Effects of phase I complex decongestive physiotherapy on physical functions and depression levels in breast cancer related lymph edema

Combined Complete Decongestive Therapy Reduces Volume and Improves Quality of Life and Functional Status in Patients With Breast Cancer-Related Lymphedema

BACKGROUND

The aim of this study was to evaluate the effects of complete decongestive therapy (CDT) in patients with breast cancer-related lymphedema (BCRL), in regard to volume reduction, functional status and quality of life (QoL).

METHODS

Fifty patients with unilateral BCRL were included. The demographic variables focusing on lymphedema were recorded. All patients received combined phase 1 CDT including skin-care, manual lymphatic drainage, multilayer bandaging and supervised exercises, 5 times a week for 3 weeks, as a total of 15 sessions. Patients were assessed by limb volumes and excess volumes according to geometric approximation derived from serial circumference-measurements of the limb, prior and at the end of third week. The functional disability was evaluated by quick disability of arm, shoulder and hand questionnaire (Q-DASH). QoL was assessed by the European Organization for Research and Treatment of Cancer Core Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its breast-cancer-module (EORTC QLQ-BR23).

RESULTS

Fifty females with mean age of 53.22 ± 11.2 years were included. The median duration of lymphedema was 12 months. There were 22 patients in stage1, 26 in stage2 and 2 patients in stage3. The mean baseline limb and excess volumes were significantly decreased at the end of therapies (3262 ± 753 cm³ vs. 2943 ± 646.6 cm³ and 31.36% ± 16.5% vs. 19.12% ± 10.4%, pP= 0.000 respectively). The Q-DASH and EORTC QLQ-C30 and BR23 scores were also decreased significantly (pP< 0.05). The improvements in volumes were related negatively with the duration of lymphedema, and the stage of lymphedema.

CONCLUSION

In conclusion phase 1 CDT in a combined manner performed daily for 3 weeks, greatly reduces the volumes as well as improves the disability and QoL, especially when performed earlier.

Proprioceptive neuromuscular facilitation in the functionality and lymphatic circulation of the upper limb of women undergoing breast cancer treatment

BACKGROUND

With the increase in survival of women treated for breast cancer, it is necessary to evaluate the effect of therapeutic resources on co-morbidities resulting from the surgical treatment of the disease. The aim of this study was to evaluate the effects of proprioceptive neuromuscular facilitation on the functionality and lymphatic circulation of the upper limb involved in the treatment of breast cancer.

METHODS

The study was conducted according to randomized clinical trial design. Thirty-two women at a mean age of 52.20 (±8.32) years, submitted to breast cancer treatment, divided into two groups, control - women submitted to standard breast cancer treatment, and treated group, composed of women who underwent breast cancer treatment and rehabilitation with the proprioceptive neuromuscular facilitation technique. Palmar grip strength with dynamometer and shoulder range of motion with goniometer were evaluated. Lymphatic circulation analysis was performed in a computerized scintillation chamber, before and after therapeutic intervention.

FINDINGS

In the results obtained, a significant increase (p < 0.05) of palmar grip strength was observed, a significant increase in range of motion of flexion (p < 0.001), extension (p < 0.0012), abduction (p < 0.0001), external rotation (p < 0.0001), internal rotation (p < 0.0001), and not significant for lymphatic flow (p > 0.05).

INTERPRETATION

The results obtained in this study allow us to conclude that proprioceptive neuromuscular facilitation favors an increase in muscle strength, range of motion, but not in lymphatic flow, in women undergoing surgical treatment for breast cancer.

Psychosocial Issues Associated with Breast Cancer-Related Lymphedema: a Literature Review

PURPOSE OF REVIEW

Breast cancer-related lymphedema (BCRL) is a chronic disease affecting breast cancer survivors. The purpose of this article is to update the scientific literature regarding psychosocial issues associated with BCRL.

RECENT FINDINGS

Reports describe economic burdens, social support, sexuality, BCRL patient-education needs, and interventions to reduce BCRL symptoms and improve QOL among women with breast cancer. The psychosocial impact of BCRL may differ between younger and older women which has implications for age-related interventions to reduce the adverse psychosocial experiences of women with BCRL. We did not locate studies reporting the psychosocial impact of BCRL on male breast cancer survivors.

SUMMARY

More psychosocial-based interventions are needed that target the concerns of those with BCRL, including age-related needs, sexual concerns, body image, and social support. Future research is indicated to study the psychosocial impact of BCRL among men. Researchers may consider how pandemic-driven health care policies affect the psychosocial needs of those with BCRL.

The effectiveness of physiotherapy interventions on pain and quality of life in adults with persistent post-surgical pain compared to usual care: A systematic review

Background

Persistent post-surgical pain (PPSP) is a common condition following surgery, resulting in persistent pain and reduced quality of life (QoL). While pharmacological management is common, its effectiveness remains equivocal. This systematic review investigated the effectiveness of physiotherapy management in adults with PPSP in comparison to usual care.

