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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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Ahmad F, Raja BS, Kaganur R. Clinical outcomes in surgically indicated scapular fracture patients managed with conservative means: a case series. Quant Imaging Med Surg 2024; 14:6200-6201. [PMID: 39144057 PMCID: PMC11320526 DOI: 10.21037/qims-23-1408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/05/2023] [Indexed: 08/16/2024]
Affiliation(s)
- Fazal Ahmad
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, India
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Patna, India
| | | | - Raghavendra Kaganur
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Patna, India
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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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Zhang X, Wang C, Fan J, Murakami S, Xie H, Huo M. The Factors Influencing Shoulder Mobility Disorders in Patients after Radical Breast Cancer Surgery: A Cross-Sectional Study. Breast Care (Basel) 2024; 19:43-48. [PMID: 38384491 PMCID: PMC10878701 DOI: 10.1159/000535063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 11/06/2023] [Indexed: 02/23/2024] Open
Abstract
Introduction This study is a cross-sectional study that investigated the factors influencing shoulder mobility in terms of pain, grip strength, and supraspinatus muscle thickness in patients with impaired shoulder mobility during chemotherapy after radical breast cancer surgery. Methods This study included 165 female patients with unilateral breast cancer who had shoulder joint mobility disorders during chemotherapy within 3 months after surgery. The clinical examination included the maximum active range of motion of the shoulder (flexion, extension, abduction, adduction, external rotation, and internal rotation), pain score (visual analog scale [VAS]), grip strength, and supraspinatus muscle thickness. Results During shoulder abduction, supraspinatus muscle thickness was greatest at 90°, lowest at 0°, and higher at 60° than at 30° (p < 0.01). The factors influencing the active movement of shoulder flexion were the VAS score, body weight, grip strength, and supraspinatus contraction rate (R2 = 0.295), while the factors influencing active shoulder abduction were the VAS score, body weight, grip strength, supraspinatus muscle thickness (drooping position), and supraspinatus contraction rate (R2 = 0.295). Moreover, the factors influencing the active movement of shoulder external rotation were age, VAS score, body weight, grip strength, and supraspinatus muscle thickness (drooping position) (R2 = 0.258). There were no significant results from multiple linear regressions for shoulder extension, adduction, or internal rotation. Conclusion Pain, weight, grip strength, supraspinatus muscle thickness, and supraspinatus distensibility are the main factors affecting shoulder flexion, abduction, and external rotation. In addition, supraspinatus muscle thickness and contraction rate may be a new index for assessing shoulder dysfunction.
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Affiliation(s)
- Xin Zhang
- Beijing Chaoyang District Sanhuan Cancer Hospital, Beijing, China
| | - Chao Wang
- Beijing Chaoyang District Sanhuan Cancer Hospital, Beijing, China
| | - Jialin Fan
- Beijing Chaoyang District Sanhuan Cancer Hospital, Beijing, China
| | | | - Hualong Xie
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Ming Huo
- Beijing Chaoyang District Sanhuan Cancer Hospital, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, China
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Park JS, Jin US. Improvement of Shoulder Motion in Two-Stage Dual-Plane Implant-Based Breast Reconstruction followed by Radiation Therapy through Delayed Prepectoral Conversion. Arch Plast Surg 2024; 51:52-61. [PMID: 38425848 PMCID: PMC10901588 DOI: 10.1055/s-0043-1775591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/04/2023] [Indexed: 03/02/2024] Open
Abstract
Background Although prepectoral implant-based breast reconstruction has recently gained popularity, dual-plane reconstruction is still a better option for patients with poor-quality mastectomy skin flaps. However, shoulder morbidity is aggravated by subpectoral reconstruction, especially in irradiated patients. This study aimed to demonstrate shoulder exercise improvement in subpectoral reconstruction by delayed prepectoral conversion with an acellular dermal matrix (ADM) inlay graft technique at the time of expander-to-implant exchange after irradiation. Methods Patients with breast cancer treated for expander-to-implant exchange after subpectoral expander insertion and subsequent radiotherapy between January 2021 and June 2022 were enrolled. An ADM inlay graft was inserted between the pectoralis major muscle and the previously inserted ADM. The ADM was sutured partially overlapping the pectoralis muscle from the medial side with the transition part, to the muscle border at the lateral side. Perioperative shoulder joint active range-of-motion (ROM) for forward flexion, abduction, and external rotation was also evaluated. Results A total of 35 patients were enrolled in the study. Active shoulder ROM significantly improved from 163 degrees preoperatively to 176 degrees postoperatively in forward flexion, 153 to 175 degrees in abduction, and 69 to 84 degrees in external rotation. There was no difference in patient satisfaction regarding the final outcome between the conventional prepectoral reconstruction group and the study group. Conclusion Shoulder exercises in irradiated patients who underwent subpectoral reconstruction were improved by delayed prepectoral conversion using an ADM inlay graft. It is recommended that subpectoral reconstruction not be ruled out due to concerns regarding muscle contracture and shoulder morbidity in radiation-planned patients with poor mastectomy skin flaps.
