program. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Presence of adhesive capsulitis, lymphedema. RESULTS The prevalence of adhesive capsulitis and lymphedema in this population was 22.2% and 33.3%, respectively. A history of mastectomy (odds ratio [OR], 3.93; 95% confidence interval [CI], 1.23-12.63; P=.021), mastectomy with reconstruction (OR, 2.72; 95% CI, 1.27-30.54; P=.024), and lymphedema (OR, 7.92; 95% CI, 2.73-22.95; P<.001) were found to be significantly associated with adhesive capsulitis on multivariate analysis. CONCLUSIONS Adhesive capsulitis and lymphedema are common in breast cancer survivors. The design of cancer rehabilitation programs for breast cancer survivors should include surveillance and management of adhesive capsulitis, especially in the presence of lymphedema.
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Affiliation(s)
- Chin Jung Wong
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore
| | | | - Hui Zhen Aw
- Singapore Cancer Society Rehabilitation Center, Singapore Cancer Society, Singapore
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23
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Kim JH, Kim SH, Kim HR, Lee SH, Yoon SY, Yang JH, Yoo YB, Park KS, Nam SE, Hong S, Min HK. Ultrasonographic evaluation of chronic shoulder pain after breast cancer surgery: single center, cross-sectional study. Sci Rep 2020; 10:16792. [PMID: 33033299 PMCID: PMC7546622 DOI: 10.1038/s41598-020-73769-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022] Open
Abstract
Chronic shoulder pain is a common complication in breast cancer patients after surgery. Chronic shoulder pain after breast cancer surgery was formerly considered as neuropathic pain, however the pathophysiology including structural damages has not been assessed comprehensively. We hypothesized that the structural change could be one of the cause of shoulder pain after breast cancer surgery and evaluated various ultrasonography findings of the shoulder in breast cancer patients with chronic shoulder pain. Patients who were suffering from chronic shoulder pain on unilateral side for at least 3 months after breast cancer surgery were enrolled from a single tertiary hospital. Demographic and clinical data were collected at the baseline. Articular and adjacent structures of both shoulders (painful and contralateral side) were evaluated by ultrasonography. The ultrasonography findings were compared between painful and contralateral sides. Logistic regression analysis was performed to determine the factors associated with abnormal ultrasonography findings. Fifty-two female patients (average age of 55) were enrolled. Significantly more abnormal ultrasonography findings were observed in the painful side than in the contralateral side [39 (75.0%) vs 11 (21.2%), P < 0.001]. The coracohumeral ligament was significantly thicker in the painful side than in the contralateral side (2.48 ± 0.69 vs 1.54 ± 1.25 mm, P < 0.001); adhesive capsulitis was also more frequent in the painful side [14 (26.9%) vs 0, P < 0.001]. Furthermore, patients with a history of breast cancer surgery on the ipsilateral side were associated with abnormal ultrasonography findings and adhesive capsulitis. This study is the first to evaluate ultrasonography in patients with chronic shoulder pain after breast cancer surgery. The results showed that ultrasonography could reveal several structural problems in these patients.
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Affiliation(s)
- Jung Hun Kim
- Department of Internal Medicine, Konkuk University Medical Center, Seoul, 05030, Republic of Korea
| | - Se Hee Kim
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Hae-Rim Kim
- Division of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, 05030, Republic of Korea
| | - Sang-Heon Lee
- Division of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, 05030, Republic of Korea
| | - So Young Yoon
- Division of Oncology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, 05030, Republic of Korea
| | - Jung-Hyun Yang
- Department of Surgery, Konkuk University School of Medicine, Seoul, 05030, Republic of Korea
| | - Young Bum Yoo
- Department of Surgery, Konkuk University School of Medicine, Seoul, 05030, Republic of Korea
| | - Kyoung Sik Park
- Department of Surgery, Konkuk University School of Medicine, Seoul, 05030, Republic of Korea
| | - Sang Eun Nam
- Department of Surgery, Konkuk University School of Medicine, Seoul, 05030, Republic of Korea
| | - Semie Hong
- Department of Radiation Oncology, Konkuk University Medical Center, Seoul, 05030, Republic of Korea
| | - Hong Ki Min
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 05030, Republic of Korea.
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Effect of Disrupted Rehabilitation Services on Distress and Quality of Life in Breast Cancer Survivors During the COVID-19 Pandemic. REHABILITATION ONCOLOGY 2020. [DOI: 10.1097/01.reo.0000000000000233] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Siqueira TC, Frágoas SP, Pelegrini A, de Oliveira AR, da Luz CM. Factors associated with upper limb dysfunction in breast cancer survivors. Support Care Cancer 2020; 29:1933-1940. [PMID: 32808138 DOI: 10.1007/s00520-020-05668-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 08/03/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyze factors associated with upper limb dysfunction in women after breast cancer treatment. METHODOLOGY A cross-sectional study with 233 women over 18 years of age diagnosed with breast cancer and undergoing at least one cancer treatment (surgery and/or adjuvant treatment). Sociodemographic, anthropometric, and cancer treatment data were collected, as well as current physical and functional complications. Changes in breast tenderness and intercostobrachial nerve pathway, winged scapula, pain, cicatricial adherence, and lymphedema were evaluated by physical examination (inspection and palpation). Upper limb dysfunction was assessed using the DASH questionnaire. Chi-square test and logistic regression were used to verify possible associations between upper limb dysfunction and other variables. RESULTS The results showed that 55.4% of women had some level of upper limb dysfunction. Evaluating treatment conditions, lymphadenectomy, lymphedema, presence of pain, and intercostobrachial nerve injury were associated with some level of upper limb dysfunction in the crude analysis. The adjusted analysis showed that only upper limb dysfunction remained associated with intercostobrachial nerve injury, regardless of age and body mass index. CONCLUSION Upper limb dysfunction is frequent after breast cancer treatment and may be associated with neuropathies due to changes in the intercostobrachial nerve pathway.
