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The sequelae of mastectomy and quadrantectomy with respect to the reaching movement in breast cancer survivors: evidence for an integrated rehabilitation protocol during oncological care

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Abstract

Background

Breast cancer (BC) is the most common cancer among women in developed countries. Several types of surgical interventions are commonly used in BC, such as mastectomy and quadrantectomy, followed by radiation or not. Today, BC rehabilitation can help survivors obtain and maintain the highest physical, social, psychological, and vocational functioning possible, within the limits that are created by cancer and its treatments.

Objective

To verify, before and after a specific rehabilitation protocol treatment, the recovery of the fluidity of the reaching movement.

Methods

Patients after BC surgery were enrolled and assigned by cluster randomization into 2 groups through a block randomization list: mastectomy (Mas) and quadrantectomy (Quad). Evaluation scales (DASH and VAS) were administered, and biomechanical evaluations were performed for each group before treatment (T0 = baseline), at the end of the rehabilitative treatment (T1 = 12 sessions, 2/week), and after 3 months of follow-up (T2).

Results

Fifty-nine (Mas group = 29; Quad group = 30) after BC surgery were enrolled. VAS scores improved along the evaluation times at T0–T1 and T0–T2 (p < 0.001), without a statistically significant difference between groups. With regard to the normalized jerk, there was no significant interaction between time group (F = 2.029; p = 0.136). There was a significant decrease between T0–T1 and T1–T2 (F = 60.189; p < 0.001). Velocity improved significantly between T0–T1 and T1–T2 (F = 10.322; p < 0.001). There was a significant interaction for the elbow angle at the end of movement between time and group at T2 (F = 5.022; p = 0.029).

Conclusion

The integrated, low-intensity, rehabilitative intervention is effective, even if it is not performed in the first period after BC surgery, without any difference between mastectomy and quadrantectomy.

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References

  1. Fisher B, Jeong JH, Anderson S, Bryant J, Fisher ER, Wolmark N (2002) Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med 347(8):567–575

    PubMed  Google Scholar 

  2. Sada A, Day CN, Hoskin TL, Degnim AC, Habermann EB, Hieken TJ (2019) Mastectomy and immediate breast reconstruction in the elderly: trends and outcomes. Surgery

  3. Puliti D, Bucchi L, Mancini S, Paci E, Baracco S, Campari C, Canuti D, Cirilli C, Collina N, Conti GM, Di Felice E, Falcini F, Michiara M, Negri R, Ravaioli A, Sassoli De’ Bianchi P, Serafini M, Zorzi M, Caldarella A, Cataliotti L, Zappa M, IMPACT COHORT Working Group (2017) Advanced breast cancer rates in the epoch of service screening: the 400,000 women cohort study from Italy. Eur J Cancer 75:109–116

    PubMed  Google Scholar 

  4. Corso G, Veronesi P, Sacchini V, Galimberti V, Luini A (2017) The Veronesi quadrantectomy: an historical overview. Ecancermedicalscience. 11:743

    PubMed  PubMed Central  Google Scholar 

  5. Huang Y, Wu H, Luo Z (2017) A retrospective study of optimal surgical management for occult breast carcinoma: mastectomy or quadrantectomy? Medicine (Baltimore) 96(52):e9490

    Google Scholar 

  6. Storm-Dickerson T, Sigalove N (2017) Prepectoral breast reconstruction: the breast surgeon's perspective. Plast Reconstr Surg 140(6S Prepectoral Breast Reconstruction):43S–48S

    PubMed  CAS  Google Scholar 

  7. Herring B, Paraskeva N, Tollow P, Harcourt D (2019) Women's initial experiences of their appearance after mastectomy and/or breast reconstruction: a qualitative study. Psychooncology 28:2076–2082

    PubMed  Google Scholar 

  8. Mangone M, Bernetti A, Agostini F, Paoloni M, De Cicco FA, Capobianco SV, Bai AV, Bonifacino A, Santilli V, Paolucci T (2019 Jul 30) Changes in spine alignment and postural balance after breast cancer surgery: a rehabilitative point of view. Biores Open Access. 8(1):121–128

    PubMed  PubMed Central  Google Scholar 

  9. de Sire A, Invernizzi M, Lippi L, Cisari C, Özçakar L, Franchignoni F (2019) Blurred lines between axillary web syndrome and Mondor's disease after breast cancer surgery: a case report. Ann Phys Rehabil Med

