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Joaquim A, Amarelo A, Antunes P, Garcia C, Leão I, Vilela E, Teixeira M, Duarte B, Vieira M, Afreixo V, Capela A, Viamonte S, Costa H, Helguero LA, Alves A. Effects of a Physical Exercise Program on Quality of Life and Physical Fitness of Breast Cancer Survivors: the MAMA_MOVE Gaia After Treatment Trial. PSYCHOL HEALTH MED 2024; 29:964-987. [PMID: 37644639 DOI: 10.1080/13548506.2023.2240074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/18/2023] [Indexed: 08/31/2023]
Abstract
To assess the effects of a group class physical exercise program on health-related quality of life (HRQOL), physical fitness and activity, and safety in early breast cancer women after treatment, a double-phase trial [16-week control phase (CP) followed by a 16-week intervention phase (IP)] was designed. Outcomes were evaluated at baseline (T1), 8 (T2) and 16 (T3) weeks (CP), and 24 (T4) and 32 (T5) weeks (IP). The primary endpoint was global health status. Out of 82 enrolled patients, 37 completed the IP. Global health status decreased (-10,1; 95% CI -19.8 to -0.4; p = 0.040) during the CP and stabilized during the IP. Physical and sexual functioning increased during the IP (p = 0.008; p = 0.017), while cardiorespiratory fitness increased in the CP (p = 0.004). Upper limb strength and lower limb functionality increased during both phases [CP: p < 0.0001, p = 0.001 (surgical and nonsurgical arm), p = 0.028; IP: p < 0.0001, p = 0.002, p = 0.009]. Body mass index decreased in the IP (p = 0.026). Waist circumference increased in the CP (p = 0.001) and decreased in the IP (p = 0.010); sedentary behaviours and moderate and vigorous physical activity did not change. Adherence to 70% of the sessions was reported in 54% of patients. No serious adverse events related to the intervention were reported. In conclusion, the physical exercise program was able to prevent the decline in global health status and to improve other domains of HRQOL and physical fitness. As physical exercise is not the standard of care in many countries, the implementation of group class programs might be an option.
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Affiliation(s)
- Ana Joaquim
- Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
- Medical Oncology Department; Centro Hospitalar Vila Nova de Gaia/Espinho, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO), Vila Nova de Gaia, Portugal
| | - Anabela Amarelo
- Medical Oncology Department; Centro Hospitalar Vila Nova de Gaia/Espinho, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO), Vila Nova de Gaia, Portugal
| | - Pedro Antunes
- Research Center in Sport Sciences, Health, and Human Development (CIDESD), University of Beira Interior, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO)
| | - Catarina Garcia
- Research Center in Sport Sciences, Health, and Human Development (CIDESD), University of Maia, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO)
| | - Inês Leão
- Medical Oncology Department; Centro Hospitalar Vila Nova de Gaia/Espinho, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO), Vila Nova de Gaia, Portugal
| | - Eduardo Vilela
- Cardiology Department; Centro Hospitalar Vila Nova de Gaia/Espinho, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO)
| | - Madalena Teixeira
- Cardiology Department; Centro Hospitalar Vila Nova de Gaia/Espinho, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO)
| | - Bárbara Duarte
- ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO)
| | - Micael Vieira
- Solinca Classic, SA, SC Fitness, SA, Lisbon, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO)
| | - Vera Afreixo
- Department of Mathematics; University of Aveiro, Center for Research & Development in Mathematics and Applications (CIDMA), University of Aveiro
| | - Andreia Capela
- Medical Oncology Department; Centro Hospitalar Vila Nova de Gaia/Espinho, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO), Vila Nova de Gaia, Portugal
| | - Sofia Viamonte
- Department of Medical Sciences, University of Aveiro Centro de Reabilitação Do Norte, Centro Hospitalar Vila Nova de Gaia/Espinho, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO), Portugal
| | - Horácio Costa
- Department of Plastic Surgery, Centro Hospitalar Vila Nova de Gaia/Espinho, Department of Medical Sciences, University of Aveiro, Portugal
| | - Luisa A Helguero
- Department of Medical Sciences, University of Aveiro, Institute of Biomedicine of Aveiro (IBIMED), University of Aveiro, Aveiro, Portugal
| | - Alberto Alves
- Research Center in Sport Sciences, Health, and Human Development (CIDESD), University of Maia, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO)