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Affiliation(s)
- Thais Cristina Siqueira
- Physiotherapy Postgraduate Program, Health and Sports Science Center, Santa Catarina State University (UDESC), Pascoal Simone, 358, Coqueiros, Florianópolis, SC, 88080-350, Brazil
| | - Simone Pedrozo Frágoas
- Physiotherapy Postgraduate Program, Health and Sports Science Center, Santa Catarina State University (UDESC), Pascoal Simone, 358, Coqueiros, Florianópolis, SC, 88080-350, Brazil
| | - Andreia Pelegrini
- Human Movement Sciences Postgraduate Program, Health and Sports Science Center, Santa Catarina State University (UDESC), Florianópolis, Brazil
| | - Ana Rosa de Oliveira
- Mastology Service, Carmela Dutra Maternity, Santa Catarina State Department of Health, Florianópolis, Brazil
| | - Clarissa Medeiros da Luz
- Physiotherapy Postgraduate Program, Health and Sports Science Center, Santa Catarina State University (UDESC), Pascoal Simone, 358, Coqueiros, Florianópolis, SC, 88080-350, Brazil.
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Rasmussen GHF, Kristiansen M, Arroyo-Morales M, Voigt M, Madeleine P. Absolute and relative reliability of pain sensitivity and functional outcomes of the affected shoulder among women with pain after breast cancer treatment. PLoS One 2020; 15:e0234118. [PMID: 32492064 PMCID: PMC7269234 DOI: 10.1371/journal.pone.0234118] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/19/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Breast cancer survivors (BCS) are often characterized by decreased pressure pain thresholds (PPT), range of motion (ROM) and strength in and around the shoulder affected by the treatment. This intra-rater reliability study was to establish the relative and absolute reliability of PPT's, active ROM and maximal isokinetic muscle strength (MIMS) of the affected shoulder in BCS with persistent pain after treatment. METHODS Twenty-one BCS participated in the study. The PPTs of 17 locations and pain intensity were assessed using a pressure algometer and a numeric rating scale. The ROM was measured using a universal goniometer and MIMS was measured using an isokinetic dynamometer. Relative reliability was estimated using intra class correlation coefficient (ICC), and absolute reliability using standard error of measurement (SEM). Minimum detectable change (MDC) was calculated from SEM. RESULTS The ICCs for PPTs ranged from 0.88-0.97, with SEM values ranging from 12.0 to 28.2 kPa and MDC ranging from 33.2 to 78.2 kPa. The ICCs for ROM ranged from 0.66-0.97, with SEM values ranging from 3.0 to 7.5° and MDC ranging from 8.4 to 20.8°. Finally, ICCs for MIMS ranged from 0.62-0.92, with SEM values ranging from 0.03 to 0.07 Nm/Kg FFM and MDC ranging from 0.09 to 0.19 Nm/kg FFM. CONCLUSION The results of this study indicate that PPTs, ROM and MIMS can be measured reliably on the affected shoulder in BCS with pain after treatment. This offer the possibility of using these measures to assess the effectiveness of interventions in this population.
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Affiliation(s)
- G. H. F. Rasmussen
- Department of Health Science and Technology, Sport Sciences - Performance and Technology, Aalborg University, Aalborg, Denmark
| | - M. Kristiansen
- Department of Health Science and Technology, Sport Sciences - Performance and Technology, Aalborg University, Aalborg, Denmark
| | - M. Arroyo-Morales
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - M. Voigt
- Department of Health Science and Technology, Sport Sciences - Performance and Technology, Aalborg University, Aalborg, Denmark
| | - P. Madeleine
- Department of Health Science and Technology, Sport Sciences - Performance and Technology, Aalborg University, Aalborg, Denmark
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Kikuuchi M, Akezaki Y, Nakata E, Yamashita N, Tominaga R, Kurokawa H, Hamada M, Aogi K, Ohsumi S, Tsuji T, Sugihara S. Risk factors of impairment of shoulder function after axillary dissection for breast cancer. Support Care Cancer 2020; 29:771-778. [PMID: 32468131 DOI: 10.1007/s00520-020-05533-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/14/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Postoperative shoulder joint dysfunction has been observed at a certain rate after breast cancer surgery with axillary lymph node dissection. The purposes of this study were to verify the feasibility and effects of home-based exercise using a DVD and clarify the target of intensive intervention with physiotherapy by identifying the factors that cause postoperative shoulder dysfunction. METHODS The study comprised 237 female patients who underwent breast cancer surgery with axillary lymph node dissection, whose data were acquired until 3 months postoperatively. All patients were instructed to exercise at home using a DVD. Range of motion (ROM) of shoulder flexion and abduction and the disability of the arm, shoulder, and hand (DASH) score were measured before surgery, 1 week and 1, 2, and 3 months after surgery. As factors influencing the recovery of shoulder ROM at 3 months after surgery, the presence or absence of radiation and factors up to 1 month after surgery (age, body mass index, the relationship between operated side and dominant side of the hand, treatment modalities, and complications). RESULTS Shoulder ROM and DASH scores had gradually recovered from 1 week to 3 months postoperatively. As the results of the multivariate analysis, the factors that were associated with the recovery of ROM of shoulder flexion at 3 months were the side of surgery corresponding to the dominant hand (negative factor) and the presence of paresthesia at 1 week postoperatively (positive factor) (p < 0.05). Radiation therapy and the side of surgery corresponding to the dominant hand were negative factors for the recovery of shoulder abduction (p < 0.01). Regarding the feasibility of the home exercise, 214/229 (93.4%), 172/210 (81.9%), and 139/206 (67.5%) of patients performed exercise at least once a day at 1, 2, and 3 months after surgery, respectively. CONCLUSION Our result indicated that the side of surgery corresponding to the dominant hand was the inhibiting factor for recovery for both shoulder flexion and abduction at 3 months after surgery. Home-based exercise with DVD was considered feasible. For the verification of this effectiveness, a randomized control study should be planned in the future.
