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Predictors of functional shoulder recovery at 1 and 12 months after breast cancer surgery

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Abstract

The objective of this study are (1) to determine if upper extremity function, as represented by shoulder ROM, self-reported symptoms and upper extremity functional limitations in activities of daily living could be predictively related to demographic and cancer characteristics post-surgery for breast cancer. And (2) to examine if variables related to early onset impairment contribute to late onset impairments in women after breast cancer surgery. Subjects were assessed preoperatively and 1, 3, 6, 9, and 12+ months post breast cancer surgery for impairments and symptoms and at 12+ months for shoulder functional limitations using a physical therapy surveillance model. Body weight, shoulder ROM, manual muscle testing, and upper limb volume were recorded. At 12+ months, the Harvard Alumni Health Study Physical Activity Questionnaire, and an Upper Limb Disability Questionnaire were administered. Symptoms and ROM impairments were compared by functional limitations. Characteristics significantly associated with early ROM impairment (but not later impairment) were axillary lymph node dissection, removal of ≥15 nodes, mastectomy surgery and stage II breast cancer. Positive nodes, older age, and BMI ≥ 25 were significantly associated with reduced shoulder ROM at 12+ months. At 12+ months, only 10 % of the patients experienced ROM impairments while rates of self-reported symptoms in the affected upper extremity at 12+ months were as follows: pain—49 %, weakness—47.1 %, numbness—55.9 %, feeling tired—42.5 %. The majority of patients used the affected upper extremity for reaching without limitation, but ≥35 % reported limitation with household chores, carrying and lifting. Difficulty carrying and lifting could be predicted by BMI ≥ 25 and use of the dominant affected upper limb. Different factors are associated with early versus later ROM loss. Symptoms reported by breast cancer survivors are frequently associated with functional limitations in upper extremity tasks and warrant intervention. Physical therapy using a prospective surveillance model of care may reduce severity of ROM loss, symptoms and functional upper extremity limitations 1 year after breast cancer surgery.

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References

  1. Devoogdt N, Van Kampen M, Christiaens MR et al (2009) Short-and long-term recovery of upper limb function after axillary lymph node dissection. Eur J Cancer Care 20:77–86

    Article  Google Scholar 

  2. Gosselink R, Rouffaer L, Vanhelden P et al (2003) Recovery of upper limb function after axillary dissection. J Surg Oncol 83:204–211

    Article  PubMed  Google Scholar 

  3. Gomide LB, Matheus PC, Candido dos Reis FJ (2007) Morbidity after breast cancer treatment and physiotherapeutic performance. Int J Clin Pract 61:972–982

    Article  PubMed  CAS  Google Scholar 

  4. Moskovitz AH, Anderson BO, Yeung RS (2001) Axillary web syndrome after axillary dissection. Am J Surg 181:434–439

    Article  PubMed  CAS  Google Scholar 

  5. Lauridsen MC, Overgaard M, Overgaard J et al (2008) Shoulder disability and late symptoms following surgery for early breast cancer. Acta Oncol 47:569–575

    Article  PubMed  Google Scholar 

  6. Gerber L, Lampert M, Wood C et al (1992) Comparison of pain, motion, and edema after modified radical mastectomy vs. local excision with axillary dissection and radiation. Breast Cancer Res Treat 21:139–145

    Article  PubMed  CAS  Google Scholar 

  7. Ernst M, Voogd A, Balder W et al (2002) Early and late morbidity associated with axillary levels I-III dissection in breast cancer. J Surg Oncol 79:151–155

    Article  PubMed  Google Scholar 

  8. Sclafani L, Baron RH (2008) Sentinel lymph node biopsy and axillary dissection: added morbidity of the arm, shoulder and chest wall after mastectomy and reconstruction. Cancer J 14:216–222

    Article  PubMed  Google Scholar 

  9. Ashikaga T, Krag D, Land S et al (2010) Morbidity results from the NSABP B-32 trial comparing sentinel lymph node dissection versus axillary dissection. J Surg Oncol 102:111–118

    Article  PubMed  Google Scholar 

  10. Lucci A, McCall LM, Beitsch PD et al (2007) Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011. J Clin Oncol 25:3657–3663

    Article  PubMed  Google Scholar 

  11. Purushotham AD, Upponi S, Klevesath MB et al (2005) Morbidity after sentinel lymph node biopsy in primary breast cancer. J Clin Oncol 23:4312–4321

    Article  PubMed  Google Scholar 

  12. Liu C, Guo Y, Shi J et al (2009) Late morbidity associated with tumour-negative sentinel lymph node biopsy in primary breast cancer patients: a systematic review. Eur J Cancer 45:1560–1568