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İlgin VE, Yayla A, Kılınç T. The Effect of Preoperative Education Given to Patients Who Will Have a Mastectomy: A Randomized Controlled Trial. J Perianesth Nurs 2024; 39:e1-e8. [PMID: 38054914 DOI: 10.1016/j.jopan.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/10/2023] [Accepted: 09/14/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE The aim of this study was to determine the effect of the education provided to patients who would undergo mastectomy on psychological well-being and quality of recovery. DESIGN The study had a randomized controlled trial design. METHODS The study was completed with 62 patients (30 in the experimental group and 32 in the control group). The experimental group received education the day before the operation, and the applications were made 3 days after the operation. A questionnaire form, the psychological well-being scale, and the quality of recovery questionnaire-40 (QoR-40) were used to collect the study data. FINDINGS The mean total score of the final measurement of the psychological well-being scale was higher in the experimental group than in the control group, and the difference was statistically significant. The difference between the final measurement total score average of QoR-40 and the final measurement point average of the subdimensions of the patients in the experimental and control groups was measured. The difference was statistically significant and the mean score of the experimental group was higher. CONCLUSIONS Education can increase the level of psychological well-being and quality of recovery in patients who undergo mastectomy. Physiological and psychological education can be used as a tool in nursing practice to improve the level of psychological well-being and quality of recovery in postoperative patients.
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Affiliation(s)
- Vesile E İlgin
- Department of Surgical Nursing, Faculty of Nursing, Ataturk University, Erzurum, Turkey.
| | - Ayşegül Yayla
- Department of Surgical Nursing, Faculty of Nursing, Ataturk University, Erzurum, Turkey
| | - Tülay Kılınç
- Department of Surgical Nursing, Faculty of Nursing, Ataturk University, Erzurum, Turkey
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Oei SL, Thronicke A, Grieb G, Schad F, Groß J. Evaluation of quality of life in breast cancer patients who underwent breast-conserving surgery or mastectomy using real-world data. Breast Cancer 2023; 30:1008-1017. [PMID: 37587322 DOI: 10.1007/s12282-023-01494-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/09/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Due to advances in the fight against breast cancer, aesthetic aspects and the prevention of breast deformities are playing an important role in surgical procedures. Currently the main form of breast cancer surgery is breast-conserving surgery (BCS), and even if mastectomy (MAS) is required, oncoplastic surgery and reconstruction options can improve outcomes, including health-related quality of life (QoL) of cancer patients. The purpose of this study was to assess whether surgery options induce different outcomes in self-reported QoL in guide-line treated breast cancer patients of the Network Oncology (NO). METHODS This prospective Real-World-Data (RWD) study was conducted using data from the NO-clinical registry. QoL was assessed by evaluation of the European Organization of Research and Treatment Health-Related Quality of Life Core Questionnaire scale (EORTC QLQ-C30). Association factors between type of surgery options, without or with immediate breast reconstructions the EORTC QLQ-C30-scales at baseline after surgery, 6, 12, and 24 months later were analyzed with adjusted multivariate regression analysis, considering age, cancer stage, and treatment regimens, using software R. RESULTS A total of 623 primary breast cancer patients (all tumor stages, median age 58 (ICR: 50-68) diagnosed and guide-line treated between 2013 and 2021), 524 BCS and 99 MAS, 24 of whom received immediate breast reconstruction (MBR), were eligible for analyses. Compared with BCS patients, MBR patients self-reported considerably lower global health, physical and social functioning, and higher burden of pain and financial difficulties at baseline. In later follow-up surveys, functional scales increased and symptoms decreased in all patients, and the differences between MAS and BCS equalized. Longitudinal analyses after 24 months were obtained from 258 patients and revealed that compared to 224 BCS, the 34 MAS patients reported increased social functioning (p = 0.04). CONCLUSIONS At 24 months after MAS, breast cancer patients' QoL improved compared with BCS, although impairments in QoL were reported immediately after MAS. A growing expertise in surgical procedures as well as supportive care is critical to optimizing patients' well-being. These findings may be considered when counseling breast cancer patients pre- and post-surgery. TRIAL REGISTRATION NUMBER DRKS00013335 on 27/11/2017 retrospectively registered.