  10. Invernizzi M, Runza L, De Sire A, Lippi L, Blundo C, Gambini D, Boldorini R, Ferrero S, Fusco N (2020) Integrating augmented reality tools in breast cancer related lymphedema prognostication and diagnosis. J Vis Exp ;(156)

  11. Losco L, Cigna E (2018 Feb 17) Aesthetic refinements in C-V flap: raising a perfect cylinder. Aesthet Surg J 38(2):NP26–NP28

    PubMed  Google Scholar 

  12. Michelotti A, Invernizzi M, Lopez G, Lorenzini D, Nesa F, De Sire A, Fusco N (2019 Apr) Tackling the diversity of breast cancer related lymphedema: perspectives on diagnosis, risk assessment, and clinical management. Breast. 44:15–23

    PubMed  Google Scholar 

  13. Thong MSY, van Noorden CJF, Steindorf K, Arndt V (2020 Feb 5) Cancer-related fatigue: causes and current treatment options. Curr Treat Options in Oncol 21(2):17

    Google Scholar 

  14. Yang EJ, Kwon Y (2018) Changes in shoulder muscle activity pattern on surface electromyography after breast cancer surgery. J Surg Oncol 117(2):116–123

    PubMed  Google Scholar 

  15. Rizzi SK, Haddad CA, Giron PS, Pinheiro TL, Nazário AC, Facina G (2016) Winged scapula incidence and upper limb morbidity after surgery for breast cancer with axillary dissection. Support Care Cancer 24(6):2707–2715

    PubMed  Google Scholar 

  16. Stubblefield MD (2017) The underutilization of rehabilitation to treat physical impairments in breast cancer survivors. PM R 9(9S2):S317–S323

    PubMed  Google Scholar 

  17. Leclerc AF, Foidart-Dessalle M, Tomasella M, Coucke P, Devos M, Bruyère O, Bury T, Deflandre D, Jerusalem G, Lifrange E, Kaux JF, Crielaard JM, Maquet D (2017) Multidisciplinary rehabilitation program after breast cancer: benefits on physical function, anthropometry and quality of life. Eur J Phys Rehabil Med 53(5):633–642

    PubMed  Google Scholar 

  18. Morone G, Iosa M, Fusco A et al (2014) Effects of a multidisciplinary educational rehabilitative intervention in breast cancer survivors: the role of body image on quality of life outcomes. ScientificWorldJournal. 2014:451935

    PubMed  PubMed Central  Google Scholar 

  19. Larsson IM, Ahm Sørensen J, Bille C (2017) The post-mastectomy pain syndrome - a systematic review of the treatment modalities. Breast J 23(3):338–343

    PubMed  Google Scholar 

  20. Gutman H, Kersz T, Barzilai T, Haddad M, Reiss R (1990) Achievements of physical therapy in patients after modified radical mastectomy compared with quadrantectomy, axillary dissection, and radiation for carcinoma of the breast. Arch Surg 125(3):389–391

    PubMed  CAS  Google Scholar 

  21. de Rezende LF, Franco RL, de Rezende MF, Beletti PO, Morais SS, Gurgel MS (2006) Two exercise schemes in postoperative breast cancer: comparison of effects on shoulder movement and lymphatic disturbance. Tumori. 92(1):55–61

    PubMed  Google Scholar 

  22. Elder EE, Brandberg Y, Björklund T, Rylander R, Lagergren J, Jurell G, Wickman M, Sandelin K (2005) Quality of life and patient satisfaction in breast cancer patients after immediate breast reconstruction: a prospective study. Breast 14(3):201–208

    PubMed  Google Scholar 

  23. Shallwani SM, King J, Thomas R, Thevenot O, De Angelis G, Aburub AS, Brosseau L (2019) Methodological quality of clinical practice guidelines with physical activity recommendations for people diagnosed with cancer: a systematic critical appraisal using the AGREE II tool. PLoS One 14(4):e0214846

    PubMed  PubMed Central  CAS  Google Scholar 

  24. Castagna A, Frittoli S, Ferrarin M, Del Sorbo F, Romito LM, Elia AE, Albanese A (2016) Quantitative gait analysis in parkin disease: possible role of dystonia. Mov Disord 31(11):1720–1728

    PubMed  Google Scholar 

  25. Gattellari M, Leung DY, Ukoumunne OC, Zwar N, Grimshaw J, Worthington JM (2011) Study protocol: the DESPATCH study: delivering stroke prevention for patients with atrial fibrillation - a cluster randomised controlled trial in primary healthcare. Implement Sci 6:48

    PubMed  PubMed Central  Google Scholar 

  26. Campbell MJ, Donner A, Klar N (2007) Developments in cluster randomized trials and statistics in medicine. Stat Med 26:2–19

