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Burlile JF, Shiraishi S, Gunn HJ, Bradt JL, Kroeplin HM, Lang KG, Cimmiyotti JK, Depauw N, Chang CY, Brom KM, Sonnicksen CL, Vu A, Jimenez RB, Corbin KS. Intensity-modulated proton radiotherapy spares musculoskeletal structures in regional nodal irradiation for breast cancer: a dosimetric comparison. Acta Oncol 2024; 63:755-762. [PMID: 39354810 DOI: 10.2340/1651-226x.2024.40084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 08/30/2024] [Indexed: 10/03/2024]
Abstract
BACKGROUND AND PURPOSE Regional nodal irradiation (RNI) for breast cancer delivers radiation in proximity to the shoulder and torso, and radiation exposure may contribute to long-term upper extremity and postural morbidity. To date, no studies have assessed the differential dosimetric impact of proton versus photon radiation on shoulder and torso anatomy. This study examined clinically relevant musculoskeletal (MSK) structures and assessed the dose delivered with each modality. PATIENTS/MATERIAL AND METHODS Ten MSK structures were contoured on IMPT (intensity-modulated proton therapy) and VMAT (volumetric modulated arc therapy) plans for 30 patients receiving RNI. Relevant dose metrics were compared for each of the structures. Intensity-modulated proton therapy dose was calculated using the relative biological effective value of 1.1. Hypo-fractionated plans were scaled to the equivalent dose in 2 Gy fractions (EQD2) using an alpha/beta ratio of four. Wilcoxon signed rank sum tests compared doses. Select three-dimensional and optimised VMAT plans were also informally compared. RESULTS AND INTERPRETATION Each of the 10 structures received a statistically significantly lower dose with the use of IMPT compared with VMAT. Differences were greatest for posterior structures, including the trapezius, latissimus dorsi and glenohumeral joint. Mean absolute differences were as great as 23 Gy (supraspinatus D5cc) and up to 30-fold dose reductions were observed (deltoid D50cc). An average 3.7-fold relative dose reduction existed across all structures. Measures of low/intermediate dose (V15Gy and D50cc) showed the largest differences. Intensity-modulated proton therapy results in statistically lower radiation exposure to relevant shoulder and torso anatomy compared to photon radiation for patients requiring RNI. Prospective study is needed to correlate functional outcomes with radiation dose.
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Affiliation(s)
| | | | - Heather J Gunn
- Mayo Clinic Department of Quantitative Health Sciences, Rochester, MN, USA
| | | | - Haley M Kroeplin
- Mayo Clinic Department of Radiation Oncology, Rochester, MN, USA
| | - Karen G Lang
- Mayo Clinic Department of Radiation Oncology, Rochester, MN, USA
| | | | - Nicolas Depauw
- Massachusetts General Hospital Department of Radiation Oncology, Boston, MA, USA
| | - Connie Y Chang
- Massachusetts General Hospital Department of Radiology, Boston, MA, USA
| | - Kevin M Brom
- Mayo Clinic Department of Medical Physics, Rochester, MN, USA
| | | | - Anhmai Vu
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Rachel B Jimenez
- Massachusetts General Hospital Department of Radiation Oncology, Rochester, MN, USA
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Sun S, Zhu M, He H, Chen L, Luo C, Zhang Y, Zhang N, Zhang B, Zhang M. Trajectory patterns and factors associated with acceptance of disability in young and middle-aged breast cancer patients: a longitudinal study. Support Care Cancer 2024; 32:658. [PMID: 39271485 DOI: 10.1007/s00520-024-08841-4] [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: 02/27/2024] [Accepted: 08/27/2024] [Indexed: 09/15/2024]
Abstract
PURPOSE To explore the trajectories of acceptance of disability in young and middle-aged breast cancer patients based on a latent class growth analysis, investigate factors associated with each trajectory, and identify whether return to normal living differs in different trajectories. METHODS Young and middle-aged patients newly diagnosed with breast cancer who underwent surgery were followed up at baseline, and 1, 3, and 6 months in China. Participants completed sociodemographic information questionnaires, the Adaptation of Disability Scale Revised, and the Reintegration to Normal Living Index. A latent class growth analysis was used to explore the trajectories of acceptance of disability. RESULTS Among 212 patients newly diagnosed with breast cancer, the mean age of patients was 45.44 years. The majority of participants were with invasive carcinoma (77.8%). Three classes were identified: high acceptance of disability increasing group (high-increasing, 13.7%), moderate acceptance of disability stable group (moderate-stable, 67.9%), and moderate acceptance of disability decreasing group (moderate-decreasing, 18.3%). Being unemployed or retired and receiving endocrine therapy are risk factors associated with acceptance of disability. Carcinoma in situ is a protective factor associated with acceptance of disability. Participants diagnosed with carcinoma in situ and who not receive endocrine therapy were more likely to be in high-increasing group. Unemployed participants before surgery were more likely to be in moderate-decreasing group. Moreover, the Reintegration to Normal Living Index scores had significant differences from baseline to 6 months of follow-up. The high-increasing group had the highest average Reintegration to Normal Living Index scores than the moderate-stable group and the moderate-decreasing group, showing similar patterns at four timepoints. CONCLUSION We identified three trajectories of acceptance of disability. Dynamic and individualized intervention should be continuously provided to ensure patients acquire adequate medical resources to comprehensively increase acceptance of disability.
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Affiliation(s)
- Shihao Sun
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Mengyao Zhu
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Haiyan He
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Lili Chen
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Chunhong Luo
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yiheng Zhang
- School of Nursing, Ji Nan University, Guangzhou, China
| | - Ni Zhang
- School of Nursing, Sun Yat-Sen University, No. 74 Zhongshan 2Nd Rd, Guangzhou, 510080, China
| | - Baoyi Zhang
- School of Nursing, Sun Yat-Sen University, No. 74 Zhongshan 2Nd Rd, Guangzhou, 510080, China
| | - Meifen Zhang
- School of Nursing, Sun Yat-Sen University, No. 74 Zhongshan 2Nd Rd, Guangzhou, 510080, China.
