Original article
Upper Limb Physical Function and Adverse Effects After Breast Cancer Surgery: A Prospective 2.5-Year Follow-Up Study and Preoperative Measures

https://doi.org/10.1016/j.apmr.2013.12.015Get rights and content

Abstract

Objective

To examine upper limb physical function and adverse effects after axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB) in patients with breast cancer to identify impairments that can inform rehabilitation strategies.

Design

Prospective longitudinal cohort. Upper limb measurements were studied preoperatively and 2.5 years after breast cancer treatment.

Setting

Hospital setting.

Participants

Two groups of patients with early-stage primary breast cancer (N=391): the ALND surgery group (mean age, 55±10y) and the SLNB group (mean age, 57±10y).

Interventions

Not applicable.

Main Outcome Measures

Arm lymphedema (≥10% increased arm volume relative to control arm volume), grip strength (in kilograms), shoulder mobility, pain intensity during isometric shoulder abduction (on a 100-mm visual analog scale), and body mass index (kg/m2). Parametric/nonparametric tests were used for hypothesized changes and differences, and regression analysis was used for confounding factors.

Results

We observed more adverse effects in women treated with ALND than with SLNB after 2.5 years (P<.05): arm lymphedema (17% vs 3%), grip strength reduction (12% vs 2%), and shoulder abduction-provoked pain (increase of 6% vs decrease of 50%). The adverse effects were similar for affected and control upper limbs for all outcomes except arm lymphedema, which occurred only on the affected side.

Conclusions

Adverse effects in both affected and control/unaffected upper limb were observed after 2.5-year follow-up in both ALND and SLNB groups, but a higher prevalence was observed in the ALND group. Thus, women going through ALND surgery may benefit from further postoperative physical therapy, including resistance and strength exercise, focusing on pain management.

Section snippets

Participants

The patients were enrolled the day before surgery at Akershus and Oslo University Hospital, Ullevaal, Norway, from 1999 through 2003 with the following inclusion criteria: age 35 to 75 years, diagnosed with early-stage primary breast cancer (grades 1–3), undergoing surgery with breast ablation, or undergoing breast-conserving surgery with ALND or SLNB only. All patients went through an SLNB to identify axillary metastases. If detected, an additional ALND was performed.22 They might or might not

Results

The patients treated with ALND were significantly younger than those treated with SLNB (ALND 55±10y vs SLNB 57±10y; P=.01), and they had significantly more lymph nodes removed (ALND 13 [6–27] vs SLNB 2 [1–5]; P<.001) (table 1). Furthermore, patients in the ALND group had breast ablation more often than those in the SLNB group (48% vs 14%; P<.001), a higher incidence of chemotherapy (39% vs 28%; P=.04), and a higher incidence of hormone therapy (52% vs 36%; P<.05) (see table 1). The prevalence

Discussion

We observed significantly more adverse effects in women treated with ALND than in women treated with SLNB 2.5 years after breast cancer treatment (see table 3), but with no differences between the groups regarding their BMI or work situation. In addition to the data in previous reports, the current study included observed preoperative data for handgrip and for pain and shoulder function for both affected and control sides. Assessing true changes in physical function is dependent on pretreatment

Conclusions

There were few adverse effects in the SLNB group compared with the ALND group, in which arm lymphedema, grip strength reduction, and pain intensity during isometric shoulder abduction were significantly (P<.05) higher after 2.5 years. The adverse effects were similar for affected and control upper limbs for all outcomes except arm lymphedema, which occurred only on the affected side. These findings suggest that the adverse effects are related to complex factors in addition to surgery. The ALND

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    Jamar, Sammons Preston, 4 Sammons Ct, Bolingbrook, IL 60440.

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    SPSS Inc, 233 S Wacker Dr, 11th Fl, Chicago, IL 60606-6307.

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    Supported by the Norwegian Cancer Society and the Norwegian Breast Cancer Society (grant no. 58248001).

    No commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a benefit on the authors or on any organization with which the authors are associated.

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