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Affiliation(s)
- Masato Kikuuchi
- Department of Rehabilitation Medicine, National Hospital Organization Shikoku Cancer Center, Ko-160, Minamiumemoto-cho, Matsuyama City, 7910280, Japan
| | - Yoshiteru Akezaki
- Division of Physical Therapy, Kochi Professional University of Rehabilitation, Kochi, Japan
| | - Eiji Nakata
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Natsumi Yamashita
- Division of Clinical Biostatistics, Clinical Research Center, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Ritsuko Tominaga
- Department of Rehabilitation Medicine, National Hospital Organization Shikoku Cancer Center, Ko-160, Minamiumemoto-cho, Matsuyama City, 7910280, Japan
| | - Hideaki Kurokawa
- Department of Rehabilitation Medicine, National Hospital Organization Shikoku Cancer Center, Ko-160, Minamiumemoto-cho, Matsuyama City, 7910280, Japan
| | - Makiko Hamada
- Department of Rehabilitation Medicine, National Hospital Organization Shikoku Cancer Center, Ko-160, Minamiumemoto-cho, Matsuyama City, 7910280, Japan
| | - Kenjiro Aogi
- Department of Breast Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Shozo Ohsumi
- Department of Breast Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shinsuke Sugihara
- Department of Rehabilitation Medicine, National Hospital Organization Shikoku Cancer Center, Ko-160, Minamiumemoto-cho, Matsuyama City, 7910280, Japan.
- Department of Orthopaedic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan.
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Stout NL, Brown JC, Schwartz AL, Marshall TF, Campbell AM, Nekhlyudov L, Zucker DS, Basen-Engquist KM, Campbell G, Meyerhardt J, Cheville AL, Covington KR, Ligibel JA, Sokolof JM, Schmitz KH, Alfano CM. An exercise oncology clinical pathway: Screening and referral for personalized interventions. Cancer 2020; 126:2750-2758. [PMID: 32212338 DOI: 10.1002/cncr.32860] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/19/2020] [Accepted: 02/25/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Nicole L Stout
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland.,Hematology Oncology Department, Division of Cancer Prevention and Control, West Virginia University Cancer Institute, Morgantown, West Virginia
| | - Justin C Brown
- Cancer Metabolism Research Program, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana
| | - Anna L Schwartz
- School of Nursing, Northern Arizona University, Flagstaff, Arizona
| | | | - Anna M Campbell
- Sighthill Campus, Edinburgh Napier University, Edinburgh, Scotland
| | - Larissa Nekhlyudov
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David S Zucker
- Swedish Cancer Rehabilitation Medicine Services, Swedish Cancer Institute, Swedish Health Services, Seattle, Washington
| | - Karen M Basen-Engquist
- Department of Behavioral Science, Division of Cancer Prevention and Population Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Grace Campbell
- University of Pittsburgh School of Nursing and Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania
| | | | - Andrea L Cheville
- Department of Rehabilitation Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kelley R Covington
- Cancer Rehabilitation Program, Select Medical, Mechanicsburg, Pennsylvania
| | | | - Jonas M Sokolof
- Department of Physical Medicine and Rehabilitation, New York University Langone Health, New York, New York
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Cho C, Lee K, Cho J, Kim D. The incidence and risk factors of frozen shoulder in patients with breast cancer surgery. Breast J 2019; 26:825-828. [DOI: 10.1111/tbj.13610] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 07/31/2019] [Accepted: 08/02/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Chul‐Hyun Cho
- Department of Orthopedic Surgery Dongsan Medical Center School of Medicine Keimyung University Daegu Korea
| | - Kyoung‐Lak Lee
- Department of Orthopedic Surgery Hanmi hospital Daegu Korea
| | - Jihyoung Cho
- Department of Surgery Breast‐Endocrine Division Dongsan Medical Center School of Medicine Keimyung University Daegu Korea
| | - Duhan Kim
- Department of Orthopedic Surgery Dongsan Medical Center School of Medicine Keimyung University Daegu Korea
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Estimating the Reliability and Validity of the Upper Extremity Functional Index in Women After Breast Cancer Surgery. Clin Breast Cancer 2018; 18:e1261-e1267. [DOI: 10.1016/j.clbc.2018.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 02/13/2018] [Accepted: 02/13/2018] [Indexed: 12/22/2022]
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Prevalence of shoulder morbidity after treatment for breast Cancer in South Africa. Support Care Cancer 2018; 27:2591-2598. [PMID: 30456720 DOI: 10.1007/s00520-018-4540-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 11/04/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Breast cancer is the most frequently diagnosed cancer and leading cause of cancer death among women, representing a considerable public health burden in South Africa and other low-middle income countries. Short- and long-term complications of these treatments include shoulder morbidities such as pain, decreased range of motion, tightness, weakness, pain, numbness and lymphoedema and may be present for up to 6 years post-treatment. An understanding of baseline demographic and clinical risk factors can guide rehabilitation and management strategies for high-risk patients. The aims of this study were to quantify the burden of shoulder pain and disability in a tertiary academic hospital in Cape Town, South Africa, and identify potential risk factors for the development of shoulder morbidity. METHODS This study was a cross-sectional analysis of the prevalence of shoulder pain and dysfunction in women attending their post-treatment annual follow-up visit for unilateral breast carcinoma. RESULTS Three in four patients reported a presence of any pain or disability while only 9% experienced severe pain and disability. Multivariable ordinal logistic regression analysis identified race, side, axillary surgery, chemotherapy and age as significant predictors of pain and chemotherapy a significant predictor of disability. CONCLUSION The substantial burden of shoulder morbidity in this population represents a significant public health burden. The use of identified clinical and demographic characteristics may guide in the development of survivorship programmes incorporating surveillance and management of these high-risk patients.