    PubMed  CAS  Google Scholar 

  27. Lo Torto F, Marcasciano M, Kaciulyte J, Redi U, Barellini L, De Luca A, Perra A, Frattaroli JM, Cavalieri E, Di Taranto G, Greco M, Casella D (2020) Prepectoral breast reconstruction with TiLoop® Bra Pocket: a single center prospective study. Eur Rev Med Pharmacol Sci 24(3):991–999

    PubMed  CAS  Google Scholar 

  28. Marcasciano M, Frattaroli J, Mori FLR, Lo Torto F, Fioramonti P, Cavalieri E, Kaciulyte J, Greco M, Casella D, Ribuffo D (2019) The new trend of pre-pectoral breast reconstruction: an objective evaluation of the quality of online information for patients undergoing breast reconstruction. Aesthet Plast Surg 43(3):593–599

    CAS  Google Scholar 

  29. Casella D, Di Taranto G, Lo Torto F, Marcasciano M, Kaciulyte J, Greco M, Onesti MG, Ribuffo D (2020) Body mass index can predict outcomes in direct-to-implant prepectoral breast reconstruction. Plast Reconstr Surg 145(4):867e–868e

    PubMed  CAS  Google Scholar 

  30. Crum RM, Anthony JC, Bassett SS, Folstein MF (1993) Population- based norms for the mini-mental state examination by age and educational level. JAMA 269:2386–2391

    PubMed  CAS  Google Scholar 

  31. Schulz KF, Altman DG, Moher D (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. BMC Med 8:18

    PubMed  PubMed Central  Google Scholar 

  32. Wingate L, Croghan I, Natarajan N, Michalek AM, Jordan C (1989) Rehabilitation of the mastectomy patient: a randomized, blind, prospective study. Arch Phys Med Rehabil 70(1):21–24

    PubMed  CAS  Google Scholar 

  33. Ciesla N, Dinglas V, Fan E, Kho M, Kuramoto J, Needham D (2011) Manual muscle testing: a method of measuring extremity muscle strength applied to critically ill patients. J Vis Exp (50)

  34. Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29(6):602–608

    PubMed  CAS  Google Scholar 

  35. Padua R, Padua L, Ceccarelli E, Romanini E, Zanoli G, Amadio PC, Campi A (2003) Italian version of the disability of the arm, shoulder and hand (DASH) questionnaire: cross-cultural adaptation and validation. J Hand Surg 28(2):179–186

    CAS  Google Scholar 

  36. Phan NQ, Blome C, Fritz F, Gerss J, Reich A, Ebata T, Augustin M, Szepietowski JC, Ständer S (2012) Assessment of pruritus intensity: prospective study on validity and reliability of the visual analogue scale, numerical rating scale and verbal rating scale in 471 patients with chronic pruritus. Acta Derm Venereol 92(5):502–507

    PubMed  Google Scholar 

  37. Postacchini R, Paoloni M, Carbone S, Fini M, Santilli V, Postacchini F, Mangone M (2015) Kinematic analysis of reaching movements of the upper limb after total or reverse shoulder arthroplasty. J Biomech 48(12):3192–3198

    PubMed  Google Scholar 

  38. Caimmi M, Guanziroli E, Malosio M, Pedrocchi N, Vicentini F, Molinari Tosatti L, Molteni F (2015) Normative data for an instrumental assessment of the upper-limb functionality. Biomed Res Int:484131

  39. Leduc O, Leduc A, Bourgeois P, Belgrado JP (1998) The physical treatment of upper limb edema. Cancer. 83(12 Suppl American):2835-9;

  40. Morone G, Iosa M, Fusco A, Scappaticci A, Alcuri MR, Saraceni VM, Paolucci S, Paolucci T (2014) Effects of a multidisciplinary educational rehabilitative intervention in breast cancer survivors: the role of body image on quality of life outcomes. ScientificWorldJournal. 451935

  41. Paolucci T, Bernetti A, Paoloni M, Capobianco SV, Bai AV, Lai C, Pierro L, Rotundi M, Damiani C, Santilli V, Agostini F, Mangone M (2019) Therapeutic alliance in a single versus group rehabilitative setting after breast cancer surgery: psychological profile and performance rehabilitation. Biores Open Access 8(1):101–110