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Affiliation(s)
- Shiao Li Oei
- Research Institut Havelhöhe gGmbH at, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.
| | - Anja Thronicke
- Research Institut Havelhöhe gGmbH at, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
| | - Gerrit Grieb
- Department of Plastic Surgery and Hand Surgery, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
| | - Friedemann Schad
- Research Institut Havelhöhe gGmbH at, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
- Interdisciplinary Oncology and Supportive Cancer Medicine, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
| | - Jessica Groß
- Breast Cancer Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
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Binkley JM, Gabram S, Finley J, Fowler D, VanHoose L, McCullough LE. Racial disparity in breast cancer survivorship: themes from a series of four national healthcare provider live virtual forums. J Cancer Surviv 2023:10.1007/s11764-023-01373-6. [PMID: 37040001 DOI: 10.1007/s11764-023-01373-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/25/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE Significant disparity exists in the diagnosis, treatment, and survivorship outcomes among Black breast cancer (BC) survivors. Black BC survivors have more significant survivorship issues and a greater burden of illness than White counterparts. Barriers to rehabilitation exist for all BC survivors but are magnified in Black BC survivors. The purpose of this qualitative research was to document patient, clinician, and researchers' perceptions surrounding contributing factors, lived experiences, and potential solutions to racial disparity in BC survivorship. METHODS A narrative approach was utilized to identify themes from a series of four virtual healthcare provider forums that explored lived personal and professional experiences, issues, and potential solutions surrounding racial disparity in BC survivorship. Forums included perspectives of patients, healthcare providers, researchers, and stakeholders in the BC field. An independent thematic analysis was performed by the investigators, all of whom have emic perspectives with respect to race and/or BC. RESULTS Three main themes were identified related to racial disparity in BC survivorship: (1) societal and cultural contributing factors, (2) contribution of healthcare providers and systems, and (3) models of care and research considerations. CONCLUSIONS The findings provide compelling documentation of lived personal and professional experiences of racial disparity in BC survivorship. Potential solutions exist and must be enacted immediately to ensure equitable survivorship outcomes for Black individuals following a BC diagnosis. IMPLICATIONS FOR CANCER SURVIVORS Increased awareness related to racial disparity in BC survivorship among survivors, healthcare providers, and researchers will contribute to health equity and improved outcomes for Black individuals.
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Affiliation(s)
- Jill M Binkley
- TurningPoint Breast Cancer Rehabilitation, Atlanta, GA, USA.
- Global Access to Breast Cancer Rehabilitation Community Partnership Initiative, Atlanta, GA, USA.
