Shoulder disability and late symptoms following surgery for early breast cancer

Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark.
Acta oncologica (Stockholm, Sweden) (Impact Factor: 3). 02/2008; 47(4):569-75. DOI: 10.1080/02841860801986627
Source: PubMed


Axillary dissection in combination with radiation therapy is thought to be the main reason why patients surgically treated for breast cancer may develop decreased shoulder mobility on the operated side. The surgery performed on the breast has not been ascribed any considerable importance. In order to evaluate the influence of the surgical technique and the adjuvant oncological therapy on the development of shoulder morbidity, we assessed the physical disability in 132 breast cancer patients with a median follow-up time of 3 years after surgery.
Eighty nine (67%) patients had been subjected to modified radical mastectomy and 43 (33%) to breast conserving therapy (BCT). All patients had axillary dissection of level I and II. The shoulder function was assessed by the Constant Shoulder Score including both subjective parameters on pain and ability to perform the normal tasks of daily living, and objective parameters assessing active range of motion and muscle strength.
Shoulder disability seems to be a frequent late complication to the treatment of early breast cancer (35%). When equal axillary dissection and radiation therapy had been applied, BCT patients were found to suffer less frequent from this complication than patients treated with mastectomy.

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    • "This impairment reduces quality of life (QoL) and increases the prevalence of conditions associated with an unhealthy lifestyle (for example, decreased aerobic capacity and strength, weight gain, and fatigue) [8]. The reduction of range of movement in the neck/shoulder complex and chronic pain in the neck/shoulder complex are the most prevalent musculoskeletal dysfunction associated with oncology treatment [9,10]. "
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    ABSTRACT: Breast cancer survivors suffer physical impairment after oncology treatment. This impairment reduces quality of life (QoL) and increase the prevalence of handicaps associated to unhealthy lifestyle (for example, decreased aerobic capacity and strength, weight gain, and fatigue). Recent work has shown that exercise adapted to individual characteristics of patients is related to improved overall and disease-free survival. Nowadays, technological support using telerehabilitation systems is a promising strategy with great advantage of a quick and efficient contact with the health professional. It is not known the role of telerehabilitation through therapeutic exercise as a support tool to implement an active lifestyle which has been shown as an effective resource to improve fitness and reduce musculoskeletal disorders of these women.Methods / Design: This study will use a two-arm, assessor blinded, parallel randomized controlled trial design. People will be eligible if: their diagnosis is of stages I, II, or IIIA breast cancer; they are without chronic disease or orthopedic issues that would interfere with ability to participate in a physical activity program; they had access to the Internet and basic knowledge of computer use or living with a relative who has this knowledge; they had completed adjuvant therapy except for hormone therapy and not have a history of cancer recurrence; and they have an interest in improving lifestyle. Participants will be randomized into e-CUIDATE or usual care groups. E-CUIDATE give participants access to a range of contents: planning exercise arranged in series with breathing exercises, mobility, strength, and stretching. All of these exercises will be assigned to women in the telerehabilitation group according to perceived needs. The control group will be asked to maintain their usual routine. Study endpoints will be assessed after 8 weeks (immediate effects) and after 6 months. The primary outcome will be QoL measured by The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 version 3.0 and breast module called The European Organization for Research and Treatment of Cancer Breast Cancer-Specific Quality of Life questionnaire. The secondary outcomes: pain (algometry, Visual Analogue Scale, Brief Pain Inventory short form); body composition; physical measurement (abdominal test, handgrip strength, back muscle strength, and multiple sit-to-stand test); cardiorespiratory fitness (International Fitness Scale, 6-minute walk test, International Physical Activity Questionnaire-Short Form); fatigue (Piper Fatigue Scale and Borg Fatigue Scale); anxiety and depression (Hospital Anxiety and Depression Scale); cognitive function (Trail Making Test and Auditory Consonant Trigram); accelerometry; lymphedema; and anthropometric perimeters. This study investigates the feasibility and effectiveness of a telerehabilitation system during adjuvant treatment of patients with breast cancer. If this treatment option is effective, telehealth systems could offer a choice of supportive care to cancer patients during the survivorship phase.Trial registration: Identifier: NCT01801527URL:
    Trials 06/2013; 14(1):187. DOI:10.1186/1745-6215-14-187 · 1.73 Impact Factor