    PubMed  PubMed Central  Google Scholar 

  42. De Groef A, Van Kampen M, Verlvoesem N, Dieltjens E, Vos L, De Vrieze T, Christiaens MR, Neven P, Geraerts I, Devoogdt N (2017) Effect of myofascial techniques for treatment of upper limb dysfunctions in breast cancer survivors: randomized controlled trial. Support Care Cancer 25(7):2119–2127

    PubMed  Google Scholar 

  43. Scano A, Chiavenna A, Malosio M, Molinari Tosatti L, Molteni F (2017) Muscle synergies-based characterization and clustering of poststroke patients in reaching movements. Front Bioeng Biotechnol 5:62

    PubMed  PubMed Central  Google Scholar 

  44. 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

    PubMed  PubMed Central  Google Scholar 

  45. Kelly AM (2001) The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg Med J 18(3):205–207

    PubMed  PubMed Central  CAS  Google Scholar 

  46. Marazzi F, Masiello V, Marchesano D, Boldrini L, Luzi S, Ferrara PE, Amabile E, Piccari D, Landi F, Moschella F, Franceschini G, Masetti R, Mantini G, Valentini V, Smaniotto D (2019) Shoulder girdle impairment in breast cancer survivors: the role of range of motion as predictive factor for dose distribution and clinical outcome. Tumori. 105(4):319–330

    PubMed  Google Scholar 

  47. De Groef A, Meeus M, De Vrieze T, Vos L, Van Kampen M, Christiaens MR, Neven P, Geraerts I, Devoogdt N (2017) Pain characteristics as important contributing factors to upper limb dysfunctions in breast cancer survivors at long term. Musculoskelet Sci Pract 29:52–59

    PubMed  Google Scholar 

  48. Hayes SC, Johansson K, Stout NL, Prosnitz R, Armer JM, Gabram S, Schmitz KH (2012) Upper-body morbidity after breast cancer: incidence and evidence for evaluation, prevention, and management within a prospective surveillance model of care. Cancer. 118(8 Suppl):2237–2249

    PubMed  Google Scholar 

  49. Ezzo J, Manheimer E, McNeely ML, Howell DM, Weiss R, Johansson KI, Bao T, Bily L, Tuppo CM, Williams AF, Karadibak D (2015) Manual lymphatic drainage for lymphedema following breast cancer treatment. Cochrane Database Syst Rev. (5):CD003475

  50. Franceschini G, Martin Sanchez A, Di Leone A, Magno S, Moschella F, Accetta C, Masetti R (2015) New trends in breast cancer surgery: a therapeutic approach increasingly efficacy and respectful of the patient. G Chir 36(4):145–152

    PubMed  PubMed Central  CAS  Google Scholar 

  51. D’Egidio V, Sestili C, Mancino M, Sciarra I, Cocchiara R, Backhaus I, Mannocci A, De Luca A, Frusone F, Monti M, La Torre G, RETURN TO BREAST Collaborative group (2017) Counseling interventions delivered in women with breast cancer to improve health-related quality of life: a systematic review. Qual Life Res 26(10):2573–2592

    PubMed  Google Scholar 

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Acknowledgments

We thank the students in the physiotherapy course at Sapienza University of Rome (Italy)—Lana Zeidan, Pablo Gnessi and Adriano Cecchini—and Francesco De Cicco, a young medical doctor who graduated with a thesis on rehabilitation in breast cancer.

In addition, we thank the Breast Unit of S. Andrea Hospital, Sapienza University of Rome, and specifically, Prof. A. Bonifacino and her team for their valuable collaboration. Finally, we thank the Association of Patients “Incontra Donna,” and all of the women who participated in our research.

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Authors and Affiliations

  1. Department of Medical, Oral and Biotechnological Sciences, G. D’Annunzio University of Chieti-Pescara, Chieti, Italy

    Teresa Paolucci

  2. Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy

    Andrea Bernetti, Arianna V. Bai, Lucia Segatori, Valter Santilli, Marco Paoloni, Francesco Agostini & Massimiliano Mangone

  3. Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy

    Massimo Monti

  4. University Hospital Umberto I of Rome, Rome, Italy

    Giuseppe Maggi, Giovanni Ippolitoni & Laura Tinelli

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  1. Teresa Paolucci
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  3. Arianna V. Bai
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by MM, FA, and AB. The first draft of the manuscript was written by TP,, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Francesco Agostini.

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Paolucci, T., Bernetti, A., Bai, A.V. et al. The sequelae of mastectomy and quadrantectomy with respect to the reaching movement in breast cancer survivors: evidence for an integrated rehabilitation protocol during oncological care. Support Care Cancer 29, 899–908 (2021). https://doi.org/10.1007/s00520-020-05567-x

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