Treatment related impairments in arm and shoulder in patients with breast cancer: a systematic review.

Janine T Hidding,Carien H G Beurskens,Philip J Van Der Wees,Maria W G Nijhuis-Van Der Sanden,Hanneke W M Van Laarhoven,Una Macleod

doi:10.1371/journal.pone.0096748

Abstract

BackgroundBreast cancer is the most common type of cancer in women in the developed world. As a result of breast cancer treatment, many patients suffer from serious complaints in their arm and shoulder, leading to limitations in activities of daily living and participation. In this systematic literature review we present an overview of the adverse effects of the integrated breast cancer treatment related to impairment in functions and structures in the upper extremity and upper body and limitations in daily activities. Patients at highest risk were defined.Methods and FindingsWe conducted a systematic literature search using the databases of PubMed, Embase, CINAHL and Cochrane from 2000 to October 2012, according to the PRISMA guidelines. Included were studies with patients with stage I–III breast cancer, treated with surgery and additional treatments (radiotherapy, chemotherapy and hormonal therapy). The following health outcomes were extracted: reduced joint mobility, reduced muscle strength, pain, lymphedema and limitations in daily activities. Outcomes were divided in within the first 12 months and >12 months post-operatively. Patients treated with ALND are at the highest risk of developing impairments of the arm and shoulder. Reduced ROM and muscle strength, pain, lymphedema and decreased degree of activities in daily living were reported most frequently in relation to ALND. Lumpectomy was related to a decline in the level of activities of daily living. Radiotherapy and hormonal therapy were the main risk factors for pain.ConclusionsPatients treated with ALND require special attention to detect and consequently address impairments in the arm and shoulder. Patients with pain should be monitored carefully, because pain limits the degree of daily activities. Future research has to describe a complete overview of the medical treatment and analyze outcome in relation to the treatment. Utilization of uniform validated measurement instruments has to be encouraged.

Highlights

Breast cancer is the most common type of cancer in women in the developed world
As a result of breast cancer treatment, many patients suffer from adverse effects and have serious complaints in their arm and shoulder e.g. decreased joint mobility, muscle strength, pain and lymphedema, leading to limitations in activities of daily living and participation in work, sports and leisure activities. [1,2,3] In a prospective Australian study, 62% of the population still suffered from at least one impairment as a complication of breast cancer treatment and 27% suffered from two to four impairments after six years
[6] Based on the misconception that disabilities such as decreased range of motion, pain and lymphedema will resolve over time without intervention, combined with denial of the possible benefits of physical therapy interventions, this has led to the inadequate monitoring of disabilities

Summary

Introduction

Breast cancer is the most common type of cancer in women in the developed world. Due to new treatment modalities, breast cancer survival has improved over time. [4] Reported variability in onset and severity of upper limb symptoms of patients with breast cancer reported in studies is large [5] and a systematic overview of risk factors related to medical treatment is lacking This information is of direct clinical relevance, as early physical therapy intervention for these complaints as well as surveillance of patients at risk for developing impairments in daily activities reduces the need for intensive rehabilitation and the associated costs. As a result of breast cancer treatment, many patients suffer from serious complaints in their arm and shoulder, leading to limitations in activities of daily living and participation In this systematic literature review we present an overview of the adverse effects of the integrated breast cancer treatment related to impairment in functions and structures in the upper extremity and upper body and limitations in daily activities.

Methods

Results

Discussion

Conclusion