| | - Sheryl Gabram
- Global Access to Breast Cancer Rehabilitation Community Partnership Initiative, Atlanta, GA, USA
- Georgia Center for Oncology Research and Education, Atlanta, GA, USA
| | - Janae Finley
- TurningPoint Breast Cancer Rehabilitation, Atlanta, GA, USA
- Global Access to Breast Cancer Rehabilitation Community Partnership Initiative, Atlanta, GA, USA
| | | | - Lisa VanHoose
- Global Access to Breast Cancer Rehabilitation Community Partnership Initiative, Atlanta, GA, USA
- College of Saint Mary, Omaha, NE, USA
- The Ujima Center, Monroe, LA, USA
| | - Lauren E McCullough
- Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Stout NL, Utzman R, Jenkins HH, Burkart M, Swisher AK. Implementing and sustaining a breast cancer prospective surveillance rehabilitation program: an institutional perspective. J Cancer Surviv 2023; 17:509-517. [PMID: 36441392 DOI: 10.1007/s11764-022-01304-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The prospective surveillance model (PSM) is an evidence-based rehabilitation care delivery model that facilitates functional screening and intervention for individuals undergoing cancer treatment. While PSM is empirically validated and feasible in practice, implementation into cancer care delivery has languished. The purpose of this manuscript is to characterize the barriers and facilitators to implementing PSM in a breast cancer center and to share policy and process outcomes that have sustained the model in practice. METHODS The PSM implementation was undertaken as a quality improvement initiative of our cancer center. We retrospectively assessed barriers to implementation and define those according to the Consolidated Framework for Implementation Research (CFIR). Implementation strategies are defined based on the Expert Recommendations for Implementation Change (ERIC) taxonomy. Breast center policy changes and stakeholder-reported process improvement outcomes at the clinic and system level are described. RESULTS PSM implementation facilitation was driven primarily by adapting the model to align with the cancer center workflow, engaging interdisciplinary stakeholders as program champions, enhancing knowledge and awareness among cancer care providers, and changing infrastructure to support the model. System and clinic-level policy and process changes included the development of clinical pathways, EHR order sets and automated referrals, new staffing models, and adapted clinical workflows. CONCLUSION Our report provides insight on implementing the PSM at a single institution in a cancer care delivery setting. Successful implementation strategies addressed individual, clinic, and system-level barriers and facilitated process and policy changes that have enabled PSM sustainment. Improving integration of rehabilitation services into oncology care has significant implications for survivorship care by enhancing proactive management of functional morbidity. IMPLICATIONS FOR CANCER SURVIVORS Improving integration of rehabilitation services into oncology care has significant implications for survivorship care by enhancing proactive management of functional morbidity.
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Affiliation(s)
- Nicole L Stout
- Department of Hematology Oncology, West Virginia University School of Medicine, Morgantown, WV, USA.
- Department of Health Policy, Management, and Leadership, West Virginia University School of Public Health, Morgantown, WV, USA.
- West Virginia University Cancer Institute, Morgantown, WV, USA.
| | - Ralph Utzman
- Division of Physical Therapy, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Hannah Hazard Jenkins
- West Virginia University Cancer Institute, Morgantown, WV, USA
- Department of Surgery, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Megan Burkart
- West Virginia University Cancer Institute, Morgantown, WV, USA
- Division of Physical Therapy, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Anne K Swisher
- West Virginia University Cancer Institute, Morgantown, WV, USA
- Division of Physical Therapy, West Virginia University School of Medicine, Morgantown, WV, USA
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Singh R, Cao L, Sarode AL, Kharouta M, Shenk R, Miller ME. Trends in surgery and survival for T1-T2 male breast cancer: A study from the National Cancer Database. Am J Surg 2023; 225:75-83. [PMID: 36208958 DOI: 10.1016/j.amjsurg.2022.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 08/14/2022] [Accepted: 09/20/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Despite evidence that early-stage male breast cancer (MBC) can be treated the same as in females, we hypothesized that men undergo more extensive surgery. METHODS Patients with clinical T1-2 breast cancer were identified in the National Cancer Database 2004-2016. Trends in surgery type and overall survival were compared between sexes. RESULTS Of 9,782 males and 1,078,105 females, most were cN0 with AJCC stage I/II disease. Unilateral mastectomy was most common in men (67.1% vs. 24.1%, p < 0.001) and partial mastectomy in women (64.7% vs. 26.4%, p < 0.001), with no significant change over time. Over 1/3 of men received ALND in 2016. While overall survival was superior in females (HR 0.83, 95% CI 0.73-0.94, p = 0.003), partial mastectomy was associated with a 42% reduction in mortality risk for males (HR 0.58, 95% CI 0.4-0.8, p = 0.003). CONCLUSIONS De-escalation of surgery could be considered for MBC to improve survival and align with current standards of care.
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Affiliation(s)
- Rashi Singh
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), USA
| | - Lifen Cao
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), USA
| | - Anuja L Sarode
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), USA
| | - Michael Kharouta
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Robert Shenk
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), USA
| | - Megan E Miller
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), USA.