    Article  PubMed  Google Scholar 

  13. Reitman JS, Geertzen JHB, Hoekstra HJ et al (2005) Long term treatment related upper limb morbidity and quality of life after sentinel lymph node biopsy for stage I or II breast cancer. EJSO 32:148–152

    Article  Google Scholar 

  14. Engel J, Kerr Schlesinger-Raab A et al (2003) Axillary surgery severely affects quality of life: results of a 5-year prospective study in breast cancer patients. Breast Cancer Res Treat 79:47–57

    Article  PubMed  Google Scholar 

  15. Yang EJ, Park WB, Seo KS et al (2010) Longitudinal change of treatment-related upper limb dysfunction and its impact on late dysfunction in breast cancer survivors: a prospective cohort study. J Surg Oncol 101:84–91

    Article  PubMed  Google Scholar 

  16. Sagen A, Karesen R, Sandvik L et al (2009) Changes in arm morbidities and health-related quality of life after breast cancer surgery—a five-year follow-up study. Acta Oncol 48:1111–1118

    Article  PubMed  Google Scholar 

  17. Loftus LS, Laronga C (2009) Evaluating patients with chronic pain after breast cancer: the search for relief. JAMA 302:2034–2035

    Article  PubMed  CAS  Google Scholar 

  18. Hack TF, Kwan WB, Thomas-MacLean RL et al (2010) Predictors of arm morbidity following breast cancer surgery. Psychooncology 19:1205–1212

    Article  PubMed  Google Scholar 

  19. Nesvold IL, Fossa S, Holm I et al (2010) Arm/shoulder problems in breast cancer survivors are associated with reduced health and poorer physical quality of life. Acta Oncol 49:347–353

    Article  PubMed  Google Scholar 

  20. Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Waldron W, Altekruse SF, Kosary CL, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Chen HS, Feuer EJ, Cronin KA, Edwards BK (eds) SEER Cancer Statistics Review, 1975–2008, National Cancer Institute. Bethesda, MD. http://seer.cancer.gov/csr/1975_2008/, based on November 2010 SEER data submission, posted to the SEER web site, 2011

  21. Box R, Reul-Hirche HM, Bullock-Saxton JE et al (2002) Shoulder movement after breast cancer surgery: results of a randomized controlled study of postoperative physiotherapy. Breast Cancer Res Treat 75:35–50

    Article  PubMed  Google Scholar 

  22. Lauridsen MC, Christiansen P, Hessov I (2005) The effect of physiotherapy on shoulder function in patients surgically treated for breast cancer: a randomized study. Acta Oncol 44:449–457

    Article  PubMed  Google Scholar 

  23. Beurskens C, van Uden CJ, Strobbe LJ (2007) The efficacy of physiotherapy upon shoulder function following axillary dissection in breast cancer, a randomized controlled study. BMC Cancer 7:166

    Article  PubMed  Google Scholar 

  24. Springer B, Levy E, McGarvey C (2010) Pre operative assessment enables early diagnosis and recovery of shoulder function in patients with breast cancer. Breast Cancer Res Treat 120:135–147

    Article  PubMed  Google Scholar 

  25. Brunelli C, Zecca E, Martini C et al (2010) Comparison of numerical and verbal pain ratings to measure pain exacerbations in patients with chronic cancer pain. Health Qual Life Outcomes 8:22

    Article  Google Scholar 

  26. Kendall F, McCreary E, Provance P (1993) Muscle testing and function, 4th edn. Williams and Wilkins, Baltimore

    Google Scholar 

  27. Lee IM, Paffenbarger RS Jr (2000) Associations of light, moderate, and vigorous intensity physical activity with longevity. The Harvard Alumni Health Study. Am J Epidemiol 151(3):293–299

    Article  PubMed  CAS  Google Scholar 

  28. Lee IM, Paffenbarger RS Jr (1996) How much physical activity is optimal for health? Methodological considerations. Res Q Exerc Sport 67(2):206–208

    PubMed  CAS  Google Scholar 

  29. Ainsworth BE, Leon AS, Richardson MT et al (1993) Accuracy of the college alumnus physical activity questionnaire. J Clin Epidemiol 46(12):1403–1411

    Article  PubMed  CAS  Google Scholar 

  30. Paffenbarger RS Jr, Blair SN, Lee IM, Hyde RT (1993) Measurement of physical activity to assess health effects in free-living populations. Med Sci Sports Exerc 25(1):60–70

    Article  PubMed  Google Scholar 

  31. Cauley J, LaPorte R, Sandler RB, Schramm M, Kriska A (1987) Comparisons of methods to measure physical activity in postmenopausal women. Am J Clin Nutr 45:14–22

