Abstract
BackgroundBreast cancer surgery frequently causes deficiencies in shoulder functioning. The study pourpode is to identify risk factors for prolonged pain, reduction in function, and decrease in range of motion (ROM) in BC patients.MethodsA prospective cohort study was designed in a private hospital; between October 2018 and April 2019 with a follow-up of 6 months. Patients following BC surgery, were divided by arm morbidities, and the different risk facrors were evaluated using univariate analysis and logistic regression.ResultsA total of 157 patients were included in the study. Risk factors for functional disabilities included; pain levels during hospitalization NPRS 1.2 (±0.8) compared to patients with no disabilities 0.5 ± 0.7 (p = .006), the size of tumors more than 1.4 ± 0.8 cm. compared with no morbidities 0.8 ± 0.9 cm. (p = .046), and breast reconstructions (p = .030). Risk factors for prolonged pain includes mastectomy (p = .006), breast reconstruction (p = .011), more than three dissected lymph nodes (p = .002), the presence of preoperative pain (p < .001), in-hospital pain (p < .001), axillary web syndrome (p < .001) and lymphedema (p < .001). Risk factors for decreased ROM were more than three dissected lymph nodes (p = .027), radiation (p = .018), and the size of dissected tissue (p = .035). Postoperative physical therapy appears to reduce the incidence of prolonged pain (p = .013) and regular physical activity may reduce long term functional disabilities (p = .021).ConclusionsUpper arm morbidity following BC treatments affect up to 70% of the patients. Identifying the different risk and beneficial factors may improve awareness among physicians to refer patients to early rehabilitation programs and thus avoid chronic morbidity and improve the course of recovery.Trial registrationThe study was registered in Clinical trial with the ID number: NCT03389204.
Highlights
Breast cancer surgery frequently causes deficiencies in shoulder functioning
Personal factors can include age, as women under 50 years are susceptible to develop chronic pain [10], obesity that causes a higher incidence of lymphedema [11], history of previous Breast cancer (BC) treatments might increase the possibility of morbidity and adversely affects recovery [12]
Previous studies found that postoperative physical therapy is effective in improving functional use of the affected arm [22, 49], our results suggest that in addition, postoperative physical therapy may reduce the incidence of prolonged pain
Summary
Breast cancer surgery frequently causes deficiencies in shoulder functioning. The study pourpode is to identify risk factors for prolonged pain, reduction in function, and decrease in range of motion (ROM) in BC patients. Breast cancer (BC) surgeries and treatments can cause arm morbidity that can progress beyond 2.5 years [1]. Radiation therapy increases the odds of lymphedema and shoulder restriction compared with nonirradiated patients [8]. Tumor characteristics such as Lymphovascular invasion is additional risk indicator for lymphedema [9]. Personal factors can include age, as women under 50 years are susceptible to develop chronic pain [10], obesity that causes a higher incidence of lymphedema [11], history of previous BC treatments might increase the possibility of morbidity and adversely affects recovery [12]. Other factors that need to be considered and can affect the course of recovery are psychological, emotional state [13] and even posture [14]
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