Original articleUpper Limb Physical Function and Adverse Effects After Breast Cancer Surgery: A Prospective 2.5-Year Follow-Up Study and Preoperative Measures
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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Cited by (95)
Comparison of Rehabilitation Training at Different Timepoints to Restore Shoulder Function in Patients With Breast Cancer After Lymph Node Dissection: A Randomized Controlled Trial
2023, Archives of Physical Medicine and RehabilitationEffect of standardised surgical assessment and shared decision-making on morbidity and patient satisfaction after breast conserving therapy: A cross-sectional study
2023, European Journal of Surgical OncologyCitation Excerpt :This is consistent with studies utilising other methods such as Likert items and visual analogue scales [28], Breast-Q [42] or other questionnaires [43]. Despite heterogeneity in methodology, or inclusion of confounders such as axillary dissection [44–47], the conclusions do not suggest association between extent of dissection and postoperative function. No other correlation than adjuvant cytotoxic therapy was found in our study, but, still, OPBCT has repeatedly been shown to yield a higher complication rate [20–22].
Cancer; Pathophysiology and Stress Modulation (Cancer, Therapeutic Interventions)
2022, Seminars in Oncology NursingCitation Excerpt :At 2.5 years postoperatively, axillary LND causes significantly more adverse effects than sentinel LND. LND in general has also been shown to reduce grip strength on both the ipsilateral and contralateral sides.14 Compared with healthy patients, patients with breast cancer have reduced shoulder and knee strength after treatment, with the greatest clinically significant reductions in patients who underwent chemotherapy.
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.