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Affiliation(s)
- Jin Sol Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ung Sik Jin
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Che Bakri NA, Kwasnicki RM, Khan N, Ghandour O, Lee A, Grant Y, Dawidziuk A, Darzi A, Ashrafian H, Leff DR. Impact of Axillary Lymph Node Dissection and Sentinel Lymph Node Biopsy on Upper Limb Morbidity in Breast Cancer Patients: A Systematic Review and Meta-Analysis. Ann Surg 2023; 277:572-580. [PMID: 35946806 PMCID: PMC9994843 DOI: 10.1097/sla.0000000000005671] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the impact of axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB) on upper limb (UL) morbidity in breast cancer patients. BACKGROUND Axillary de-escalation is motivated by a desire to reduce harm of ALND. Understanding the impact of axillary surgery and disparities in operative procedures on postoperative arm morbidity would better direct resources to the point of need and cement the need for de-escalation strategies. METHODS Embase, MEDLINE, CINAHL, and PsychINFO were searched from 1990 until March 2020. Included studies were randomized-controlled and observational studies focusing on UL morbidities, in breast surgery patients. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The prevalence of UL morbidity comparing SLNB and ALND at <12 months, 12 to 24 months, and beyond 24 months were analyzed. RESULTS Sixty-seven studies were included. All studies reported a higher rate of lymphedema and pain after ALND compared with SLNB. The difference in lymphedema and pain prevalence between SLNB and ALND was 13.7% (95% confidence interval: 10.5-16.8, P <0.005) and 24.2% (95% confidence interval: 12.1-36.3, P <0.005), respectively. Pooled estimates for prevalence of reduced strength and range of motion after SLNB and ALND were 15.2% versus 30.9% and 17.1% versus 29.8%, respectively. Type of axillary surgery, greater body mass index, and radiotherapy were some of the predictors for UL morbidities. CONCLUSIONS Prevalence of lymphedema after ALND was higher than previously estimated. ALND patients experienced greater rates of lymphedema, pain, reduced strength, and range of motion compared with SLNB. The findings support the continued drive to de-escalate axillary surgery.