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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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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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Kasgri KA, Abazari M, Badeleh SM, Badeleh KM, Peyman N. Comprehensive Review of Breast Cancer Consequences for the Patients and Their Coping Strategies: A Systematic Review. Cancer Control 2024; 31:10732748241249355. [PMID: 38767653 PMCID: PMC11107334 DOI: 10.1177/10732748241249355] [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: 09/22/2023] [Revised: 03/29/2024] [Accepted: 04/04/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Women with breast cancer usually face multiple short-term and long-term problems in dealing with their acute and chronic symptoms during and after cancer treatment. However, serious gaps remain in addressing these issues in clinical and public health practice. METHODS According to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, we conducted a systematic literature search from 2000-2021 in electronic databases, including Medline, PubMed, Embase, Scopus, Web of Knowledge, and Google Scholar databases using predefined keywords. RESULTS The review identified several significant and interconnected problems in breast cancer patient's treatment and supportive care. The results revealed that these issues are very common among breast cancer patients, and specific attention and serious measures are needed to address these problems. Despite implementing different protocols and programs for covering and addressing these problems, serious gaps still exist in supporting breast cancer patients during clinical and follow-up care. CONCLUSION Developing innovative and holistic approaches and programs based on the multifactorial assessment of symptoms are suggested for addressing and covering the multidimensional requirements of this population. Consequently, thorough evaluation, education, treatment, and referrals should be provided for the most common sequelae of these patients by including appropriate medication, exercise, counselling, occupational therapy, and complementary therapies. The present study provides a more comprehensive source of information about breast cancer patient's medical and supportive needs in comparison with individual studies on symptom experiences.
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Affiliation(s)
- Kobra A. Kasgri
- Department of Midwifery, Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Morteza Abazari
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Safa M. Badeleh
- Department of Food and Drug Control, School of Pharmacy, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Kosar M. Badeleh
- Department of Sciences, Islamic Azad University, Sari Branch, Sari, Iran
| | - Nooshin Peyman
- Department of Health Education and Health Promotion, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
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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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Martín-Martín J, Pajares-Hachero B, Alba-Conejo E, Ribelles N, Cuesta-Vargas AI, Roldán-Jiménez C. Validation of the Upper Limb Functional Index on Breast Cancer Survivor. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4997. [PMID: 36981904 PMCID: PMC10049349 DOI: 10.3390/ijerph20064997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
UNLABELLED Breast cancer survivors (BCS) may face functional alterations after surgical intervention. Upper Limb Disorders (ULDs) are highly prevalent even years after a diagnosis. Clinicians may assess the upper limbs after breast cancer. The Upper Limb Functional Index (ULFI) has been validated across different populations and languages. This study aimed to assess the psychometric properties of the Upper Limb Functional Index Spanish version (ULFI-Sp) in the BCS. METHODS A psychometric validation study of the ULFI-Sp was conducted on 216 voluntary breast cancer survivors. The psychometric properties were as follows: analysis of the factor structure by maximum likelihood extraction (MLE), internal consistency, and construct validity by confirmatory factor analysis (CFA). RESULTS The factor structure was one-dimensional. ULFI-Sp showed a high internal consistency for the total score (α = 0.916) and the regression score obtained from MLE (α = 0.996). CFA revealed a poor fit, and a new 14-item model (short version) was further tested. The developed short version of the ULFI-SP is preferable to assess upper limb function in Spanish BCS. CONCLUSIONS Given the high prevalence of ULD in this population and the broader versions of ULFI across different languages, this study's results may be transferred to clinical practice and integrated as part of upper limb assessment after breast cancer.
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Affiliation(s)
- Jaime Martín-Martín
- Legal and Forensic Medicine Area, Department of Human Anatomy, Legal Medicine and History of Science, Faculty of Medicine, University of Malaga, 29010 Málaga, Spain
- Grupo Clinimetría en Fisioterapia (F-14), Instituto de Investigación Biomédica de Málaga (IBIMA), 29590 Málaga, Spain
| | - Bella Pajares-Hachero
- UGCI Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29590 Málaga, Spain
| | - Emilio Alba-Conejo
- UGCI Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29590 Málaga, Spain
| | - Nuria Ribelles
- UGCI Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29590 Málaga, Spain
| | - Antonio I. Cuesta-Vargas
- Grupo Clinimetría en Fisioterapia (F-14), Instituto de Investigación Biomédica de Málaga (IBIMA), 29590 Málaga, Spain
- Department Physiotherapy, Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain
- School of Clinical Science, Faculty of Health, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Cristina Roldán-Jiménez
- Grupo Clinimetría en Fisioterapia (F-14), Instituto de Investigación Biomédica de Málaga (IBIMA), 29590 Málaga, Spain
- Department Physiotherapy, Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain
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Roldán-Jiménez C, Martín-Martín J, Pajares B, Ribelles N, Alba E, Cuesta-Vargas AI. Factors associated with upper limb function in breast cancer survivors. PM R 2023; 15:151-156. [PMID: 34713595 DOI: 10.1002/pmrj.12731] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 09/24/2021] [Accepted: 10/25/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Breast cancer survivors may have side effects from treatment, such as impaired upper limb function after surgery, which may be affected by a range of factors. OBJECTIVE To analyze the association between upper limb function and strength, fear avoidance, and central sensitization symptoms among breast cancer survivors, and to explore how these variables are associated with upper limb function. DESIGN Validation cohort. SETTING Institutional practice at a public hospital. PATIENTS One hundred seventy-four breast cancer survivors who had been undergone surgery for a primary tumor. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Upper limb function was measured by the Upper Limb Functional Index (ULFI-Sp). Independent outcomes were: handgrip strength, which was measured using a Jamar dynamometer on the dominant side; fear avoidance, measured using the Fear-Avoidance Components Scale (FACS-Sp); and central sensitization symptoms, which were measured using the Central Sensitisation Inventory (CSI-Sp). A linear regression model explaining the ULFI-Sp results was constructed with the variables. RESULTS The regression model was significant (F = 46.826; p < .0001), and explained 45% of the variance of the ULFI values. All variables showed strong associations with upper limb function. CONCLUSIONS Greater upper limb function is associated with higher grip strength, lower fear-avoidance behavior and fewer central sensitization symptoms among breast cancer survivors. These variables explained 45% of the upper limb function in the regression model, and concur with earlier research showing that factors such as central sensitization symptoms and kinesiophobia negatively affect upper limb function in such patients. Clinicians should therefore take into account strength, fear avoidance, and central sensitization symptoms when considering interventions aimed at improving upper limb function among breast cancer survivors.