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Głowacka-Mrotek I, Sowa M, Nowikiewicz T, Siedlecki Z, Hagner W, Zegarski W. Foot posture in female patients 5 years after breast-conserving surgery: a case-control study. Breast Cancer 2018; 25:325-333. [PMID: 29368210 PMCID: PMC5906506 DOI: 10.1007/s12282-018-0835-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 01/10/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Along with the improvement in the outcomes of breast cancer treatment being observed in the recent years, long-term studies to assess distant adverse effects of the treatment have become increasingly important. The objective of this study was to assess the foot posture in patients subjected to breast-conserving therapy. The assessment was made 5 years after the surgical procedure. METHODS 116 female patients (mean age of 58.75 years) were qualified into a case-control study. Foot posture on the operated breast side (F1) as well as on the contralateral side (F2) was evaluated using a computer-based foot analysis tool as an extension of projection moiré-based podoscopic examination. Comparisons were made for the following parameters: limb load, L-foot length, W-foot width, L/W-Wejsflog index, ALPHA-hallux valgus angle, BETA-little toe varus angle, GAMMA-heel angle, KY-Sztriter-Godunov index, CL-Clarke's angle, HW-heel width. RESULTS Five years after BCT, patients placed higher load on the foot on the side of the healthy breast (p = 0.0011). No statistically significant differences were observed between F1 and F2 with respect to other foot posture parameters (p > 0.05). No statistically significant differences were observed in foot posture parameters in patients having undergone BCT + ALND (axillary lymph node dissection) procedure as compared to patients subjected to BCT + SLNB (sentinel lymph node biopsy) procedure (p > 0.05). CONCLUSIONS No changes in foot posture were observed in patients 5 years after the BCT procedure. The type of the surgical procedure related to the lymph nodes within the axillary fossa has no effect on changes in foot posture.
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Affiliation(s)
- Iwona Głowacka-Mrotek
- Department of Rehabilitation, Collegium Medicum of the Nicolaus Copernicus University in Torun, Bydgoszcz, Poland.
| | - Magdalena Sowa
- Department of Surgical Oncology, Collegium Medicum of the Nicolaus Copernicus University in Torun, Bydgoszcz, Poland.,Department of Laser Therapy and Physiotherapy, Collegium Medicum of the Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Tomasz Nowikiewicz
- Department of Surgical Oncology, Collegium Medicum of the Nicolaus Copernicus University in Torun, Bydgoszcz, Poland.,Department of Clinical Breast Cancer and Reconstructive Surgery, Oncology Centre-Prof. F. Łukaszczyk Memorial Hospital, Bydgoszcz, Poland
| | - Zygmunt Siedlecki
- Department of Neurosurgery, Collegium Medicum of the Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Wojciech Hagner
- Department of Rehabilitation, Collegium Medicum of the Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Wojciech Zegarski
- Department of Surgical Oncology, Collegium Medicum of the Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
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de Oliveira MMF, Gurgel MSC, Amorim BJ, Ramos CD, Derchain S, Furlan-Santos N, dos Santos CC, Sarian LO. Long term effects of manual lymphatic drainage and active exercises on physical morbidities, lymphoscintigraphy parameters and lymphedema formation in patients operated due to breast cancer: A clinical trial. PLoS One 2018; 13:e0189176. [PMID: 29304140 PMCID: PMC5755747 DOI: 10.1371/journal.pone.0189176] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 11/15/2017] [Indexed: 01/01/2023] Open
Abstract
PURPOSE evaluate whether manual lymphatic drainage (MLD) or active exercise (AE) is associated with shoulder range of motion (ROM), wound complication and changes in the lymphatic parameters after breast cancer (BC) surgery and whether these parameters have an association with lymphedema formation in the long run. METHODS Clinical trial with 106 women undergoing radical BC surgery, in the Women's Integrated Healthcare Center-University of Campinas. Women were matched for staging, age and body mass index and were allocated to performed AE or MLD, 2 weekly sessions during one month after surgery. The wound was evaluated 2 months after surgery. ROM, upper limb circumference measurement and upper limb lymphoscintigraphy were performed before surgery, and 2 and 30 months after surgery. RESULTS The incidence of seroma, dehiscence and infection did not differ between groups. Both groups showed ROM deficit of flexion and abduction in the second month postoperative and partial recovery after 30 months. Cumulative incidence of lymphedema was 23.8% and did not differ between groups (p = 0.29). Concerning the lymphoscintigraphy parameters, there was a significant convergent trend between baseline degree uptake (p = 0.003) and velocity visualization of axillary lymph nodes (p = 0.001) with lymphedema formation. A reduced marker uptake before or after surgery predicted lymphedema formation in the long run (>2 years). None of the lymphoscintigraphy parameters were shown to be associated with the study group. Age ≤39 years was the factor with the greatest association with lymphedema (p = 0.009). In women with age ≤39 years, BMI >24Kg/m2 was significantly associated with lymphedema (p = 0.017). In women over 39 years old, women treated with MLD were at a significantly higher risk of developing lymphedema (p = 0.011). CONCLUSION Lymphatic abnormalities precede lymphedema formation in BC patients. In younger women, obesity seems to be the major player in lymphedema development and, in older women, improving muscle strength through AE can prevent lymphedema. In essence, MLD is as safe and effective as AE in rehabilitation after breast cancer surgery.