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Affiliation(s)
- Nur Amalina Che Bakri
- Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, St. Mary’s Hospital, London, UK
| | - Richard M. Kwasnicki
- Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, St. Mary’s Hospital, 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
| | - Alice Lee
- Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, St. Mary’s Hospital, London, UK
| | - Yasmin Grant
- Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, St. Mary’s Hospital, London, UK
| | | | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, St. Mary’s Hospital, London, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, St. Mary’s Hospital, London, UK
| | - Daniel R. Leff
- Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, St. Mary’s Hospital, London, UK
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Ryu J, Lee EY, Min J, Yeon S, Lee JW, Chu SH, Lee H, Kim SI, Kim JY, Park S, Jeon JY. Effect of a 1-year tailored exercise program according to cancer trajectories in patients with breast cancer: study protocol for a randomized controlled trial. BMC Cancer 2023; 23:200. [PMID: 36864418 PMCID: PMC9983270 DOI: 10.1186/s12885-023-10664-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/20/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Patients with breast cancer undergo various treatments according to their tumor subtype and cancer stages within 1 year after being diagnosed. Each treatment may cause treatment-related symptoms that have negative impacts on patients' health and quality of life (QoL) The symptoms can be mitigated when exercise interventions are appropriately applied to patients' physical and mental conditions. Although many exercise programs were developed and implemented during this period, the effects of tailored exercise programs according to symptoms and cancer trajectories on patients' long-term health outcomes have not yet been fully elucidated. Therefore, this randomized controlled trial (RCT) aims to investigate the effect of tailored home-based exercise programs on short-term and long-term physiological outcomes in patients with breast cancer. METHODS This 12-month RCT includes 96 patients with (stages 1-3) breast cancer randomly assigned to the exercise or control groups. Participants in the exercise group will receive an exercise program tailored to their phase of treatment, type of surgery, and physical function. During post-operative recovery, exercise interventions will be emphasized to improve shoulder range of motion (ROM) and strength. During chemoradiation therapy, exercise intervention will focus on improving physical function and preventing loss of muscle mass. Once chemoradiation therapy is completed, exercise intervention will focus on improving cardiopulmonary fitness and insulin resistance. All interventions will be home-based exercise programs supplemented with once-monthly exercise education and counseling sessions. The main outcome of the study is fasting insulin level at baseline, 6 months, and 1 year post-intervention. Our secondary outcomes include shoulder ROM and strength at 1 month and 3 months, body composition, inflammatory markers, microbiome, QoL, and physical activity levels at 1 month, 6 months, and 1 year post-intervention. CONCLUSION This trial is the first tailored home-based exercise oncology trial to better understand the comprehensive phase-dependent short- and long-term effects of exercise on shoulder function, body composition, fasting insulin, biomarkers, and microbiome. The results of this study will inform the development of effective exercise programs tailored to the needs of patients with breast cancer post-operatively. TRIAL REGISTRATION The protocol for this study is registered with the Korean Clinical Trials Registry (KCT0007853).
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Affiliation(s)
- Jiin Ryu
- grid.15444.300000 0004 0470 5454Department of Sport Industry Studies, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722 Republic of Korea
| | - Eun-Young Lee
- grid.410356.50000 0004 1936 8331School of Kinesiology & Health Studies, Queen’s University, Kingston, ON Canada
| | - Jihee Min
- grid.410914.90000 0004 0628 9810National Cancer Survivorship Center, National Cancer Center, Goyang, Republic of Korea
| | - Sujin Yeon
- grid.15444.300000 0004 0470 5454Department of Sport Industry Studies, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722 Republic of Korea
| | - Ji-Won Lee
- grid.15444.300000 0004 0470 5454Department of Family Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hui Chu
- grid.15444.300000 0004 0470 5454Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Korea
| | - Hyangkyu Lee
- grid.15444.300000 0004 0470 5454Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Korea
| | - Seung Il Kim
- grid.15444.300000 0004 0470 5454Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Jee Ye Kim
- grid.15444.300000 0004 0470 5454Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Seho Park
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.