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Affiliation(s)
- Cristina Roldán-Jiménez
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Andalucía Tech., Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Grupo de Clinimetría (F-14), Málaga, Spain
| | - Jaime Martín-Martín
- Instituto de Investigación Biomédica de Málaga (IBIMA), Grupo de Clinimetría (F-14), Málaga, Spain.,Department of Human Anatomy, Legal Medicine and History of Science; Area of Legal Medicine, University of Málaga, Faculty of Medicine, Málaga, Spain
| | - Bella Pajares
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Nuria Ribelles
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Emilio Alba
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Antonio I Cuesta-Vargas
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Andalucía Tech., Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Grupo de Clinimetría (F-14), Málaga, Spain.,School of Clinical Science, Faculty of Health Science, Queensland University Technology, Brisbane, Queensland, Australia
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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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10
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Koehler L, Day A, Hunter D, Blaes A, Haddad T, Shanley R. Five-Year Cumulative Incidence of Axillary Web Syndrome and Comparison in Upper Extremity Movement, Function, Pain, and Lymphedema in Survivors of Breast Cancer With and Without Axillary Web Syndrome. Arch Phys Med Rehabil 2022; 103:1798-1806. [PMID: 35398047 PMCID: PMC9452471 DOI: 10.1016/j.apmr.2022.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/07/2022] [Accepted: 03/08/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the cumulative incidence and natural history of axillary web syndrome (AWS) and its related postoperative risk for physical impairments in a cohort of women followed for 5 years post breast cancer surgery. DESIGN Prospective, longitudinal study. SETTING Academic health center. PARTICIPANTS Women (N=36) with and without AWS after breast cancer surgery with sentinel node biopsy or axillary lymph node dissection. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participants were assessed for AWS, shoulder goniometric flexion and abduction range of motion, function (Disability of the Arm, Shoulder, and Hand), lymphedema (bioimpedance spectroscopy, girth measures, tissue dielectric constant), and pain (visual analog scale) at 2, 4, 12, and 78 weeks and 5 years after breast cancer surgery. Analysis of variance compared range of motion, function, lymphedema, and pain in women identified with AWS with those without AWS across visits. Univariate logistic regression assessed if AWS was a risk factor for physical impairment at 5 years. RESULTS The cumulative incidence of AWS was 57%. Fifty percent (14/28) of the women who completed all study visits had signs of AWS at 5 years. Abduction active range of motion was significantly lower in women with AWS at 2 and 4 weeks post surgery. AWS was identified as a risk factor for reduced shoulder motion at 5 years. Regardless of AWS, 75% of the women experienced 1 or more upper extremity physical impairments at 5 years, which is an increase from 66% at 78 weeks in the same cohort. CONCLUSIONS AWS is associated with reduced shoulder range of motion in the early postoperative time period, can persist for 5 years after breast cancer surgery, and increases the risk of long-term reduced shoulder range of motion. Long-term physical issues are apparent after breast cancer surgery regardless of AWS.
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Affiliation(s)
- Linda Koehler
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota; Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota; Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.
| | - Amanda Day
- Division of Physical Medicine and Rehabilitation, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - David Hunter
- Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Anne Blaes
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota; Hematology/Oncology, University of Minnesota, Minneapolis, Minnesota
| | - Tufia Haddad
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | - Ryan Shanley
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota; Clinical and Translational Science Institute, Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, Minnesota, United States
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11
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Güloğlu S, Özdemir Y, Basim P, Tolu S. YouTube English videos as a source of information on arm and shoulder exercise after breast cancer surgery. Eur J Cancer Care (Engl) 2022; 31:e13685. [PMID: 35970600 DOI: 10.1111/ecc.13685] [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: 11/25/2021] [Revised: 07/06/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To examine the reliability, quality and content of YouTube videos on exercises that can be performed after breast cancer (BC) surgery. METHODS Videos selected from YouTube using the search terms 'shoulder exercise and BC surgery', 'arm exercise and BC surgery' and 'physiotherapy/physical therapy and BC surgery' were categorised as useful or misleading by a surgeon and a physiotherapist. The videos were analysed using the 5-point DISCERN scale for reliability, the Global Quality Scale for quality and a 10-item scale for comprehensiveness. RESULTS Of the 180 videos initially analysed, 82 were included in the study, and 42 (51.2%) were classified as having misleading information and 40(48.8%) as having useful information. The reliability, quality and content scores of the videos containing useful information were higher (p < 0.001). Most of the videos in the useful information group (80%) were uploaded by universities/professional organisations/physicians/physiotherapists, while the majority of those in the misleading information group (47.6%) were uploaded by websites providing independent healthcare information. CONCLUSION YouTube can be an important instrument to protect patients from musculoskeletal system complications after BC treatment and improve existing complications. Universities, physicians and physiotherapists should be encouraged to prepare more videos containing full and accurate information on this subject.