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Joaquim A, Leão I, Antunes P, Capela A, Viamonte S, Alves AJ, Helguero LA, Macedo A. Impact of physical exercise programs in breast cancer survivors on health-related quality of life, physical fitness, and body composition: Evidence from systematic reviews and meta-analyses. Front Oncol 2022; 12:955505. [PMID: 36568235 PMCID: PMC9782413 DOI: 10.3389/fonc.2022.955505] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022] Open
Abstract
Background Breast cancer is the most common cancer worldwide, and despite remarkable progress in its treatment, the survivors' quality of life is hampered by treatment-related side effects that impair psychosocial and physiological outcomes. Several studies have established the benefits of physical exercise in breast cancer survivors in recent years. Physical exercise reduces the impact of treatment-related adverse events to promote a better quality of life and functional outcomes. Aim This study aims to provide an overview of systematic reviews and meta-analyses on the effect of physical exercise on the health-related quality of life, cardiorespiratory fitness, muscle strength, and body composition of breast cancer survivors. Methods PubMed and Cochrane databases were searched for systematic reviews and meta-analyses from January 2010 to October 2022. The main focus was ascertaining the effectiveness of physical exercise in breast cancer survivors undergoing curative treatment (surgery and/or radiotherapy and/or chemotherapy). Two reviewers independently screened the literature, extracted the data, and assessed the risk of bias in the included studies. Results A total of 101 studies were identified, and 12 were yielded for final analysis. The eligible studies included nine systematic reviews/meta-analyses, one meta-analysis/meta-regression, and two systematic reviews. The number of randomised clinical trials included in each review varied from 11 to 63, and the number of participants was from 214 to 5761. A positive and significant effect of different physical exercise interventions on health-related quality of life was reported in 83.3% (10 studies) of the eligible studies. Physical exercise also improved cardiorespiratory fitness (3 studies; 25%) and showed to be effective in reducing body weight (3 studies; 25%) and waist circumference (4 studies; 33.3%). Conclusions Our results suggest that physical exercise is an effective strategy that positively affects breast cancer survivors' quality of life, cardiorespiratory fitness, and body composition. Healthcare professionals should foster the adoption of physical exercise interventions to achieve better health outcomes following breast cancer treatments. Systematic review registration https://inplasy.com/inplasy-2022-11-0053/, identifier INPLASY2022110053.
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Affiliation(s)
- Ana Joaquim
- Department of Medical Oncology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal,ONCOMOVE, AICSO – Associação de Investigação de Cuidados de Suporte em Oncologia, Vila Nova de Gaia, Portugal,Institute of Biomedicine (IBIMED), University of Aveiro, Aveiro, Portugal,*Correspondence: Ana Joaquim,
| | - Inês Leão
- Department of Medical Oncology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal,ONCOMOVE, AICSO – Associação de Investigação de Cuidados de Suporte em Oncologia, Vila Nova de Gaia, Portugal
| | - Pedro Antunes
- ONCOMOVE, AICSO – Associação de Investigação de Cuidados de Suporte em Oncologia, Vila Nova de Gaia, Portugal,Research Center in Sport Sciences, Health, and Human Development (CIDESD), University of Beira Interior, Covilhã, Portugal
| | - Andreia Capela
- Department of Medical Oncology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal,ONCOMOVE, AICSO – Associação de Investigação de Cuidados de Suporte em Oncologia, Vila Nova de Gaia, Portugal
| | - Sofia Viamonte
- ONCOMOVE, AICSO – Associação de Investigação de Cuidados de Suporte em Oncologia, Vila Nova de Gaia, Portugal,Centro de Reabilitação do Norte, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal,Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Alberto J. Alves
- ONCOMOVE, AICSO – Associação de Investigação de Cuidados de Suporte em Oncologia, Vila Nova de Gaia, Portugal,Research Center in Sports Sciences Health Sciences and Human Development (CIDESD), University of Maia, Maia, Portugal
| | - Luísa A. Helguero
- Institute of Biomedicine (IBIMED), University of Aveiro, Aveiro, Portugal,Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Ana Macedo
- Faculdade de Medicina e Ciências Biomédicas, Universidade do Algarve, Faro, Portugal,Medical Education Department, Evidenze Group, Lisboa, Portugal