    PubMed  CAS  Google Scholar 

  32. Gummesson C, Atroshi I, Ekdahl C (2003) The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord 4:11

    Article  PubMed  Google Scholar 

  33. Gummesson C, Ward MM, Atroshi I (2006) The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH. BMC Musculoskelet Disord 7:44

    Article  PubMed  Google Scholar 

  34. Motion Joint (1985) Method of measuring and recording. American Academy of Orthopedic Surgery, Chicago

    Google Scholar 

  35. Okunieff P, Augustine E, Hicks J et al (2004) Pentoxifylline in the treatment of radiation-induced fibrosis. J Clin Oncol 22:2207–2213

    Article  PubMed  CAS  Google Scholar 

  36. Albert US, Koller M, Kopp I et al (2006) Early self reported impairments in arm functioning of primary breast cancer patients predict late side effects of axillary lymph node dissection: results from a population-based cohort study. Breast Cancer Res Treat 100:285–292

    Article  PubMed  Google Scholar 

  37. Karki A, Simonen R, Malkia E, Selfe J (2005) Impairments, activity limitations and participation restrictions 6 and 12 months after breast cancer operation. J Rehabil Med 37:180–188

    PubMed  Google Scholar 

  38. Madsen AH, Haugaard K, Soerensen J et al (2008) Arm morbidity following sentinel lymph node biopsy or axillary lymph node dissection: a study from the Danish Breast Cancer Cooperative Group. Breast 17:138–147

    Article  Google Scholar 

  39. Leidenius M, Leppanen E, Krogerus L et al (2003) Motion restriction and axillary web syndrome after sentinel node biopsy and axillary clearance in breast cancer. Am J Surg 185:127–130

    Article  PubMed  Google Scholar 

  40. Hack T, Cohen L, Katz J et al (1999) Physical and psychological morbidity after axillary lymph node dissection for breast cancer. J Clin Oncol 17:143–149

    PubMed  CAS  Google Scholar 

  41. Temple LKF, Baron R, Cody HS et al (2002) Sensory morbidity after sentinel lymph node biopsy and axillary dissection: a prospective study of 233 women. Ann Surg Oncol 9:654–662

    Article  PubMed  Google Scholar 

  42. Bosompra K, Ashikaga T, O’Brien PJ et al (2002) Swelling, numbness, pain and their relationship to arm function among breast cancer survivors: a disablement process model perspective. Breast J 8:338–348

    Article  PubMed  Google Scholar 

  43. Gartner R, Jensen MB, Nielsen J et al (2009) Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA 302:1985–1992

    Article  PubMed  Google Scholar 

  44. Swisher A, Davison C, Aranda R et al (2010) Frequency and severity of self-reported upper extremity impairments, activity limitations, and participation restrictions following breast cancer treatment. Rehabil Oncol 28:3–9

    Google Scholar 

  45. Kootstra JJ, Hoekstra-Weebers JE, Rietman JS et al (2010) A longitudinal comparison of arm morbidity in stage I-II breast cancer patients with sentinel lymph node biopsy, sentinel lymph node biopsy followed by completion lymph node dissection or axillary lymph node dissection. Ann Surg Oncol 17:2384–2394

    Article  PubMed  Google Scholar 

  46. Helms G, Kuhn T, Moser L (2009) Shoulder-arm morbidity in patients with sentinel node biopsy and complete axillary dissection—data from a prospective randomised trial. Eur J Surg Oncol 35:696–701

    Article  PubMed  CAS  Google Scholar 

  47. Shamley DR, Srinanaganathan R, Weatherall R et al (2007) Changes in shoulder muscle size and activity following treatment for breast cancer. Breast Cancer Res Treat 1:19–27

    Article  Google Scholar 

  48. Shamley DR, Srinanaganathan R, Oskrochi R (2009) Three-dimensional scapulothoracic motion following treatment for breast cancer. Breast Cancer Res Treat 118:315–322

    Article  PubMed  Google Scholar 

  49. Crosbie J, Kilbreath SL, Dylke E (2010) Effects of mastectomy on shoulder and spinal kinematics during bilateral upper-limb movement. Phys Ther 90:679–692

    Article  PubMed  Google Scholar 

  50. Borstad JD, Szucs KA (2011) Three-dimensional scapula kinematics and shoulder function examined before and after surgical treatment for breast cancer. Hum Mov Sci. doi:10.1016/j.humov.2011.04.002

  51. Iannotti JP, Williams GR (eds) (2006) Disorders of the shoulder: diagnosis and management. Lippincott, Williams & Wilkins, Philadelphia