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Affiliation(s)
- Selen Güloğlu
- Department of Physical Therapy and Rehabilitation, Institute of Health Sciences, Istanbul Medipol University, Beykoz/İstanbul, Turkey
| | - Yunus Özdemir
- Department of Physical Therapy and Rehabilitation, Institute of Health Sciences, Istanbul Medipol University, Beykoz/İstanbul, Turkey
| | - Pelin Basim
- Department of General Surgery, Faculty of Medicine, Istanbul Medipol University, Bağcılar/İstanbul, Turkey
| | - Sena Tolu
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Istanbul Medipol University, Bağcılar/İstanbul, Turkey
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12
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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: 10] [Impact Index Per Article: 3.3] [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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13
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Che Bakri NA, Kwasnicki RM, Dhillon K, Khan N, Ghandour O, Cairns A, Darzi A, Leff DR. Objective Assessment of Postoperative Morbidity After Breast Cancer Treatments with Wearable Activity Monitors: The "BRACELET" Study. Ann Surg Oncol 2021; 28:5597-5609. [PMID: 34309777 PMCID: PMC8312212 DOI: 10.1245/s10434-021-10458-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/21/2021] [Indexed: 12/14/2022]
Abstract
Background Current validated tools to measure upper limb dysfunction after breast cancer treatment, such as questionnaires, are prone to recall bias and do not enable comparisons between patients. This study aimed to test the feasibility of wearable activity monitors (WAMs) for achieving a continuous, objective assessment of functional recovery by measuring peri-operative physical activity (PA). Methods A prospective, single-center, non-randomized, observational study was conducted. Patients undergoing breast and axillary surgery were invited to wear WAMs on both wrists in the peri-operative period and then complete upper limb function (DASH) and quality-of-life (EQ-5D-5L) questionnaires. Statistical analyses were performed to determine the construct validity and concurrent validity of WAMs. Results The analysis included 39 patients with a mean age of 55 ± 13.2 years. Regain of function on the surgically treated side was observed to be an increase of arm activity as a percentage of preoperative levels, with the greatest increase observed between the postoperative days 1 and 2. The PA was significantly greater on the side not treated by surgery than on the surgically treated side after week 1 (mean PA, 75.8% vs. 62.3%; p < 0.0005) and week 2 (mean PA, 91.6% vs. 77.4%; p < 0.005). Subgroup analyses showed differences in recovery trends between different surgical procedures. Concurrent validity was demonstrated by a significant negative moderate correlation between the PA and DASH questionnaires (R = −0.506; p < 0.05). Conclusion This study demonstrated the feasibility and validity of WAMs to objectively measure postoperative recovery of upper limb function after breast surgery, providing a starting point for personalized rehabilitation through early detection of upper limb physical morbidity. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-021-10458-4.
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Affiliation(s)
- Nur Amalina Che Bakri
- Department of Surgery and Cancer, Imperial College London, London, UK. .,Academic Surgical Unit, Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK.
| | - Richard M Kwasnicki
- Department of Surgery and Cancer, Imperial College London, London, UK.,Academic Surgical Unit, Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK
| | - Kieran Dhillon
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Naairah Khan
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Omar Ghandour
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Alexander Cairns
- Academic Surgical Unit, Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London, UK.,Academic Surgical Unit, Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK
| | - Daniel R Leff
- Department of Surgery and Cancer, Imperial College London, London, UK.,Academic Surgical Unit, Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK
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14
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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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15
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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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16
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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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17
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Vidt ME, Potochny J, Dodge D, Green M, Sturgeon K, Kass R, Schmitz KH. The influence of mastectomy and reconstruction on residual upper limb function in breast cancer survivors. Breast Cancer Res Treat 2020; 182:531-541. [PMID: 32506338 DOI: 10.1007/s10549-020-05717-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/01/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE Breast cancer survivorship is common (90% of women survive 5 or more years), but many women are not able to return to full function and well-being after treatment due to functional limitations, persistent pain, and inability to perform daily activities. Since each surgical reconstructive option (e.g., autologous tissue flaps versus implants) can impact shoulder and arm function differently, it is important to understand how shoulder and upper limb strength, mobility, and function are influenced by the type of surgical intervention. Efforts can then focus on prehabiliation strategies to prevent the onset of limitations and on developing rehabilitation protocols that directly target shortcomings. METHODS The current paper presents a review summarizing how shoulder and upper limb function may be affected by surgical mastectomy and breast reconstruction. RESULTS Mastectomy and breast reconstruction with implants or autologous tissues present different functional outcomes for patients. Each surgical procedure is associated with unique sequelae derived from the tissues and procedures associated with each surgery. Characterizing the specific functional outcomes associated with each surgical approach will promote the development of targeted rehabilitation strategies that can be implemented into a multidisciplinary treatment planning pathway for breast cancer patients. CONCLUSIONS Surgical treatments for breast cancer, including mastectomy and breast reconstruction, can have negative effects. Focused efforts are needed to better understand treatment-specific effects so that targeted rehabilitation can be developed to improve patient function, QoL, and ability to return to work and life activities post-breast cancer.