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    • "It is well known that pain has a strong influence on both physical and mental QoL in BCSs [4]. Lauridsen et al. reported that BCSs with impaired shoulder mobility had significantly higher frequency of pain in shoulder, arm or neck compared to BCSs with normal shoulder function [28]. Although not an aim in our study, we confirmed these results on the self-rated data both in 2004 and 2007, but we also found such differences at both time points in BCSs with self-rated lymphedema. "
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    ABSTRACT: This cross-sectional and longitudinal study of breast cancer survivors (BCSs) examines the associations between arm/shoulder problems (ASPs), which consist of pain, restricted mobility and lymphedema, and different aspects of quality of life (QoL). BCSs who had breast surgery, axillary lymph node dissection and radiotherapy (n = 255) were examined in 2004 (mean 4.1 years post-surgery) and a sub-sample (n = 187) was re-examined in 2007. ASPs was rated clinically in 2004 and by self-report (EORTC BR23) in 2004 and 2007. QoL was self-reported with The Short Form-36 (SF-36) and The Impact of Cancer scale (IOC). In 2004 BCSs with ASPs showed significantly poorer mean scores in most SF-36 domains compared to those without. No group differences were observed for positive IOC domains, while BCSs with ASPs showed significantly poorer mean scores in the negative ones. BCSs with clinically defined movement restriction showed significantly poorer SF-36 and negative IOC mean scores than those with clinically defined lymphedema. The longitudinal sub-study of self-rated pain, restricted mobility and lymphedema showed significant changes over time only for negative IOC domains in the pain group. Self-rated restricted mobility and lymphedema were significantly associated with most SF-36 domains both in 2004 and 2007, while few were associated with pain. Self-rated pain and restricted mobility showed significant associations with negative IOC domains. Not only lymphedema, but pain and restricted mobility in the arm/shoulder are significantly associated with poor QoL in BCSs at long-term. These problems should be diagnosed and treated in order to improve QoL.
    Journal of Cancer Survivorship 10/2010; 5(1):62-72. DOI:10.1007/s11764-010-0156-4 · 3.30 Impact Factor
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    ABSTRACT: Le cancer du sein est la forme de cancer la plus souvent diagnostiquée chez les femmes. Elles doivent vivre avec des séquelles qui nuisent à leur qualité de vie. Plusieurs études ont montré les bienfaits de l’activité physique (AP) sur les composantes physiques et psychologiques des patientes. Toutefois, elles réduisent souvent leur pratique d'AP suite aux traitements en raison de la détérioration de leur condition physique. Or, le maintien à long terme de la pratique d’AP est essentiel pour en conserver les bénéfices. La première section du mémoire présente une recension des écrits sur les bienfaits de l’AP auprès des femmes atteintes d'un cancer du sein et la seconde rend compte d'une étude expérimentale ayant pour objectif d'évaluer l’impact d’un programme d’AP sur le sentiment d’efficacité personnel et sur le plaisir associé à la pratique d'AP. Une enquête de suivi a été menée trois mois après la fin du programme afin d’évaluer le maintien à long terme de la pratique d'AP. L'étude a été réalisée auprès de 18 patientes en cours de traitement. Le groupe expérimental a suivi un programme supervisé d’AP combiné à des séances de counseling sur une période de 16 semaines. Le groupe témoin avait la possibilité de suivre un programme de yoga. Nos résultats indiquent une amélioration statistiquement significative des trois composantes mesurées, soit le sentiment d'efficacité personnelle, le plaisir à faire de l'AP et le maintien de la pratique après la participation au programme. Breast cancer is the most common type of cancer in women. They have to live with the negative impacts of the disease on their quality of life. Many studies have shown that exercise benefits women with breast cancer in several ways, including improved quality of life. However, women reduce their physical activity levels following the treatment due to the relative deterioration of their physical condition. To keep the benefits of participation in an exercise program, breast cancer patients need to maintain their physical activity involvement. The first part of this thesis presents a literature review of the physical activity benefits among women with breast cancer, and the second part assesses the impact of a circuit training and counseling program on exercise self-efficacy and physical activity enjoyment as well as the level of physical activity involvement at 3-month follow-up. Eighteen women undergoing treatment participated in this study. The experimental group followed a 16-week supervised circuit training and counseling program. The control group was offered yoga lessons. The results showed statistically significant improvements on the three patient-rated outcomes. The results showed that a supervised circuit training program combined with counseling enhances exercise self-efficacy. This suggests that it can be a promising program to maintain physical activity involvement.
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