    Google Scholar 

  52. Smoot B, Wong J, Cooper B et al (2010) Upper extremity impairments in women with or without lymphedema following breast cancer treatment. J Cancer Surviv 4:167–178

    Article  PubMed  Google Scholar 

  53. Chachaj A, Malyszczak K, Pyszel K et al (2010) Physical and psychological impairments of women with upper limb lymphedema following breast cancer treatment. Psychooncology 19(3):299–305

    Article  PubMed  Google Scholar 

  54. Stout Gergich NL, Pfalzer LA, McGarvey C (2008) Preoperative assessment enables the early diagnosis and successful treatment of lymphedema. Cancer 112:2809–2819

    Article  PubMed  Google Scholar 

  55. Hodges P (2011) Pain and motor control: from the laboratory to rehabilitation. J Electromyogr Kinesiol 21(2):220–228

    Article  PubMed  Google Scholar 

  56. Devoogdt N, VanKampen M, Geraerts I (2010) Physical activity levels after treatment for breast cancer: one-year follow-up. Breast Cancer Res Treat 123:417–425

    Article  PubMed  Google Scholar 

  57. Hayes SC, Rye S, Battistutta D et al (2010) Upper-body morbidity following breast cancer treatment is common, may persist longer-term and adversely influences quality of life. Health Qual Life Outcomes 8:92

    Article  PubMed  Google Scholar 

  58. Lee T, Kilbreath SL, Refshauge KM et al (2008) Prognosis of the upper limb following surgery and radiation for breast cancer. Breast Cancer Res Treat 110:19–37

    Article  PubMed  Google Scholar 

  59. Gerber LH, Stout N, McGarvey C et al (2010) Factors predicting clinically significant fatigue in women following treatment for primary breast cancer. Support Care Cancer. doi:10.1007/s00520-010-0986-7

  60. Reinertsen KV, Cvancarova M, Loge JH et al (2010) Predictors and course of chronic fatigue in long-term breast cancer survivors. J Cancer Surviv 4:405–414

    Article  PubMed  Google Scholar 

  61. Wielgus KK, Berger AM, Hertzog M (2009) Predictors of fatigue 30 days after completing anthracycline plus taxane adjuvant chemotherapy for breast cancer. Oncol Nurs Forum 36:38–48

    Article  PubMed  Google Scholar 

  62. Popko K, Gorska E, Stelmaszczyk-Emmel A et al (2010) Proinflammatory cytokines IL-6 and TNF-α and the development of inflammation in obese subjects. Eur J Med Res 15(Suppl 2):120–122

    PubMed  Google Scholar 

  63. Mills PJ, Parker B, Dimsdale JE et al (2005) The relationship between fatigue and quality of life and inflammation during anthracycline-based chemotherapy in breast cancer. Biol Psychol 69:85–96

    Article  PubMed  Google Scholar 

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Acknowledgments

This research was supported by the Walter Reed National Military Medical Center at Bethesda, Breast Care Center (protocol NNMC #B01-052) and the Intramural Research Program of the NIH, Mark O. Hatfield Clinical Research Center, Rehabilitation Medicine Department, Physical Therapy Section (protocol NIH #02-CC-0044). The authors thank Violeta Gutierrez and Wendy Chen for their statistical contributions; and Leighton Chan and Ismail Jatoi for their support of this project.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Physical Therapy Section, Rehabilitation Medicine, National Institutes of Health, Hatfield Clinical Research Center, 10/1-1469, Rockville Pike, Bethesda, MD, 20892, USA

    Ellen W. Levy, Ching-yi Shieh & Alicia Morehead-Gee

  2. University of Michigan-Flint, Flint, MI, USA

    Lucinda A. Pfalzer

  3. George Washington University, Washington, DC, USA

    Jerome Danoff

  4. Project Hero, Ride 2 Recovery, Washington, DC, USA

    Barbara A. Springer

  5. CLM Consulting Services LLC, Rockville, MD, USA

    Charles McGarvey

  6. George Mason University, Fairfax, VA, USA

    Lynn H. Gerber

  7. Walter Reed National Military Medical Center at Bethesda, Bethesda, MD, USA

    Nicole L. Stout

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  1. Ellen W. Levy
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  2. Lucinda A. Pfalzer
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  3. Jerome Danoff
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  4. Barbara A. Springer
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Correspondence to Ellen W. Levy.

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Levy, E.W., Pfalzer, L.A., Danoff, J. et al. Predictors of functional shoulder recovery at 1 and 12 months after breast cancer surgery. Breast Cancer Res Treat 134, 315–324 (2012). https://doi.org/10.1007/s10549-012-2061-1

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  • DOI: https://doi.org/10.1007/s10549-012-2061-1

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