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Affiliation(s)
- Meghan E Vidt
- Department of Biomedical Engineering, Pennsylvania State University, 331 Chemical and Biomedical Engineering Building, University Park, PA, 16802, USA. .,Department of Physical Medicine and Rehabilitation, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA.
| | - John Potochny
- Department of Plastic Surgery, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA
| | - Daleela Dodge
- Department of Surgery, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA.,Department of Humanities, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA
| | - Michael Green
- Department of Humanities, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA.,Department of Medicine, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA
| | - Kathleen Sturgeon
- Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA
| | - Rena Kass
- Department of Surgery, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA.,Department of Medicine, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA
| | - Kathryn H Schmitz
- Department of Physical Medicine and Rehabilitation, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA.,Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA
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18
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Zomkowski K, Wittkopf PG, Baungarten Hugen Back B, Bergmann A, Dias M, Sperandio FF. Pain characteristics and quality of life of breast cancer survivors that return and do not return to work: an exploratory cross-sectional study. Disabil Rehabil 2020; 43:3821-3826. [PMID: 32393077 DOI: 10.1080/09638288.2020.1759150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Purpose: the aim of this study is two-fold: 1) to explore the pain characteristics among breast cancer survivors that return to work and do not return to work; 2) to identify the factors associated with pain on the upper quadrant of the affected side.Materials and methods: Sixty-two breast cancer survivors were included. Quality of life was assessed using EORTC QLQ-C30 and QLQ-BR23. Pain characteristics were assessed with a body diagram and a numeric rating scale.Results: Thirty-five breast cancer survivors did not return to work. Ninety-one percent of women that did not return to work reported pain. The most frequent pain sites were the cervical spine and the axilla of the affected side. There were no significant differences in pain intensity between groups. The factors associated with pain on the upper quadrant of the affected side were perception of shoulder stiffness OR = 5.93 (1.38-44.87, 95%CI) and time since surgery of more than four years OR = 5.54 (1.36-20.97, 95% CI).Conclusions: Pain was highly prevalent among breast cancer survivors. Breast cancer survivors that returned to work presented better quality of life. Longer time since surgery and perception of shoulder stiffness were associated with pain on the upper quadrant of the affected side.Implications for rehabilitationPain is a major factor following breast cancer surgery preventing returning to work.This group reported more pain on the cervical spine and axilla of the affected side.Rehabilitation needs to focus specifically on pain management in order to improve quality of life.A multidisciplinary approach involving pain specialists and vocational support is recommended.
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Affiliation(s)
- Kamilla Zomkowski
- Physiotherapy Department, Universidade do Sul de Santa Catarina - UNISUL, Palhoça, Brazil
| | | | - Bruna Baungarten Hugen Back
- Physiotherapy Department, College of Health and Sport Science - CEFID, Santa Catarina State University - UDESC, Florianópolis, Brazil
| | - Anke Bergmann
- Molecular carcinogenesis program, National Cancer Institute - INCA, Rio de Janeiro, Brazil
| | - Mirella Dias
- Physiotherapy department, Oncology Research Center - CEPON, Florianópolis, Brazil
| | - Fabiana Flores Sperandio
- Physiotherapy Department, College of Health and Sport Science - CEFID, Santa Catarina State University - UDESC, Florianópolis, Brazil
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Akbas A, Dagmura H, Daldal E, Dasiran FM, Deveci H, Okan I. Association between Shoulder Range of Motion and Pain Catastrophizing Scale in Breast Cancer Patients after Surgery. Breast Care (Basel) 2020; 16:66-71. [PMID: 33716634 DOI: 10.1159/000506922] [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: 11/18/2019] [Accepted: 02/29/2020] [Indexed: 11/19/2022] Open
Abstract
Background Prolonged survival period as a result of early diagnosis and treatment in breast cancer has increased the importance of postoperative morbidities. The aim of the present study was to investigate the association of pain ca-tastrophizing with shoulder pain in patients with decreased shoulder range of motion in the postoperative period. Patients and Methods The present study included 53 patients who underwent surgery due to breast cancer. Patients who had bilateral mastectomy, distant metastases, cervical-cranial originated lesions, patients with problems involving one of the shoulders or upper extremities before the operation, and patients with cognitive impairment, heart failure, or low albumin levels (liver parenchyma disease or renal failure) were excluded. Shoulder range of motion was measured in the postoperative period, and two study groups were established: one with a limited shoulder range of motion level and the other with a normal level. Effects of pain catastrophizing and shoulder pain severity on shoulder range of motion limitation were compared between the two groups. Results The average age of 53 female patients who had breast surgery was 52.3 ± 10.5 years. In the group with limited shoulder range of motion, the median pain catastrophizing scale value was 27 (range 5-32) and the shoulder pain severity score was 4 (range 0-8), while in the group with normal shoulder range of motion these values were 11 (range 3-39) and 2 (range 0-6), respectively (p < 0.05). In addition, it was found that factors such as surgical treatment modality and postoperative radiotherapy did not significantly affect shoulder range of motion limitation. Conclusion Determining the pain catastrophizing scale of patients and controlling pain in the early postoperative period could have positive effects on shoulder range of motion.
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Affiliation(s)
- Ahmet Akbas
- Department of General Surgery, Surgical Oncology Center, Gaziosmanpaşa University School of Medicine, Tokat, Turkey
| | - Hasan Dagmura
- Department of General Surgery, Surgical Oncology Center, Gaziosmanpaşa University School of Medicine, Tokat, Turkey
| | - Emin Daldal
- Department of General Surgery, Tokat Gaziosmanpaşa University, Tokat, Turkey
| | | | - Hülya Deveci
- Department of Physical Therapy and Rehabilitation, Tokat Gaziosmanpaşa University, Tokat, Turkey
| | - Ismail Okan
- Department of General Surgery, Surgical Oncology Center, Gaziosmanpaşa University School of Medicine, Tokat, Turkey
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20
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Feyzioğlu Ö, Dinçer S, Akan A, Algun ZC. Is Xbox 360 Kinect-based virtual reality training as effective as standard physiotherapy in patients undergoing breast cancer surgery? Support Care Cancer 2020; 28:4295-4303. [PMID: 31907649 DOI: 10.1007/s00520-019-05287-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/26/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE Breast cancer surgery may be associated with pain and physical symptoms in the upper limbs. Functional impairment and pain-related avoidance of movement may further increase disability level. This study aimed to investigate the potential effects of early postoperative virtual reality (VR) therapy on pain, range of motion (ROM), muscle strength, functionality, and fear of movement. METHODS Forty women with breast cancer who had undergone unilateral mastectomy with axillary lymph node dissection and who were receiving adjuvant therapy were included in the study and randomly assigned to two groups: the Kinect-based rehabilitation group (KBRG) and the standardized physical therapy group (SPTG). The KBRG (n = 20) received VR therapy using Xbox Kinect-based games and the SPTG (n = 20) received standard physiotherapy. Study subjects were assessed at baseline and after the 6-week treatment. Outcome measures were pain (visual analogue scale), grip strength (dynamometer), functionality (disabilities of the arm shoulder and hand questionnaire), muscle strength (handheld dynamometer), ROM (digital goniometer), and fear of movement (Tampa kinesiophobia scale (TKS)). RESULTS Both groups detected significant changes in pain, ROM, muscle strength, grip strength, functionality, and TKS scores after the treatment (p < 0.01). Fear of movement was significantly improved in the KBRG and the SPTG displayed more improvement in functionality (p < 0.05). There were no differences in ROM, muscle strength, grip strength, and pain between the groups after the treatment (p > 0.05). CONCLUSION Kinect-based VR therapy resulted in significant outcomes that were comparable to those obtained under standard physiotherapy in the early postoperative phase in patients who had undergone breast cancer surgery. TRIAL REGISTRATION This study is registered at ClinicalTrials.gov ( ClinicalTrials.gov identifier: NCT03618433).