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Affiliation(s)
| | - Maria Salete Costa Gurgel
- Department of Obstetrics and Gynecology- University of Campinas, School of Medicine, Campinas, São Paulo, Brazil
| | - Bárbara Juarez Amorim
- Department of Nuclear Medicine and Radiology, University of Campinas, School of Medicine, Campinas, São Paulo, Brazil
| | - Celso Dario Ramos
- Department of Nuclear Medicine and Radiology, University of Campinas, School of Medicine, Campinas, São Paulo, Brazil
| | - Sophie Derchain
- Department of Obstetrics and Gynecology- University of Campinas, School of Medicine, Campinas, São Paulo, Brazil
| | - Natachie Furlan-Santos
- Department of Obstetrics and Gynecology- University of Campinas, School of Medicine, Campinas, São Paulo, Brazil
| | - César Cabello dos Santos
- Department of Obstetrics and Gynecology- University of Campinas, School of Medicine, Campinas, São Paulo, Brazil
| | - Luís Otávio Sarian
- Department of Obstetrics and Gynecology- University of Campinas, School of Medicine, Campinas, São Paulo, Brazil
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Harder H, Holroyd P, Burkinshaw L, Watten P, Zammit C, Harris PR, Good A, Jenkins V. A user-centred approach to developing bWell, a mobile app for arm and shoulder exercises after breast cancer treatment. J Cancer Surviv 2017; 11:732-742. [PMID: 28741202 PMCID: PMC5671540 DOI: 10.1007/s11764-017-0630-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 07/10/2017] [Indexed: 12/03/2022]
Abstract
PURPOSE The study aim was to develop a mobile application (app) supported by user preferences to optimise self-management of arm and shoulder exercises for upper-limb dysfunction (ULD) after breast cancer treatment. METHODS Focus groups with breast cancer patients were held to identify user needs and requirements. Behaviour change techniques were explored by researchers and discussed during the focus groups. Concepts for content were identified by thematic analysis. A rapid review was conducted to inform the exercise programme. Preliminary testing was carried out to obtain user feedback from breast cancer patients who used the app for 8 weeks post surgery. RESULTS Breast cancer patients' experiences with ULD and exercise advice and routines varied widely. They identified and prioritised several app features: tailored information, video demonstrations of the exercises, push notifications, and tracking and progress features. An evidence-based programme was developed with a physiotherapist with progressive exercises for passive and active mobilisation, stretching and strengthening. The exercise demonstration videos were filmed with a breast cancer patient. Early user testing demonstrated ease of use, and clear and motivating app content. CONCLUSIONS bWell, a novel app for arm and shoulder exercises, was developed by breast cancer patients, health care professionals and academics. Further research is warranted to confirm its clinical effectiveness. IMPLICATIONS FOR CANCER SURVIVORS Mobile health has great potential to provide patients with information specific to their needs. bWell is a promising way to support breast cancer patients with exercise routines after treatment and may improve future self-management of clinical care.
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Affiliation(s)
- Helena Harder
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
| | - Patrick Holroyd
- School of Engineering and Informatics, University of Sussex, Brighton, UK
| | - Lynn Burkinshaw
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Phil Watten
- School of Engineering and Informatics, University of Sussex, Brighton, UK
| | - Charles Zammit
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Peter R Harris
- School of Psychology, University of Sussex, Brighton, UK
| | - Anna Good
- School of Psychology, University of Sussex, Brighton, UK
| | - Val Jenkins
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, UK
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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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Huang MH, Blackwood J, Godoshian M, Pfalzer L. Prevalence of self-reported falls, balance or walking problems in older cancer survivors from Surveillance, Epidemiology and End Results—Medicare Health Outcomes Survey. J Geriatr Oncol 2017; 8:255-261. [DOI: 10.1016/j.jgo.2017.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 02/28/2017] [Accepted: 05/27/2017] [Indexed: 01/31/2023]
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De Groef A, Meeus M, De Vrieze T, Vos L, Van Kampen M, Christiaens MR, Neven P, Geraerts I, Devoogdt N. Pain characteristics as important contributing factors to upper limb dysfunctions in breast cancer survivors at long term. Musculoskelet Sci Pract 2017; 29:52-59. [PMID: 28319882 DOI: 10.1016/j.msksp.2017.03.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/10/2017] [Accepted: 03/11/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to explore the treatment, patient, and impairment-related risk factors associated with upper limb dysfunctions in breast cancer survivors. METHODS A cross-sectional study was performed in 274 women treated for breast cancer. The following risk factors were analysed by bivariable and multivariable analysis: 1) treatment-related variables (type of surgery, levels of lymph node dissected, radiotherapy, chemotherapy, hormone therapy and trastuzumab); 2) patient's related variables (age and Body Mass Index); 3) and finally impairment-related variables such as pain (intensity, quality and pressure hypersensitivity, signs of central sensitisation, the degree of pain catastrophizing and vigilance and awareness to pain), active ROM and upper limb strength were investigated. The dependent variable was upper limb function measured with the Disability of Arm, Shoulder and Hand (DASH) questionnaire. Additionally, a stepwise regression was performed. RESULTS An impaired upper limb function was noted in 170 (62%) of patients. Mean time after surgery was 1.5 (1.6) years. From multivariable analysis, it appears that in particular certain pain characteristics such as pain intensity, pain quality, signs of central sensitisation and pain catastrophizing are contributing to upper limb dysfunctions after breast cancer treatment at long term. Additionally, higher age, shoulder ROM and handgrip strength are possible contributing factors. The stepwise regression analysis revealed that central sensitisation mechanisms alone can explain about 40% of the variance in upper limb function. CONCLUSIONS At long term, especially pain and central sensitisation mechanisms contribute to upper limb function in breast cancer survivors.
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Affiliation(s)
- An De Groef
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium.