Methods

A systematic search of six electronic databases was conducted. Studies of human adults (>18 years) with PPSP localised or directly referred from the surgical site, pain persisting for at least two months post-surgery and with physiotherapy as the intervention were included. This review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The McMaster critical review form for quantitative studies was utilised to assess the methodological quality. A descriptive synthesis was undertaken due to the heterogeneity of the included studies.

Results

Of the 1395 articles that were screened, eight studies met the inclusion criteria. A diverse range of physiotherapy interventions were utilised, and effectiveness was measured through diverse outcomes and measures. Summarised findings from the heterogenous evidence base indicated that physiotherapy interventions for PPSP has a positive impact across a range of outcomes, including pain, quality of life (QoL), physical function and depression. While these are encouraging findings, the current evidence base lacks uniformity with regards to participant characteristics, time periods since diagnosis, interventions delivered, and its parameters, and outcomes measured.

Conclusion

Due to ongoing challenges in the management of PPSP, alternate treatment strategies such as physiotherapy are being trialled. Despite a number of methodological constraints, current evidence indicates that physiotherapy could play a role in the management of PPSP.

PROSPERO registration

CRD42019129580

Factors associated with depression symptoms in women after breast cancer

OBJECTIVE:

To analyze the factors associated with the presence of depression symptoms in women after breast cancer.

METHODS:

Cross-sectional study with 181 women with breast cancer, aged 57.0 years (SD = 9.5), who were undergoing treatment or after treatment in the Oncology Research Center in Florianópolis, state of Santa Catarina, Brazil. The questionnaire comprised items addressing general and health information, economic level, anthropometric measures, depression symptoms (Beck Depression Inventory), self-esteem (Rosenberg Self-Esteem Scale), and body image (Body Image After Breast Cancer Questionnaire). Descriptive and inferential statistical analysis were performed by chi-square and Fisher's exact tests to verify association, Mann-Whitney U test to compare the groups and Poisson regression to identify the prevalence ratio of the factors associated with presence of depression symptoms (p < 0.05).

RESULTS:

We found an association between the presence of depression symptoms and the group of younger women (aged 40–60 years), those who had another disease besides cancer, those who had mastectomy surgery, those who suffered from lymphedema, and those who presented low–medium self-esteem. Less educated women presented more depressive symptoms, as did women with worse body image on the subscales of limitations, transparency, and arm concerns.

CONCLUSIONS:

Age, educational attainment, diagnosis of other diseases, type of surgery, lymphedema, self-esteem, and body image were factors associated with the presence of depression symptoms in Brazilian women after breast cancer. Health professionals should be aware of these relationships and try to detect depression symptoms earlier and improve the care they provide to these women.

[The feasibility of the early application of the means for the physical rehabilitation with a view to improvement of life quality in the women presenting with postmastectomy syndrome]

BACKGROUND

the problem of rehabilitation and improvement of the life quality of women with the postmastectomy syndrome holds an important place in the modern concept of the treatment of breast cancer.

AIM

The objective of the present study was to determine the purposefulness of the early application of the available means and methods of physical rehabilitation for the improvement of the life quality in the women presenting with postmastectomy syndrome.

PATIENTS AND METHODS

The study included 135 women with the postmastectomy syndrome who had undergone radical mastectomy as described by Madden followed by postoperative radiotherapy. Fifty women were examined and treated as in-patients whereas the remaining 85 ones were out-patients under regular medical check-up The average age of the treated patients was 60.27±0.79 years. The in-patients were randomly subdivided into two groups: the main one (n=25) and the group of comparison (n=25). At the stage of dispensary observations, the women were also allocated to two groups: the first (n=45) and the second main groups (n=40), depending on the choice of the personality-oriented program for physical rehabilitation. The analysis of the quality of life was carried out in the beginning of the out-patient rehabilitation treatment, then within 6 and 12 months after its initiation making use of the standardized Functional Assessment of Cancer Therapy (FACT-B + 4) questionnaire.

RESULTS AND DISCUSSION

The benefits of the early physical rehabilitation of the in-patients first became apparent within six months after the onset of training as follows from the significantly better performance of the physical, social, emotional functions estimated taking into consideration the subscales of breast cancer and hand disorders in the women comprising the main group of the patients in comparison with those in the first and second main groups: the difference amounted to 2.34 (p<0.05), 1,88 (р<0.01), 2,52 (р<0.001), 3,52 (р<0.001) and 4,09 (р<0.001) points respectively. In a year, only the improvement of the social and emotional state persisted.

CONCLUSION

The proposed personality-oriented program of physical rehabilitation can be used in the clinical practice of the relevant specialized departments for the improvement of the quality of life of the women presenting with postmastectomy syndrome.