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Affiliation(s)
- Özlem Feyzioğlu
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey. .,Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey.
| | - Selvi Dinçer
- Department of Radiation Oncology, Ministry of Health Okmeydanı Research and Training Hospital, Istanbul, Turkey
| | - Arzu Akan
- Department of Breast and Endocrine Surgery, Ministry of Health Okmeydanı Research and Training Hospital, Istanbul, Turkey
| | - Zeliha Candan Algun
- Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Istanbul Medipol University, Istanbul, Turkey
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21
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Mechanical properties of the shoulder and pectoralis major in breast cancer patients undergoing breast-conserving surgery with axillary surgery and radiotherapy. Sci Rep 2019; 9:17737. [PMID: 31780712 PMCID: PMC6882786 DOI: 10.1038/s41598-019-54100-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/10/2019] [Indexed: 11/17/2022] Open
Abstract
Breast-conserving surgery (BCS) and radiotherapy reduce breast cancer recurrence but can cause functional deficits in breast cancer survivors. A cross-sectional study quantified the long-term pathophysiological impact of these treatments on biomechanical measures of shoulder stiffness and ultrasound shear wave elastography measures of the shear elastic modulus of the pectoralis major (PM). Nine node-positive patients treated with radiotherapy to the breast and regional nodes after BCS and axillary lymph node dissection (Group 1) were compared to nine node-negative patients treated with radiotherapy to the breast alone after BCS and sentinel node biopsy (Group 2) and nine healthy age-matched controls. The mean follow-up for Group 1 and Group 2 patients was 988 days and 754 days, respectively. Shoulder stiffness did not differ between the treatment groups and healthy controls (p = 0.23). The PM shear elastic modulus differed between groups (p = 0.002), with Group 1 patients exhibiting a stiffer PM than Group 2 patients (p < 0.001) and healthy controls (p = 0.027). The mean prescribed radiotherapy dose to the PM was significantly correlated with passive shear elastic modulus (p = 0.018). Breast cancer patients undergoing more extensive axillary surgery and nodal radiotherapy did not experience long-term functional deficits to shoulder integrity but did experience long-term mechanical changes of the PM.
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22
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Physical symptoms and components of labor tasks associated with upper limb disability among working breast cancer survivors. Breast Cancer 2019; 27:140-146. [DOI: 10.1007/s12282-019-01004-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
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Lovelace DL, McDaniel LR, Golden D. Long-Term Effects of Breast Cancer Surgery, Treatment, and Survivor Care. J Midwifery Womens Health 2019; 64:713-724. [PMID: 31322834 DOI: 10.1111/jmwh.13012] [Citation(s) in RCA: 166] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/11/2019] [Accepted: 03/27/2019] [Indexed: 01/13/2023]
Abstract
Women are increasingly surviving breast cancer, but up to 90% experience unexpected long-term sequelae as a result of treatment. Symptoms may include physical, functional, emotional, and psychosocial changes that can dramatically alter the quality of life for breast cancer survivors. Primary care clinicians, including midwives, are likely to care for these women and should be familiar with common symptoms, treatment, and best practices to avoid permanent dysfunction. A holistic approach to assessment, treatment, and referral as needed is the most effective strategy. Although women experience significant changes after breast cancer treatment, many fail to receive thorough assessment of their symptoms, education about interventions, and treatment options to optimize health promoting strategies. Disparities exist in treatment availability, options, and survivorship. Long-term physical changes include anatomic changes, chronic pain, phantom breast pain, axillary web syndrome, and lymphedema. In addition, women may have decreased strength, aerobic capacity, mobility, fatigue, and cognitive dysfunction. Emotional and psychosocial changes include depression, anxiety, fatigue, concerns about body image, and issues with sexuality. Treatment should be multifactorial based on thorough assessment of symptoms and can include medication, exercise, counseling, physical and occupational therapy, and alternative and complementary therapies. Primary care and gynecologic clinicians are well positioned to provide thorough evaluation, education, treatment, and referral for the most common sequelae of mastectomy and breast cancer treatments.