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Lukas A, Theunissen M, Boer DDKD, van Kuijk S, Van Noyen L, Magerl W, Mess W, Buhre W, Peters M. AMAZONE: prevention of persistent pain after breast cancer treatment by online cognitive behavioral therapy-study protocol of a randomized controlled multicenter trial. Trials 2022; 23:595. [PMID: 35879728 PMCID: PMC9310687 DOI: 10.1186/s13063-022-06549-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Surviving breast cancer does not necessarily mean complete recovery to a premorbid state of health. Among the multiple psychological and somatic symptoms that reduce the quality of life of breast cancer survivors, persistent pain after breast cancer treatment (PPBCT) with a prevalence of 15–65% is probably the most invalidating. Once chronic, PPBCT is difficult to treat and requires an individualized multidisciplinary approach. In the past decades, several somatic and psychological risk factors for PPBCT have been identified. Studies aiming to prevent PPBCT by reducing perioperative pain intensity have not yet shown a significant reduction of PPBCT prevalence. Only few studies have been performed to modify psychological distress around breast cancer surgery. The AMAZONE study aims to investigate the effect of online cognitive behavioral therapy (e-CBT) on the prevalence of PPBCT. Methods The AMAZONE study is a multicenter randomized controlled trial, with an additional control arm. Patients (n=138) scheduled for unilateral breast cancer surgery scoring high for surgical or cancer-related fears, general anxiety or pain catastrophizing are randomized to receive either five sessions of e-CBT or online education consisting of information about surgery and a healthy lifestyle (EDU). The first session is scheduled before surgery. In addition to the online sessions, patients have three online appointments with a psychotherapist. Patients with low anxiety or catastrophizing scores (n=322) receive treatment as usual (TAU, additional control arm). Primary endpoint is PPBCT prevalence 6 months after surgery. Secondary endpoints are PPBCT intensity, the intensity of acute postoperative pain during the first week after surgery, cessation of postoperative opioid use, PPBCT prevalence at 12 months, pain interference, the sensitivity of the nociceptive and non-nociceptive somatosensory system as measured by quantitative sensory testing (QST), the efficiency of endogenous pain modulation assessed by conditioned pain modulation (CPM) and quality of life, anxiety, depression, catastrophizing, and fear of recurrence until 12 months post-surgery. Discussion With perioperative e-CBT targeting preoperative anxiety and pain catastrophizing, we expect to reduce the prevalence and intensity of PPBCT. By means of QST and CPM, we aim to unravel underlying pathophysiological mechanisms. The online application facilitates accessibility and feasibility in a for breast cancer patients emotionally and physically burdened time period. Trial registration NTR NL9132, registered December 16 2020.
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Affiliation(s)
- Anne Lukas
- Department of Anesthesiology & Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.
| | - Maurice Theunissen
- Department of Anesthesiology & Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Dianne de Korte-de Boer
- Department of Anesthesiology & Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Sander van Kuijk
- Department of Clinical Epidemiology and Medical Technology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Lotte Van Noyen
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Walter Magerl
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Ruprecht-Karls-University Heidelberg, Medical Faculty Mannheim, Heidelberg, Germany
| | - Werner Mess
- Department of Clinical Neurophysiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Wolfgang Buhre
- Department of Anesthesiology & Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Madelon Peters
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
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Respiratory Physiotherapy Intervention Strategies in the Sequelae of Breast Cancer Treatment: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073800. [PMID: 35409486 PMCID: PMC8997605 DOI: 10.3390/ijerph19073800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/10/2022] [Accepted: 03/19/2022] [Indexed: 02/05/2023]
Abstract
Breast cancer treatments can trigger respiratory sequelae. Respiratory physiotherapy helps to eliminate or mitigate the sequelae by optimizing respiratory function. This systematic review aims to synthesize the scientific evidence and assess its quality regarding the use of respiratory physiotherapy in the sequelae of breast cancer. The Cochrane Library, Physiotherapy Evidence Database, PubMed, Web of Science, Scientific Electronic Library Online, Cumulative Index of Nursing and Allied Literature Complete, and Scopus were searched. Study quality was determined using the PEDro scale, STROBE Statement, and Single-Case Experimental Design Scale. Ten studies, six clinical trials, one case study, and three observational studies were selected. The mean methodological quality of the clinical trials was 5.6, that of the case study was 7, and that of the observational studies was 56%. Respiratory physiotherapy has been observed to improve respiratory capacity, lung function, respiratory muscle strength, effort tolerance, dyspnea, fatigue, thoracic mobility, upper limb volume, sleep quality and quality of life, as well as sensitivity to adverse physiological reactions, nausea, vomiting, and anxiety. However, it is not effective for vasomotor symptoms. More clinical trials are needed. These studies should homogenize the techniques used, as well as improve their methodological quality.
