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Cording following treatment for breast cancer

Breast Cancer Research and Treatment volume 140, pages 105–111 (2013)Cite this article

Abstract

Treatment for breast cancer may result in the formation of palpable cords in the axillary region. Our aim was to evaluate cording incidence, risk factors, and association with upper extremity functional impairment and measured arm volume change. We included 308 patients with unilateral breast cancer prospectively screened for upper extremity lymphedema, symptoms and function. Patients were assessed pre- and post-operatively and at 3–8-month intervals with perometer arm measurements and the LEFT-BC questionnaire. Cording was determined by patient self-report. The cumulative incidence of cording and its association with clinicopathologic factors, upper extremity functional impairment, and measured arm volume change were analyzed. 31.5 % (97/308) of patients reported cording, with a cumulative incidence of 36.2 % at 24 months post-operative. Clinicopathologic factors significantly associated with cording by multivariate analysis included axillary lymph node dissection (p < 0.0001) and younger age at diagnosis (p = 0.0005). Cording was associated with increased functional impairment (p = 0.0018) and an arm volume increase of ≥5 % (p = 0.028). Cording following breast cancer treatment is common, and may occur beyond the post-operative period. Our findings emphasize the importance of identifying patients at high risk for cording, and developing strategies to minimize functional impairment and arm volume elevation associated with cording. Future studies should investigate the effectiveness of interventions for cording following breast cancer treatment.

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Acknowledgments

This project was supported by Award R01CA139118 (AGT) and Award P50CA089393 (AGT) from the National Cancer Institute. The content is solely the responsibility of the authors and does not necessarily represent the views of the National Cancer Institute or the National Institutes of Health.

Conflict of interest

The authors have no conflicts of interest to disclose.

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Affiliations

  1. Department of Physical and Occupational Therapy, Massachusetts General Hospital, Boston, MA, USA

    Jean O’Toole

  2. Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom Street, Boston, MA, 02114, USA

    Cynthia L. Miller, Melissa N. Skolny, Lauren S. Jammallo, Andrzej Niemierko & Alphonse G. Taghian

  3. Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA

    Michelle C. Specht & Krista Elliott

  4. Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA

    Nora Horick

Authors
  1. Jean O’Toole
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  2. Cynthia L. Miller
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  3. Michelle C. Specht
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  4. Melissa N. Skolny
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  5. Lauren S. Jammallo
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  6. Nora Horick
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  7. Krista Elliott
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  8. Andrzej Niemierko
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  9. Alphonse G. Taghian
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Corresponding author

Correspondence to Alphonse G. Taghian.

Additional information

Jean O’Toole and Cynthia L. Miller are co-first authors, and have contributed equally to this manuscript.

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O’Toole, J., Miller, C.L., Specht, M.C. et al. Cording following treatment for breast cancer. Breast Cancer Res Treat 140, 105–111 (2013). https://doi.org/10.1007/s10549-013-2616-9

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  • DOI: https://doi.org/10.1007/s10549-013-2616-9

Keywords

  • Cording
  • Axillary web syndrome
  • Functional impairment
  • Lymphedema
  • Quality of life
  • Breast surgery