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24
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Chrischilles EA, Riley D, Letuchy E, Koehler L, Neuner J, Jernigan C, Gryzlak B, Segal N, McDowell B, Smith B, Sugg SL, Armer JM, Lizarraga IM. Upper extremity disability and quality of life after breast cancer treatment in the Greater Plains Collaborative clinical research network. Breast Cancer Res Treat 2019; 175:675-689. [PMID: 30852760 PMCID: PMC6534523 DOI: 10.1007/s10549-019-05184-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 02/20/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Chronic upper extremity disability (UED) is common after breast cancer treatment but under-identified and under-treated. Although UED has been linked to quality of life (QoL), the role of UED as mediator between contemporary treatment practices and QoL has not been quantified. This investigation describes UED in a contemporary sample of breast cancer patients and examines its relationship with personal and treatment factors and QoL. METHODS Eight hundred and thirty-three women diagnosed at eight medical institutions during 2013-2014 with microscopically confirmed ductal carcinoma in situ or invasive stage I-III breast cancer were surveyed an average of 22 months after diagnosis. UED was measured with a modified QuickDASH and QoL with the FACT-B. The questionnaire also collected treatments, sociodemographic information, comorbidity, body mass index, and a 3-item health literacy screener. RESULTS Women who received post-mastectomy radiation and chemotherapy experienced significantly worse UED and QoL. Women who had lower income, lower health literacy and prior diabetes, arthritis or shoulder diagnoses had worse UED. Patients with worse UED reported significantly worse QoL. Income and health literacy were independently associated with QoL after adjustment for UED but treatment and prior conditions were not, indicating mediation by UED. UED mediated 52-79% of the effect of mastectomy-based treatments on QoL as compared with unilateral mastectomy without radiation. UED and QoL did not differ by type of axillary surgery or post-mastectomy reconstruction. CONCLUSIONS A large portion of treatment effect on QoL is mediated by UED. Rehabilitation practices that prevent and alleviate UED are likely to improve QoL for breast cancer survivors.
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Affiliation(s)
- Elizabeth A Chrischilles
- University of Iowa College of Public Health, Iowa City, IA, USA.
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA.
- College of Public Health, University of Iowa, S424 CPHB, 145 N. Riverside Dr., Iowa City, IA, 52242-2007, USA.
| | - Danielle Riley
- University of Iowa College of Public Health, Iowa City, IA, USA
| | - Elena Letuchy
- University of Iowa College of Public Health, Iowa City, IA, USA
| | | | - Joan Neuner
- Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Brian Gryzlak
- University of Iowa College of Public Health, Iowa City, IA, USA
| | - Neil Segal
- University of Iowa College of Public Health, Iowa City, IA, USA
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Bradley McDowell
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA
| | - Brian Smith
- University of Iowa College of Public Health, Iowa City, IA, USA
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA
| | - Sonia L Sugg
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Jane M Armer
- University of Missouri Sinclair School of Nursing, Columbia, MO, USA
| | - Ingrid M Lizarraga
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
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25
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Tan C, Wilson CM. Clinical Outcomes After Physical Therapy Treatment for Secondary Lymphedema After Breast Cancer. Cureus 2019; 11:e4779. [PMID: 31367497 PMCID: PMC6666846 DOI: 10.7759/cureus.4779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Breast cancer is the most commonly diagnosed cancer in women and approximately 33% of survivors will develop lymphedema. Untreated lymphedema may be limb threatening or cause substantial functional limitations. The purpose of this case report is to detail the physical therapy (PT) management and outcomes for a patient with right upper extremity and breast lymphedema. The goal of this case report is to provide rehabilitation clinicians with an example of effective treatment management and the underlying treatment rationale. A 64-year-old female with stage 2A breast cancer underwent neoadjuvant chemotherapy, a lumpectomy with 18 lymph nodes removed, and radiation therapy. She subsequently developed secondary lymphedema of the right breast and upper extremity. Physical therapy interventions included instruction on a complete decongestive therapy program, which consists of manual lymphatic drainage and compression bandaging and exercises to improve shoulder range of motion (ROM), posture, and strength. As a result of PT, her right shoulder ROM and anthropometric measurements improved and the patient achieved independence with self-lymphatic massage and compression bandaging techniques to maintain these gains. This case report is unique as it details the clinical decision making required during a complex course of cancer care that necessitated adjustments to the PT plan of care for sustainable outcomes.
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Affiliation(s)
- Cynthia Tan
- Physical Therapy, Beaumont Health, Royal Oak, USA
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26
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Mafu TS, September AV, Shamley D. KDR inferred haplotype is associated with upper limb dysfunction in breast cancer survivors of mixed ancestry. Cancer Manag Res 2019; 11:3829-3845. [PMID: 31118800 PMCID: PMC6502440 DOI: 10.2147/cmar.s191969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/29/2019] [Indexed: 01/27/2023] Open
Abstract
Introduction: Shoulder pain and disability are well-documented sequelae of breast cancer treatment. Angiogenesis signaling may have a role in the development of shoulder pain or shoulder disability in breast cancer survivors. The aim of this study was to determine if polymorphisms in angiogenesis-related genes are associated with shoulder pain or disability following breast cancer treatment. Participants and methods: A cross-sectional study was conducted on 220 South African breast cancer survivors. The study aimed to evaluate associations between shoulder pain/disability and seven single nucleotide polymorphisms (SNPs) within five angiogenesis-associated genes: KDR (rs2305948 C>T; rs7667298 C>T), NOS3 (rs1549758 C>T), MMP2 (rs708269 A>T), THBS2 (rs9766678 A>G) and TIMP3 (rs5754312 T>A; rs715572 G>A). In addition, associations between shoulder pain/disability and inferred haplotypes for KDR and TIMP3 SNPs were evaluated. Participants were grouped into no–low and moderate–high shoulder pain/disability based on total pain/disability scores: ≤30 and >30, respectively using the shoulder pain and disability index (SPADI). Results: No independent associations with shoulder pain/disability categories were found for all SNPs. However, 1 inferred haplotype (KDR “TT”) differed significantly (P=0.014) between the shoulder disability categories. After adjusting for participants’ age, the differences in KDR inferred haplotype frequencies between shoulder disability categories became non-significant (P=0.052). Conclusion: Our findings provide a preliminary suggestion of a possible association between polymorphisms in genes involved in angiogenesis and the presence of moderate–high shoulder disability among South African breast cancer survivors. A larger prospective cohort study is currently being conducted by our group.