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Access to Physical Rehabilitation for a Range of Adverse Physical Effects Following Different Types of Breast Cancer Surgery. REHABILITATION ONCOLOGY 2022. [DOI: 10.1097/01.reo.0000000000000297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bruce J, Mazuquin B, Mistry P, Rees S, Canaway A, Hossain A, Williamson E, Padfield EJ, Lall R, Richmond H, Chowdhury L, Lait C, Petrou S, Booth K, Lamb SE, Vidya R, Thompson AM. Exercise to prevent shoulder problems after breast cancer surgery: the PROSPER RCT. Health Technol Assess 2022; 26:1-124. [PMID: 35220995 DOI: 10.3310/jknz2003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Upper limb problems are common after breast cancer treatment. OBJECTIVES To investigate the clinical effectiveness and cost-effectiveness of a structured exercise programme compared with usual care on upper limb function, health-related outcomes and costs in women undergoing breast cancer surgery. DESIGN This was a two-arm, pragmatic, randomised controlled trial with embedded qualitative research, process evaluation and parallel economic analysis; the unit of randomisation was the individual (allocated ratio 1 : 1). SETTING Breast cancer centres, secondary care. PARTICIPANTS Women aged ≥ 18 years who had been diagnosed with breast cancer and were at higher risk of developing shoulder problems. Women were screened to identify their risk status. INTERVENTIONS All participants received usual-care information leaflets. Those randomised to exercise were referred to physiotherapy for an early, structured exercise programme (three to six face-to-face appointments that included strengthening, physical activity and behavioural change strategies). MAIN OUTCOME MEASURES The primary outcome was upper limb function at 12 months as assessed using the Disabilities of Arm, Hand and Shoulder questionnaire. Secondary outcomes were function (Disabilities of Arm, Hand and Shoulder questionnaire subscales), pain, complications (e.g. wound-related complications, lymphoedema), health-related quality of life (e.g. EuroQol-5 Dimensions, five-level version; Short Form questionnaire-12 items), physical activity and health service resource use. The economic evaluation was expressed in terms of incremental cost per quality-adjusted life-year and incremental net monetary benefit gained from an NHS and Personal Social Services perspective. Participants and physiotherapists were not blinded to group assignment, but data collectors were blinded. RESULTS Between 2016 and 2017, we randomised 392 participants from 17 breast cancer centres across England: 196 (50%) to the usual-care group and 196 (50%) to the exercise group. Ten participants (10/392; 3%) were withdrawn at randomisation and 32 (8%) did not provide complete baseline data. A total of 175 participants (89%) from each treatment group provided baseline data. Participants' mean age was 58.1 years (standard deviation 12.1 years; range 28-88 years). Most participants had undergone axillary node clearance surgery (327/392; 83%) and 317 (81%) had received radiotherapy. Uptake of the exercise treatment was high, with 181 out of 196 (92%) participants attending at least one physiotherapy appointment. Compliance with exercise was good: 143 out of 196 (73%) participants completed three or more physiotherapy sessions. At 12 months, 274 out of 392 (70%) participants returned questionnaires. Improvement in arm function was greater in the exercise group [mean Disabilities of Arm, Hand and Shoulder questionnaire score of 16.3 (standard deviation 17.6)] than in the usual-care group [mean Disabilities of Arm, Hand and Shoulder questionnaire score of 23.7 (standard deviation 22.9)] at 12 months for intention-to-treat (adjusted mean difference Disabilities of Arm, Hand and Shoulder questionnaire score of -7.81, 95% confidence interval -12.44 to -3.17; p = 0.001) and complier-average causal effect analyses (adjusted mean difference -8.74, 95% confidence interval -13.71 to -3.77; p ≤ 0.001). At 12 months, pain scores were lower and physical health-related quality of life was higher in the exercise group than in the usual-care group (Short Form questionnaire-12 items, mean difference 4.39, 95% confidence interval 1.74 to 