Effects of complex decongestive therapy on quality of life, depression, neuropathic pain, and fatigue in women with breast cancer-related lymphedema

Objectives

To investigate the effects of complex decongestive therapy (CDT) on the quality of life, depression, neuropathic pain, and fatigue in patients with breast cancer-related lymphedema (BCRL).

Patients and methods

Between March 2015 and June 2015, a total number of 60 patients (mean age 55.7±10.3 years; range 18 to 85 years) with BCRL were included in the study. Demographic data and previous medical records were recruited from medical files. The European Organization for Research and Treatment of Cancer Quality of Life- C30 (EORTC QLQ-C30) for the quality of life, the Brief Fatigue Inventory (BFI) for fatigue, Douleur Neuropathique 4 Questions (DN4) for neuropathic pain, and the Beck Depression Inventory (BDI) for the emotional status were used before and after the treatment. All patients received 20 sessions (one hour) of CDT for four weeks (five days per week).

Results

There was a statistically significant reduction in the volume of the involved limbs after the treatment (p<0.001). There was also a significant reduction in the general health and functional scores of the EORTC QLQ-C30 (p<0.001, p=0.004, respectively). The DN4, BFI, and BDI scores were significantly improved after the treatment (p<0.001, p=0.043, p=0.019, respectively).

Conclusion

Our study results suggest that CDT is an effective and safe method to achieve not only a significant volume reduction in the limbs involved by lymphedema, but also good outcomes in the management of other symptoms related to BCRL.

Accessory Joint and Neural Mobilizations for Shoulder Range of Motion Restriction After Breast Cancer Surgery: A Pilot Randomized Clinical Trial

OBJECTIVE

The aim of this study was to assess the methods to conduct a substantive clinical trial to evaluate the effects of accessory joint mobilization (AJM) vs neural mobilization (NM) techniques for shoulder motion restriction after breast cancer surgery.

METHODS

This pilot study was a prospective randomized and double-blind clinical trial in which 18 women who underwent unilateral breast cancer surgery and axillary lymph node dissection participated. The study was conducted at the Women's Health Research Group at the Physical Therapy Department of Alcalá University, Madrid, Spain. The intervention was AJM vs NM, with a 6-month follow-up. Primary outcomes included recruitment, adherence to treatment and retention rates, assessment procedures, and implementation of the 2 manual therapy techniques. Secondary outcomes included range of motion, sensory disturbance, pain, and upper limb functionality.

RESULTS

All participants accepted to be randomly assigned to study groups. One hundred percent retention was attained with all participants attending the 3-month and 6-month assessments. Adherence with treatment attendance was excellent. At 6-month follow-up, flexion range of motion had a mean change of 38.4° (±28.9) (P = .002) in the AJM group and a mean change of 36.8° (±21.8) (P = .002) in the NM group. Abduction range of motion had a median change of 52.4° (±43.6) (P = .004) in AJM group and a median change of 44° (±17.5) (P = .012).

CONCLUSIONS

These preliminary results of the effects of AJM and NM techniques in breast cancer survivors indicate that a full clinical trial will be worthwhile. The research methods tested and the modifications proposed within this pilot study offer a suitable foundation to conduct a substantive clinical trial.

Comparison between the treatment area of electrode used for radiofrequency ablation of liver cancer focusing on 15G cooled-tip and CWT electrode

Objectives:

To analyze the comparison between the treatment area of 15Gage internally cooled electrodes and 17 Gage Cool Wet-tip(CWT) electrodes. They are manufactured to broaden treatment area of the tumor in the radiofrequency ablation of hepatocellular carcinoma(HCC).

Methods:

The study was designed for 62 patients with a mean age of 61, ranging from 44 to 87 years. The sample comprised of patients who used 15 G internally cooled electrodes and 17 G CWT electrodes respectively. Computed tomography (CT) images obtained after the procedure were observed, however, for the ablation lesion, the volume was determined by measuring complete necrotic tissue that did not contrast enhancement in the image.

Results:

The treatment area of the tumor after radiofrequency ablation was 17.26±6.02 in the CWT, which was bigger than 15G. The treatment area ratio of the treatment before or after was significant at 581.85±339.56 in the CWT. After radiofrequency ablation, the treatment area got bigger, as 15G electrodes went toward CWT electrodes. Treatment area per electrode was 1.34 times higher in CWT than in 15G while the treatment area ratio of the treatment before or after was 1.001 times higher in the CWT than 15G.

Conclusions:

Ablation is more common for the safety margin in stable tumor and CWT type electrodes that can make larger ablation to reduce the number of times ablation is required for residual tumor and it decreases recurrence, ablation time and reoperation. Therefore it is considered t useful to reduce patients’ pain.