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Affiliation(s)
- Trevor S Mafu
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Alison V September
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Delva Shamley
- Clinical Research Centre, Faculty of Health Sciences, University of Cape Town, Rondebosch, South Africa
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27
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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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28
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The effect of preoperative exercise on upper extremity recovery following breast cancer surgery: a systematic review. Int J Rehabil Res 2018; 41:189-196. [PMID: 29683834 DOI: 10.1097/mrr.0000000000000288] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Prehabilitation benefits among patients undergoing various oncological surgeries have been demonstrated. However, the effects of presurgical exercise and fitness on postoperative ipsilateral upper extremity recovery outcomes in patients with breast cancer surgery are less evident. A systematic review was performed to assess the effects of preoperative exercise and fitness on postmastectomy recovery. Systematic literature search was performed in 12 electronic databases. Study eligibility was accessed using the PICOS (Participants, Interventions, Comparison, Outcome and Study Design) criteria. Six eligible studies were found: three cohort-control and three prospective observational studies. One randomized-controlled trial showed that prehabilitation was beneficial in shoulder range of motion (ROM) and upper extremity functional recovery. One cohort-control study demonstrated that preoperative exercises reduced postoperative pain without increasing the risk of developing a seroma. A prospective cohort study showed that preoperatively active individuals had a significantly better chance of feeling recovered physically at 3 weeks after surgery. Baseline ipsilateral grip strength, shoulder flexion, and abduction ROM were reliable predictors of shoulder flexion and abduction ROM and grip strength improvements at 1 month following breast cancer surgery. One study showed that preoperative conditioning alone without postoperative rehabilitation was insufficient to aid recovery. Implementing exercise program and optimizing preoperative fitness, especially shoulder ROM, before breast cancer surgery in conjunction with individualized rehabilitation program may benefit postmastectomy ipsilateral upper extremity recovery.
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29
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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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30
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Yang F, Zhao Z, Zhao N. Clinical implications of tumor necrosis factor receptor 2 in breast cancer. Oncol Lett 2017; 14:2393-2398. [PMID: 28789455 DOI: 10.3892/ol.2017.6410] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 03/03/2017] [Indexed: 11/05/2022] Open
Abstract
Tumor necrosis factor receptor 2 (TNFR2) is a member of the tumor necrosis factor receptor family. Its high expression and oncogenic roles have been reported in several types of tumors in previous years. However, the clinical implication of TNFR2 in breast cancer (BC) tissue (i.e., not soluble TNFR2 in blood or genetic variation of TNFR2) has not been reported. In the present study, TNFR2 expression was detected in BC tissue using immunohistochemistry and, to the best of our knowledge, it was confirmed for the first time that TNFR2 was positively associated with increased tumor size, advanced clinical stage and higher pathological grade. Survival analysis revealed that TNFR2 was positively associated with shorter overall survival (OS) time and disease-free survival (DFS) time. In addition, univariate regression analysis demonstrated that TNFR2 expression (P=0.045), tumor size (P<0.0001), clinical stage (P<0.0001), pathological grade (P=0.002), estrogen and progesterone receptor and human epidermal growth factor receptor 2 (HER2) triple-status (P=0.001) all had a significant impact on the OS rate of patients with BC. TNFR2 expression (P=0.017), age (P=0.011), menopausal status (P<0.0001), tumor size (P=0.016), clinical stage (P=0.005), pathological grade (P=0.002) and estrogen/progesterone receptor and HER2 triple-status (P=0.008) were all shown to significantly impact the DFS rate of patients with BC. Multivariate regression analysis showed that only clinical stage (P=0.024), estrogen and progesterone receptor status and HER2 status (P=0.009) had a significant impact on the OS rate of patients with BC, while TNFR2 expression (P=0.043) and menopausal status (P=0.033) were shown to significantly impact the DFS rate of patients with BC. These data indicated that TNFR2 may perform important roles in the progression and prognosis of BC. This enriches previous understanding about TNFR2 in BC.
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Affiliation(s)
- Fuqian Yang
- Department of Breast Surgery, Weifang People's Hospital, Weifang, Shandong 261041, P.R. China
| | - Zhonghua Zhao
- Department of Oncology, The Affiliated Hospital of Binzhou Medical College, Binzhou, Shandong 256600, P.R. China
| | - Nana Zhao
- Department of Medical Examination, Fangzi People's Hospital, Weifang, Shandong 261000, P.R. China
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De Groef A, Van Kampen M, Vervloesem N, De Geyter S, Christiaens MR, Neven P, Vos L, De Vrieze T, Geraerts I, Devoogdt N. Myofascial techniques have no additional beneficial effects to a standard physical therapy programme for upper limb pain after breast cancer surgery: a randomized controlled trial. Clin Rehabil 2017; 31:1625-1635. [DOI: 10.1177/0269215517708605] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- An De Groef
- Department of Rehabilitation Sciences, KU Leuven – University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Marijke Van Kampen
- Department of Rehabilitation Sciences, KU Leuven – University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Nele Vervloesem
- Department of Rehabilitation Sciences, KU Leuven – University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Sophie De Geyter
- Department of Rehabilitation Sciences, KU Leuven – University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Marie-Rose Christiaens
- Multidisciplinary Breast Center, University Hospitals Leuven, Leuven, Belgium
- Department of Surgical Oncology, KU Leuven – University of Leuven, Leuven, Belgium
| | - Patrick Neven
- Multidisciplinary Breast Center, University Hospitals Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Lore Vos
- Department of Rehabilitation Sciences, KU Leuven – University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Tessa De Vrieze
- Department of Rehabilitation Sciences, KU Leuven – University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Inge Geraerts
- Department of Rehabilitation Sciences, KU Leuven – University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven – University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, 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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