| | - Mira Meeus
- Univeristy of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Antwerp, Belgium
| | - Tessa De Vrieze
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium
| | - Lore Vos
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium
| | - Marijke Van Kampen
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium
| | - Marie-Rose Christiaens
- Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium; KU Leuven - University of Leuven, Oncology Department, Department of Surgical Oncology, Belgium
| | - Patrick Neven
- Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium; Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Inge Geraerts
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium
| | - Nele Devoogdt
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium
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Yang S, Park DH, Ahn SH, Kim J, Lee JW, Han JY, Kim DK, Jeon JY, Choi KH, Kim W. Prevalence and risk factors of adhesive capsulitis of the shoulder after breast cancer treatment. Support Care Cancer 2016; 25:1317-1322. [DOI: 10.1007/s00520-016-3532-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 12/05/2016] [Indexed: 12/12/2022]
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Scapulothoracic and Glenohumeral Motions During Functional Reaching Tasks in Women With a History of Breast Cancer and Healthy Age-Matched Controls. REHABILITATION ONCOLOGY 2016. [DOI: 10.1097/01.reo.0000000000000033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lee BG, Kim JK, Choi SH, Ahn HC, Chung MS. Is immediate reconstruction after mastectomy in breast cancer patients beneficial to shoulder function? ANZ J Surg 2016; 88:363-368. [DOI: 10.1111/ans.13735] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 07/17/2016] [Accepted: 07/18/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Bong Gun Lee
- Department of Orthopaedic Surgery, College of Medicine; Hanyang University; Seoul Republic of Korea
| | - Joon Kuk Kim
- Department of Orthopaedic Surgery, College of Medicine; Hanyang University; Seoul Republic of Korea
| | - Sung Hyouk Choi
- Department of Surgery, College of Medicine; Hanyang University; Seoul Republic of Korea
| | - Hee Chang Ahn
- Department of Plastic Surgery, College of Medicine; Hanyang University; Seoul Republic of Korea
| | - Min Sung Chung
- Department of Surgery, College of Medicine; Hanyang University; Seoul Republic of Korea
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De Groef A, Van Kampen M, Tieto E, Schönweger P, Christiaens MR, Neven P, Geraerts I, Gebruers N, Devoogdt N. Arm lymphoedema and upper limb impairments in sentinel node-negative breast cancer patients: A one year follow-up study. Breast 2016; 29:102-8. [PMID: 27479040 DOI: 10.1016/j.breast.2016.07.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/24/2016] [Accepted: 07/18/2016] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The aim of this study is (1) to investigate the prevalence rate of arm lymphedema, pain, impaired shoulder range of motion, strength and shoulder function one year after a sentinel lymph node biopsy (SLNB) for breast cancer and (2) to determine predictive factors for these complications. METHODS A longitudinal study was performed. One hundred patients with a sentinel-lymph node negative breast cancer were included. All patients were measured before surgery and one year after. Arm lymphedema was measured with the perimeter, pain with the Visual Analogue Scale, shoulder range of motion with an inclinometer, strength with a handheld dynamometer and shoulder function with the Disability of Arm, Shoulder and Hand questionnaire. Patient-, breast cancer- and treatment-related variables were recorded. RESULTS One year after surgery 8% of sentinel node-negative breast cancer patients had developed arm lymphedema. Fifty percent of patients had pain, 30% had an impaired shoulder range of motion, 8% had a decreased handgrip strength and 49% had an impaired shoulder function. Pain, shoulder range of motion, strength and shoulder dysfunctions changed significantly over one year (p < 0.001). Higher Body Mass Index is a predictive variable for shoulder dysfunctions one year post-SLNB. CONCLUSIONS Prevalence rate of lymphedema and other upper limb impairments may not be underestimated after SLNB. Pain, shoulder range of motion, handgrip strength and shoulder function change significantly up to one year compared to preoperative values in sentinel node-negative breast cancer patients.
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Affiliation(s)
- An De Groef
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium.
| | - Marijke Van Kampen
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium
| | - Elena Tieto
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium
| | - Petra Schönweger
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium
| | - Marie-Rose Christiaens
- Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium; KU Leuven - University of Leuven, Oncology Department, Department of Surgical Oncology, Belgium
| | - Patrick Neven
- Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium; Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Inge Geraerts
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium
| | - Nick Gebruers
- Univeristy of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Antwerp, Belgium
| | - Nele Devoogdt
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium
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A longitudinal analysis of chronic arm morbidity following breast cancer surgery. Breast Cancer Res Treat 2016; 157:413-25. [PMID: 27194415 DOI: 10.1007/s10549-016-3834-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
Abstract
Arm morbidity (AM) arising from breast cancer (BC) treatment can detrimentally impact quality of life; often limiting a survivor's ability to participate in valued activities. The present study explored (a) the developmental time course of AM [restricted range of motion (ROM), pain, and arm volume changes], negative affect, and perceived disability in the immediate years post-surgery, and (b) the mediating role of perceived disability on the relationship between AM and negative affect over time. In this 5-year longitudinal study, BC survivors from four Canadian oncology clinics (n = 431) completed five annual clinical assessments, where differences in ROM (shoulder abduction, external rotation) and arm volume between the affected and non-affected arm were measured. The profile of mood states (POMS), disability of arm, shoulder, hand, and McGill Pain Questionnaire-Short form were completed. Results from general linear modeling showed that AM, negative affect, and perceived disability were greatest 1-year post-surgery, declined, and with the exception of arm volume changes, were significantly lower 5 years later. Negative affect was significantly associated with restrictions in shoulder abduction and external rotation (average r = -0.15; p < 0.05) and present arm pain (average r = 0.28, p < 0.01) at most assessments. The mediating role of perceived disability on the relationship between AM and negative affect was statistically significant in a majority of assessments. Perceived disability is the underlying factor driving the relationship between AM and mood disturbance over time. Rehabilitative therapy to improve survivors' functional well-being might mitigate the negative impacts of AM on emotional health.
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Self-reported Balance Confidence Relates to Perceived Mobility Limitations in Older Cancer Survivors. REHABILITATION ONCOLOGY 2016. [DOI: 10.1097/01.reo.0000000000000017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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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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Dean LT, DeMichele A, LeBlanc M, Stephens-Shields A, Li SQ, Colameco C, Coursey M, Mao JJ. Black breast cancer survivors experience greater upper extremity disability. Breast Cancer Res Treat 2015; 154:117-25. [PMID: 26420404 DOI: 10.1007/s10549-015-3580-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/19/2015] [Indexed: 01/06/2023]
Abstract
Over one-third of breast cancer survivors experience upper extremity disability. Black women present with factors associated with greater upper extremity disability, including: increased body mass index (BMI), more advanced disease stage at diagnosis, and varying treatment type compared with Whites. No prior research has evaluated the relationship between race and upper extremity disability using validated tools and controlling for these factors. Data were drawn from a survey study among 610 women with stage I-III hormone receptor positive breast cancer. The disabilities of the arm, shoulder and hand (QuickDASH) is an 11-item self-administered questionnaire that has been validated for breast cancer survivors to assess global upper extremity function over the past 7 days. Linear regression and mediation analysis estimated the relationships between race, BMI and QuickDASH score, adjusting for demographics and treatment types. Black women (n = 98) had 7.3 points higher average QuickDASH scores than White (n = 512) women (p < 0.001). After adjusting for BMI, age, education, cancer treatment, months since diagnosis, and aromatase inhibitor status, Black women had an average 4-point (95 % confidence interval 0.18-8.01) higher QuickDASH score (p = 0.04) than White women. Mediation analysis suggested that BMI attenuated the association between race and disability by 40 %. Even several years post-treatment, Black breast cancer survivors had greater upper extremity disability, which was partially mediated by higher BMIs. Close monitoring of high BMI Black women may be an important step in reducing disparities in cancer survivorship. More research is needed on the relationship between race, BMI, and upper extremity disability.