| | - Justin Y. Jeon
- grid.15444.300000 0004 0470 5454Department of Sport Industry Studies, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722 Republic of Korea ,grid.15444.300000 0004 0470 5454Exercise Medicine Center for Diabetes and Cancer Patients, ICONS, Yonsei University, Seoul, Republic of Korea ,grid.15444.300000 0004 0470 5454Cancer Prevention Center, Shinchon Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University, Seoul, Republic of Korea
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Min J, Yeon S, Ryu J, Kim JY, Yang EJ, Kim SI, Park S, Jeon JY. Shoulder function and health outcomes in newly diagnosed breast cancer patients receiving surgery: a prospective study. Clin Breast Cancer 2023; 23:e247-e258. [PMID: 36990840 DOI: 10.1016/j.clbc.2023.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Breast cancer surgery is associated with upper-body morbidities that may last several years postsurgery. Research has not determined if the type of surgery leads to differential effects on shoulder function, activity levels, and QoL during the early rehabilitation period. The main objective of this study is to examine changes in shoulder function, health, and fitness outcomes from the day before to surgery to 6 months postsurgery. PATIENTS AND METHODS We recruited breast cancer patients (N = 70) scheduled to receive breast cancer surgery at Severance Hospital in Seoul to participate in this prospective study. Shoulder range of motion (ROM) and upper body strength, the disabilities of Arm, Shoulder, and Hand (quick-DASH), body composition, physical activity levels, and QoL were measured at baseline (presurgery) and then weekly for 4 weeks, and at 3 months and 6 months postsurgery. RESULTS During 6 months after surgery, shoulder ROM was reduced only affected arm while shoulder strength was significantly declined in both affected and unaffected arms. Within 4 weeks postsurgery, patients who underwent total mastectomy were significantly less recovered than patients with partial mastectomy in ROM of flexion (P < .05) and abduction (P < .05). However, shoulder strength of both arms observed no interaction between surgical type and time. We observed significant changes in body composition, quick-DASH score, physical activity levels, and QoL from presurgery to 6-months postsurgery. CONCLUSIONS Shoulder function, activity levels, and QoL improved significantly from surgery to 6-months postsurgery. Surgery type influenced changes in shoulder ROM.
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Bertoli J, Bezerra EDS, Winters-Stone KM, Alberto Gobbo L, Freitas IF. Mat Pilates improves lower and upper body strength and flexibility in breast cancer survivors undergoing hormone therapy: a randomized controlled trial (HAPiMat study). Disabil Rehabil 2023; 45:494-503. [PMID: 35107399 DOI: 10.1080/09638288.2022.2032410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To evaluate the effects of 24 weeks of Mat Pilates in breast cancer survivors (BCS) undergoing hormone therapy on lower and upper body muscle strength parameters and flexibility. MATERIALS AND METHODS Forty-three BCS (≥40 years) with confirmed breast cancer stage 0-III undergoing hormone therapy were included. Participants were randomized into Mat Pilates (three times/week, 60 min session) or control group (relaxation activities every two weeks). The difficulty and number of exercise repetitions were increased over the weeks. Assessments were performed at three times points (baseline, 12 weeks, and 24 weeks). The generalized estimating equations (GEE) model was used to compare each outcome measure during the analysis of intention to treat (ITT) and "Per protocol analysis" (PPA). RESULTS The Pilates group presented significantly increased (p < 0.05) isometric flexor-extensor PT, and concentric and eccentric flexor PT and mechanical work (MW) after the intervention. Most of the upper body strength parameters, time to achieve maximal force (TFmax), maximal force (Fmax), and rapid force index (RFI) and right-left upper and lower body flexibility (p < 0.05) also improved. CONCLUSIONS From our findings, we conclude that 24 and 12-weeks of Mat Pilates induced strength and flexibility gains for lower and upper body, respectively.Implications for rehabilitationMat Pilates can be adapted to the fitness level of breast cancer survivors, with a great variety of exercises that can be performed using a mat only or a few pieces of equipment.Patients can practice at home to gain different health benefits (i.e., increasing strength, flexibility, and functional capacity level), which could positively impact on quality of life.Mat Pilates performed three times per week with systematized increments in exercise level, load, and volume throughout the intervention was effective to improve hip extensor-flexor muscles peak torque and mechanical work at different muscle contractions, as well as upper and lower body flexibility.Mat Pilates was also able to improve right-left shoulder abductor and trunk extensor muscles strength parameters after 12 weeks of intervention, as well as both surgery and non-surgery sides of the upper body.
