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Prognosis of the upper limb following surgery and radiation for breast cancer

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Abstract

The aim of this systematic review was to identify the prevalence and severity of upper limb problems following surgery and radiation for early breast cancer. Additionally, the independent prognostic contribution of radiation, type of breast surgery, type of axillary surgery, age and body mass index (BMI) was evaluated. Searches of electronic databases were conducted to identify articles that reported upper limb and quality of life outcomes after breast cancer surgery and external radiation. Eligible studies for prognosis were longitudinal in design, with ≥95% of patients treated by surgery and radiation that excluded the axilla. Cross-sectional studies were also included for identification of prognostic factors. Where possible, the contribution of independent prognostic factors was analyzed. The review identified 32 relevant studies. Shoulder restriction was reported in between <1% and 67% of participants, lymphedema was reported in between 0 and 34% of participants, shoulder/arm pain was reported in between 9 and 68% of participants and arm weakness was reported in between 9 and 28% of participants. Quality of life was high across studies. Irradiated patients had slightly increased odds of lymphedema (OR = 1.46, 95% CI 1.16–1.84) and shoulder restriction (OR = 1.67, 95% CI 0.98–2.86) compared with non-irradiated patients. For patients undergoing surgery and radiation for breast cancer, the prognosis is good in terms of the upper limb and quality of life. Radiation that excludes the axilla does not appear to be a strong prognostic indicator of adverse upper limb outcomes.

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Acknowledgement

TSL is a scholarship holder funded by the University of Sydney Postgraduate Award.

Author information

Authors and Affiliations

  1. Discipline of Physiotherapy, University of Sydney, PO Box 170, Lidcombe, NSW, 2141, Australia

    Teresa S. Lee, Sharon L. Kilbreath, Kathryn M. Refshauge & Robert D. Herbert

  2. Sydney Cancer Centre, Royal Prince Alfred Hospital, Missenden Rd., Camperdown, NSW, 2050, Australia

    Jane M. Beith

Authors
  1. Teresa S. Lee
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  2. Sharon L. Kilbreath
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  3. Kathryn M. Refshauge
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  4. Robert D. Herbert
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Corresponding author

Correspondence to Teresa S. Lee.

Appendix 1

Appendix 1

Search Strategy

  1. 1.

    epidemiological studies/

  2. 2.

    randomized controlled trials/

  3. 3.

    clinical trials/

  4. 4.

    exp evaluation studies/

  5. 5.

    exp case control studies/

  6. 6.

    exp cohort studies/

  7. 7.

    exp prospective studies/

  8. 8.

    exp “outcome assessment (health care)”/

  9. 9.

    exp prognosis/

  10. 10.

    exp follow-up/

  11. 11.

    longitudinal.mp

  12. 12.

    retrospective.mp

  13. 13.

    observational.mp

  14. 14.

    prognos$.mp

  15. 15.

    clinical course.mp

  16. 16.

    predict$.mp

  17. 17.

    outcome$.mp

  18. 18.

    control$.mp

  19. 19.

    random$.mp

  20. 20.

    cohort$.mp

  21. 21.

    or 1–20/

  22. 22.

    animal/ not human/

  23. 23.

    recurr$.mp

  24. 24.

    22 not 23

  25. 25.

    21 not 24

  26. 26.

    exp breast cancer/

  27. 27.

    (breast neoplasm or breast tumour or ductal carcinoma).mp

  28. 28.

    26 or 27

  29. 29.

    female not male

  30. 30.

    28 and 29

  31. 31.

    shoulder$.mp

  32. 32.

    glenohumer$.mp

  33. 33.

    humer$.mp

  34. 34.

    pector$.mp

  35. 35.

    (chest wall or upper limb or arm).mp

  36. 36.

    exp radiation/

  37. 37.

    (Xray or Radiation Therapy or Radiation Treatment or electron boost).mp

  38. 38.

    exp surgery/

  39. 39.

    (wide local excision or lumpectomy or mastectomy).mp

  40. 40.

    or/31–39

  41. 41.

    patient report$.mp

  42. 42.

    quality of life.mp

  43. 43.

    function$.mp

  44. 44.

    disability$.mp

  45. 45.

    range of motion.mp

  46. 46.

    movement$.mp

  47. 47.

    degree$.mp

  48. 48.

    stiff$.mp

  49. 49.

    tight$.mp

  50. 50.

    strength$.mp

  51. 51.

    weak$.mp

  52. 52.

    force$.mp

  53. 53.

    power$.mp

  54. 54.

    circumference$.mp

  55. 55.

    (lymphoedema or lymphedema or swelling).mp

  56. 56.

    pain$.mp

  57. 57.

    discomfort.mp

  58. 58.

    or/41–57

  59. 59.

    25 and 30 and 40 and 58

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Lee, T.S., Kilbreath, S.L., Refshauge, K.M. et al. Prognosis of the upper limb following surgery and radiation for breast cancer. Breast Cancer Res Treat 110, 19–37 (2008). https://doi.org/10.1007/s10549-007-9710-9

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  • DOI: https://doi.org/10.1007/s10549-007-9710-9

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