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Affiliation(s)
- Lorraine T Dean
- School of Medicine, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 909 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA.
| | - Angela DeMichele
- School of Medicine, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 909 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
| | - Mously LeBlanc
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA.,Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, USA
| | - Alisa Stephens-Shields
- School of Medicine, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 909 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA
| | - Susan Q Li
- Family Medicine and Community Health at the Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, USA
| | - Chris Colameco
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
| | - Morgan Coursey
- School of Medicine, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 909 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA
| | - Jun J Mao
- School of Medicine, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 909 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA.,Family Medicine and Community Health at the Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, USA
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Yang EJ, Kang E, Kim SW, Lim JY. Discrepant Trajectories of Impairment, Activity, and Participation Related to Upper-Limb Function in Patients With Breast Cancer. Arch Phys Med Rehabil 2015; 96:2161-8. [PMID: 26343172 DOI: 10.1016/j.apmr.2015.08.426] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 08/20/2015] [Accepted: 08/21/2015] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To explore upper-limb disability with respect to health outcomes, operationalized by Disabilities of the Arm, Shoulder, and Hand, and to identify factors associated with each element of upper-limb disability over a 2-year period in breast cancer survivors. DESIGN Prospective cohort study. SETTING University hospital cancer center. PARTICIPANTS Individuals (N=191) recruited from all the patients with newly diagnosed breast cancer before cancer surgery at a university hospital between April 2006 and March 2007. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES We evaluated demographics, social variables, and upper-limb disability in a baseline assessment preoperatively. Follow-up evaluations were conducted in outpatient clinics 3 months after surgery and at 12 and 24 months after surgery. Linear regression models with the generalized estimating equations of the compound symmetry covariance structure were used. RESULTS Time since surgery was inversely associated with the impairment items score (β=-.20; 95% confidence interval [CI], -.49 to -.08) and positively associated with the activity limitation items score (β=.59; 95% CI, .29-.88). The impact of upper-limb disability preoperatively on the items involving both the activity limitation and participation restrictions scores was positive (β=2.89; 95% CI, .76-5.02) after adjusting for demographic, treatment type, and socioeconomic factors. CONCLUSIONS Our study revealed that upper-limb impairment recovered with time after breast cancer surgery; however, upper-limb function-related activity and participation were reduced through 2 years after surgery.
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Affiliation(s)
- Eun Joo Yang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Eunyoung Kang
- Department of Surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Sung-Won Kim
- Department of Surgery, Daerim Saint Mary's Hospital, Seoul, Republic of Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea.
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Ezzo J, Manheimer E, McNeely ML, Howell DM, Weiss R, Johansson KI, Bao T, Bily L, Tuppo CM, Williams AF, Karadibak D. Manual lymphatic drainage for lymphedema following breast cancer treatment. Cochrane Database Syst Rev 2015; 2015:CD003475. [PMID: 25994425 PMCID: PMC4966288 DOI: 10.1002/14651858.cd003475.pub2] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND More than one in five patients who undergo treatment for breast cancer will develop breast cancer-related lymphedema (BCRL). BCRL can occur as a result of breast cancer surgery and/or radiation therapy. BCRL can negatively impact comfort, function, and quality of life (QoL). Manual lymphatic drainage (MLD), a type of hands-on therapy, is frequently used for BCRL and often as part of complex decongestive therapy (CDT). CDT is a fourfold conservative treatment which includes MLD, compression therapy (consisting of compression bandages, compression sleeves, or other types of compression garments), skin care, and lymph-reducing exercises (LREs). Phase 1 of CDT is to reduce swelling; Phase 2 is to maintain the reduced swelling. OBJECTIVES To assess the efficacy and safety of MLD in treating BCRL. SEARCH METHODS We searched Medline, EMBASE, CENTRAL, WHO ICTRP (World Health Organization's International Clinical Trial Registry Platform), and Cochrane Breast Cancer Group's Specialised Register from root to 24 May 2013. No language restrictions were applied. SELECTION CRITERIA We included randomized controlled trials (RCTs) or quasi-RCTs of women with BCRL. The intervention was MLD. The primary outcomes were (1) volumetric changes, (2) adverse events. Secondary outcomes were (1) function, (2) subjective sensations, (3) QoL, (4) cost of care. DATA COLLECTION AND ANALYSIS We collected data on three volumetric outcomes. (1) LE (lymphedema) volume was defined as the amount of excess fluid left in the arm after treatment, calculated as volume in mL of affected arm post-treatment minus unaffected arm post-treatment. (2) Volume reduction was defined as the amount of fluid reduction in mL from before to after treatment calculated as the pretreatment LE volume of the affected arm minus the post-treatment LE volume of the affected arm. (3) Per cent reduction was defined as the proportion of fluid reduced relative to the baseline excess volume, calculated as volume reduction divided by baseline LE volume multiplied by 100. We entered trial data into Review Manger 5.2 (RevMan), pooled data using a fixed-effect model, and analyzed continuous data as mean differences (MDs) with 95% confidence intervals (CIs). We also explored subgroups to determine whether mild BCRL compared to moderate or severe BCRL, and BCRL less than a year compared to more than a year was associated with a better response to MLD. MAIN RESULTS Six trials were included. Based on similar designs, trials clustered in three categories.(1) MLD + standard physiotherapy versus standard physiotherapy (one trial) showed significant improvements in both groups from baseline but no significant between-groups differences for per cent reduction.