Barriers to rehabilitation following surgery for primary breast cancer. J Surg Oncol

Mayo Clinic, Rochester, Minnesota, USA.
Journal of Surgical Oncology (Impact Factor: 3.24). 04/2007; 95(5):409-18. DOI: 10.1002/jso.20782
Source: PubMed


Surgery is a mainstay of primary breast cancer therapy. Alterations in surgical technique have reduced normal tissue injury, yet pain and functional compromise continue to occur following treatment. A tenuous evidence base bolstered by considerable expert opinion suggests that early intervention with conventional rehabilitative modalities can reduce surgery-associated pain and dysfunction. Barriers to the timely rehabilitation of functionally morbid sequelae are discussed at length in this article. Barriers arise from a wide range of academic, human, logistic, and financial sources. Despite obstacles, expeditious and effective post-surgical rehabilitation is being regularly delivered to breast cancer patients at many institutions. This experience has given rise to anecdotal information on the management of common sequelae that may undermine function. The epidemiology, pathophysiology, and management of these sequelae are outlined in this article with an emphasis on the caliber of supporting evidence. Myofascial dysfunction, axillary web syndrome, frozen shoulder, lymphostasis, post-mastectomy syndrome, and donor site morbidity following breast reconstruction are addressed. A critical need for more definitive evidence to guide patient management characterizes the current treatment algorithms for surgical sequelae.

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    • "The high incidence rate along with relatively favorable survival rate makes the quality of survival important.1 Especially, breast cancer patients with shoulder and arm pain have significantly decreased quality of life compared to women without breast cancer, as well as breast cancer patients who do not have shoulder and arm pain.2 Different diagnoses, such as rotator cuff disease, myofascial trigger point (MTrP), adhesive capsulitis, axillary web syndrome, and lateral epicondylitis have been used to describe shoulder and arm pain among breast cancer patients.3,4 "
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    ABSTRACT: To investigate the therapeutic effectiveness of ultrasound (US)-guided trigger point injection for myofascial trigger points (MTrPs) in the internal rotator muscles of the shoulder in post-mastectomy patients. This pilot study was a non-controlled, prospective, clinical trial. Nineteen post-mastectomy patients with a diagnosis of at least one active MTrP in the subscapularis and/or pectoralis muscles were included. We performed trigger point injections into the subscapularis muscle deep behind the scapula as well as the pectoralis muscle for diagnostic and therapeutic purpose by the newly developed US-guided method. Visual analogue scale and range of motion of the shoulder for external rotation and of abduction showed significant improvement immediately after the first injection and 3 months after the last injection compared with baseline (p<0.05 for both). Duration from onset to surgery and duration of myofascial pain syndrome in the good responder group were significantly shorter than in the bad responder group (p<0.05). Patients did not report any complications related to the procedure or serious adverse events attributable to the treatment. In post-mastectomy patients with shoulder pain, US-guided trigger point injections of the subscapularis and/or pectoralis muscles are effective for both diagnosis and treatment when the cause of shoulder pain is suspected to originate from active MTrPs in these muscles, particularly, the subscapularis.
    Yonsei medical journal 05/2014; 55(3):792-9. DOI:10.3349/ymj.2014.55.3.792 · 1.29 Impact Factor
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    • "Pathogenesis mechanisms have been proposed, such as endocrine, immunological, and inflammatory processes4. In addition, thyroid diseases, diabetes mellitus, Dupuytren contractures, breast cancer treatment, and autoimmune diseases have been associated with adhesive capsulitis in previous studies56789. Furthermore, patients diagnosed with myocardial infarctions and cerebral vascular diseases are reportedly at risk of adhesive capsulitis1011. "
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    ABSTRACT: The purpose of this study was to investigate the prevalence and risk of adhesive capsulitis among hyperthyroidism patients. The data were obtained from the Longitudinal Health Insurance Database 2005 (LHID 2005) in Taiwan, using 1 million participants and a prospective population-based 7-year cohort study of survival analysis. The ambulatory-care claim records of patients diagnosed according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes relating to hyperthyroidism between January 1, 2004 and December 31, 2007, were obtained. The prevalence and the adjusted hazard ratio (HR) of adhesive capsulitis among hyperthyroid patients and the control group were estimated. Of 4472 hyperthyroid patients, 162 (671/100,000 person-years) experienced adhesive capsulitis during the 24,122 person-year follow-up period. The crude HR of stroke was 1.26 (95% confidence interval [CI], 1.06 to 1.49), which was larger than that of the control group. The adjusted HR of developing adhesive capsulitis was 1.22 (95% CI, 1.03 to 1.45) for hyperthyroid patients during the 7-year follow-up period, which achieved statistical significance. The results of our large-scale longitudinal population-based study indicated that hyperthyroidism is an independent risk factor of developing adhesive capsulitis.
    Scientific Reports 02/2014; 4:4183. DOI:10.1038/srep04183 · 5.58 Impact Factor
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    • "Therefore, the factors influencing the use of rehabilitation among survivors of breast cancer do not include age, income, location, or occupation/identity. In the first few years after diagnosis, patients with breast cancer must spend a considerable amount of time caring for their wounds and receiving radiotherapy or chemotherapy [21]. Other problems, such as post-treatment fatigue and psychosocial disturbance also interfere with the survivor’s ability to seek rehabilitation services [8]. "
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    ABSTRACT: Breast cancer is the most common malignancy in women. Along with improvements in treatment, the number of women who survive breast cancer has increased. Rehabilitation can alleviate post-treatment side effects and maintain quality of life. This study aimed to explore the use of rehabilitation among a cohort of patients diagnosed with breast cancer. A retrospective longitudinal cohort study was conducted using a National Health Insurance (NHI) research database in Taiwan. The study cohort consisted of 632 patients with breast cancer diagnosed in 2005. Their NHI claims over a period spanning 2005 through 2009 were analyzed. Overall, 39.6% of the cohort received rehabilitation therapy, with 9,691 rehabilitation visits claimed (an average of 38.8 visits per user). The prevalence of rehabilitation service use among the cohort was 16.5%, 13.3%, 13.0%, 13.3%, and 12.8% in the years 2005 through 2009, respectively. The average number of visits per rehabilitation user was 16.8, 25.0, 31.1, 24.2, and 23.8 in the years 2005 through 2009, respectively. Most rehabilitation therapy occurred as an outpatient service (96.0%). Physical therapy was the most commonly used form of rehabilitation (84.2%), followed by occupational therapy (15.4%). The most frequently recorded diagnoses were malignant neoplasm of the female breast, peripheral enthesopathies and allied syndromes, and osteoarthrosis and allied disorders. Only a small proportion of patients with breast cancer received rehabilitation therapy in the first five years after diagnosis. The average number of rehabilitation visits per user peaked in the third year after diagnosis.
    BMC Health Services Research 08/2012; 12(1):282. DOI:10.1186/1472-6963-12-282 · 1.71 Impact Factor
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