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Affiliation(s)
- Josefina Bertoli
- Faculdade de Ciência e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, Brazil
| | | | - Kerri M Winters-Stone
- School of Nursing, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Luis Alberto Gobbo
- Faculdade de Ciência e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, Brazil
| | - Ismael Forte Freitas
- Faculdade de Ciência e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, Brazil
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Effects of Ultrasound-Guided Injection Combined with a Targeted Therapeutic Exercise in Breast Cancer Women with Subacromial Pain Syndrome: A Randomized Clinical Study. J Pers Med 2022; 12:jpm12111833. [PMID: 36579554 PMCID: PMC9697338 DOI: 10.3390/jpm12111833] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/01/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
In this randomized controlled study, we aimed to assess the effects of US-guided injections of the subacromial bursa followed by a personalized rehabilitation program for breast cancer (BC) survivors. We assessed patients with subacromial pain syndrome without tendon lesions and with a history of post-surgical non-metastatic BC. Thirty-seven patients were enrolled and randomly assigned 1:1 to receive US-guided corticosteroid injections combined with a personalized rehabilitation program (Group A; n: 19) or US-guided corticosteroid injections alone (Group B; n: 18). The primary outcome was pain relief, assessed using a numerical pain rating scale (NPRS). The secondary outcomes were muscle strength, shoulder function, and quality of life. No major or minor late effects were reported after the multidisciplinary intervention. Statistically significant within-group differences were found in terms of NPRS (p ≤ 0.05) in both groups. No significant between-group differences were reported after one week. However, the between-group analysis showed significant differences (p ≤ 0.05) after three months of follow-up in terms of pain intensity, muscle strength, shoulder function, and quality of life. Our findings suggested positive effects of a multidisciplinary approach including US-guided corticosteroid injections combined with a personalized rehabilitation program in improving pain intensity and quality of life of BC survivors with subacromial pain syndrome.
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Incidence, risk factors, prevention and treatment of postmastectomy pain syndrome in breast cancer: A multicenter study. Int J Surg 2022; 106:106937. [PMID: 36152923 DOI: 10.1016/j.ijsu.2022.106937] [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: 06/22/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Postmastectomy pain syndrome (PMPS) is a common postoperative condition after breast cancer surgery. PURPOSE The aim of this study was to investigate the incidence rate and risk factors of PMPS, and to propose prevention and treatment methods. METHODS The study included 1790 postoperative breast cancer patients from three hospitals from 2017 to 2021, of which 302 (13.0%) patients with PMPS were included in the study. RESULTS Age, breast surgery type, axillary surgery type and radiotherapy are the risk factors of PMPS. Age, radiotherapy and chemotherapy affect the pain degree of PMPS during movement. CONCLUSIONS For breast cancer patients with high risk factors, pain should be actively prevented during perioperative period. Oral pharmacological agents, multidisciplinary combination therapy, local anesthetics and regional anesthesia are the most common treatment of PMPS.
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Differences in the Glenohumeral Joint before and after Unilateral Breast Cancer Surgery: Motion Capture Analysis. Healthcare (Basel) 2022; 10:healthcare10040707. [PMID: 35455884 PMCID: PMC9030468 DOI: 10.3390/healthcare10040707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 11/24/2022] Open
Abstract
After mastectomy, women might lose mobility and develop kinematic changes in the shoulder. The objective of this research was to compare the kinematics of the glenohumeral joint in women, before and after unilateral breast cancer surgery. This was a longitudinal study with a pre- and post-evaluation design; in total, 15 Mexican women who had a mastectomy for breast cancer and who received a physical therapy program after surgery were evaluated. Flexion–extension and abduction–adduction movements of the glenohumeral joint were evaluated (15 days before and 60 days after mastectomy). For the kinematic analysis of the glenohumeral joint, an optoelectronic motion capture system was used to monitor 41 reflective markers located in anatomical landmarks. There was no significant difference in the range of motion of the glenohumeral joint when comparing pre- and post-mastectomy, flexion–extension (p = 0.138), and abduction–adduction (p = 0.058). Furthermore, patients who received chemotherapy (53%) before mastectomy were more affected (lower range of motion) than those who did not receive it. There were no significant differences in the kinematics of the glenohumeral joint after mastectomy in this group of patients who received a physical therapy program after surgery. Moreover, patients who received chemotherapy treatment before breast cancer surgery tended to have a lower range of motion than those who did not receive it. Therefore, it is necessary for the physical rehabilitation team to attend to these patients even before the mastectomy.
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