(2) MLD + compression bandaging versus compression bandaging (two trials) showed significant per cent reductions of 30% to 38.6% for compression bandaging alone, and an additional 7.11% reduction for MLD (MD 7.11%, 95% CI 1.75% to 12.47%; two RCTs; 83 participants). Volume reduction was borderline significant (P = 0.06). LE volume was not significant. Subgroup analyses was significant showing that participants with mild-to-moderate BCRL were better responders to MLD than were moderate-to-severe participants.(3) MLD + compression therapy versus nonMLD treatment + compression therapy (three trials) were too varied to pool. One of the trials compared compression sleeve plus MLD to compression sleeve plus pneumatic pump. Volume reduction was statistically significant favoring MLD (MD 47.00 mL, 95% CI 15.25 mL to 78.75 mL; 1 RCT; 24 participants), per cent reduction was borderline significant (P=0.07), and LE volume was not significant. A second trial compared compression sleeve plus MLD to compression sleeve plus self-administered simple lymphatic drainage (SLD), and was significant for MLD for LE volume (MD -230.00 mL, 95% CI -450.84 mL to -9.16 mL; 1 RCT; 31 participants) but not for volume reduction or per cent reduction. A third trial of MLD + compression bandaging versus SLD + compression bandaging was not significant (P = 0.10) for per cent reduction, the only outcome measured (MD 11.80%, 95% CI -2.47% to 26.07%, 28 participants).MLD was well tolerated and safe in all trials.Two trials measured function as range of motion with conflicting results. One trial reported significant within-groups gains for both groups, but no between-groups differences. The other trial reported there were no significant within-groups gains and did not report between-groups results. One trial measured strength and reported no significant changes in either group.Two trials measured QoL, but results were not usable because one trial did not report any results, and the other trial did not report between-groups results.Four trials measured sensations such as pain and heaviness. Overall, the sensations were significantly reduced in both groups over baseline, but with no between-groups differences. No trials reported cost of care.Trials were small ranging from 24 to 45 participants. Most trials appeared to randomize participants adequately. However, in four trials the person measuring the swelling knew what treatment the participants were receiving, and this could have biased results. AUTHORS' CONCLUSIONS MLD is safe and may offer additional benefit to compression bandaging for swelling reduction. Compared to individuals with moderate-to-severe BCRL, those with mild-to-moderate BCRL may be the ones who benefit from adding MLD to an intensive course of treatment with compression bandaging. This finding, however, needs to be confirmed by randomized data.In trials where MLD and sleeve were compared with a nonMLD treatment and sleeve, volumetric outcomes were inconsistent within the same trial. Research is needed to identify the most clinically meaningful volumetric measurement, to incorporate newer technologies in LE assessment, and to assess other clinically relevant outcomes such as fibrotic tissue formation.Findings were contradictory for function (range of motion), and inconclusive for quality of life.For symptoms such as pain and heaviness, 60% to 80% of participants reported feeling better regardless of which treatment they received.One-year follow-up suggests that once swelling had been reduced, participants were likely to keep their swelling down if they continued to use a custom-made sleeve.
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Affiliation(s)
- Jeanette Ezzo
- JME EnterprisesResearch Director1905 West Rogers AveBaltimoreMarylandUSA21209
| | - Eric Manheimer
- University of Maryland School of MedicineCenter for Integrative Medicine520 W. Lombard StRoom 101DBaltimoreMarylandUSA21201
| | - Margaret L McNeely
- University of AlbertaDepartment of Physical Therapy/ Department of Oncology2‐50, Corbett HallEdmontonABCanadaT6G 2G4
| | - Doris M Howell
- University Health Network (PMH site)Nursing610 University AveRoom 15‐617TorontoONCanadaM5G 2M9
| | - Robert Weiss
- 10671 Baton Rouge AvenuePorter RanchCaliforniaUSA91326
| | - Karin I Johansson
- Skane University HospitalLymphoedema Unit, Department of OncologyLundSweden22185
| | - Ting Bao
- Memorial Sloan Kettering Cancer CentreIntegrative Medicine and Breast Cancer Services1429 First AvenueNew YorkNew YorkUSA10021
| | - Linda Bily
- Stony Brook Medicine133 Boyle Rd.SeldenNew YorkNew YorkUSA11784
| | - Catherine M Tuppo
- Stony Brook MedicineBariatric and Metabolic Weight Loss Center101 Nicolls RoadStony BrookNew YorkUSA11794
| | | | - Didem Karadibak
- Dokuz Eylul UniversitySchool of Physical Therapy and RehabilitationIzmirTurkey9035340
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Wennman-Larsen A, Petersson LM, Saboonchi F, Alexanderson K, Vaez M. Consistency of breast and arm symptoms during the first two years after breast cancer surgery. Oncol Nurs Forum 2015; 42:145-55. [PMID: 25806881 DOI: 10.1188/15.onf.145-155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine the severity and development of breast and arm symptoms separately during the two years following breast cancer surgery, and to examine whether previously defined predictors of arm symptoms are associated with breast symptoms. DESIGN Prospective cohort study with two-year follow-up. SETTING Three institutions in the Stockholm, Sweden, region. SAMPLE 645 women, aged 20-63 years, enrolled within 12 weeks of surgery for primary breast cancer. METHODS Baseline register and questionnaire data with five follow-ups were submitted to descriptive, inferential, and logistic regression analysis. MAIN RESEARCH VARIABLES Severity of breast and arm symptoms measured by the European Organisation for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire. FINDINGS Most participants had undergone breast-conserving
surgery and sentinel lymph node dissection, and were scheduled for postoperative radiation therapy. Overall mean levels of breast and arm symptoms were low, but with large individual variations. At all six time points, the mean levels of breast symptoms were significantly higher than those of arm symptoms. Overall, the mean level of both types of symptoms decreased during follow-up. A body mass index (BMI) of 25 or greater and breast symptoms at eight months were associated with having breast symptoms at two years. Arm symptoms at baseline and at eight months, and radiation therapy and a BMI of 25 or greater were associated with having arm symptoms at two years. CONCLUSIONS Breast symptoms show different patterns of change and are not associated with the same factors as arm symptoms. IMPLICATIONS FOR NURSING For nurses monitoring women treated for breast cancer, the results of this study provide knowledge regarding the importance of early symptom identification and long-term symptoms after treatment.
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