7.04; p = 0.001). We found no differences in the rate of adverse events or lymphoedema over 12 months. The qualitative findings suggested that women found the exercise programme beneficial and enjoyable. Exercise accrued lower costs (-£387, 95% CI -£2491 to £1718) and generated more quality-adjusted life years (0.029, 95% CI 0.001 to 0.056) than usual care over 12 months. The cost-effectiveness analysis indicated that exercise was more cost-effective and that the results were robust to sensitivity analyses. Exercise was relatively cheap to implement (£129 per participant) and associated with lower health-care costs than usual care and improved health-related quality of life. Benefits may accrue beyond the end of the trial. LIMITATIONS Postal follow-up was lower than estimated; however, the study was adequately powered. No serious adverse events directly related to the intervention were reported. CONCLUSIONS This trial provided robust evidence that referral for early, supported exercise after breast cancer surgery improved shoulder function in those at risk of shoulder problems and was associated with lower health-care costs than usual care and improved health-related quality of life. FUTURE WORK Future work should focus on the implementation of exercise programmes in clinical practice for those at highest risk of shoulder problems. TRIAL REGISTRATION This trial is registered as ISRCTN35358984. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Julie Bruce
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Bruno Mazuquin
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Pankaj Mistry
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Sophie Rees
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Alastair Canaway
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Anower Hossain
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
- Institute of Statistical Research and Training (ISRT), University of Dhaka, Dhaka, Bangladesh
| | - Esther Williamson
- Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Emma J Padfield
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Ranjit Lall
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Helen Richmond
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada
| | - Loraine Chowdhury
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Clare Lait
- Gloucestershire Care Services NHS Trust, Gloucester, UK
| | - Stavros Petrou
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Katie Booth
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Sarah E Lamb
- College of Medicine and Health, University of Exeter, Exeter, UK
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Ye XX, Ren ZY, Vafaei S, Zhang JM, Song Y, Wang YX, Song PG. Effectiveness of Baduanjin Exercise on Quality of Life and Psychological Health in Postoperative Patients With Breast Cancer: A Systematic Review and Meta-analysis. Integr Cancer Ther 2022; 21:15347354221104092. [PMID: 35699146 PMCID: PMC9202258 DOI: 10.1177/15347354221104092] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: Baduanjin exercise is a traditional Chinese Qigong exercise. This study aimed
to investigate the effects of Baduanjin exercise on the quality of life and
psychological status of postoperative patients with breast cancer. Methods: A systematic review and meta-analysis were conducted. Eight databases were
searched from inception to December 15, 2021, restricting the language to
English and Chinese. RevMan5.3 software was employed for data analysis. This
study was registered in PROSPERO, number CRD 42020222132. Results: A total of 7 randomized controlled trials (RCTs) with 450 postoperative
breast cancer patients with or without Baduanjin exercise were collected.
Compared with the group without Baduanjin, those who practiced Baduanjin
showed significant improvement in quality of life (WMD = 5.70, 95% CI
3.11-8.29, P < .0001). Subgroup analysis showed
significant improvement in physical (WMD = 1.83, 95% CI 1.13-2.53,
P < .00001) and functional well-being (WMD = 1.58,
95% CI 0.77-2.39, P = .0001), which were measured by the
functional assessment of cancer therapy-breast (FACT-B). Subgroup analysis
also showed that role-physical (WMD = 11.49, 95% CI 8.86-14.13,
P < .00001) and vitality (WMD = 8.58, 95% CI
5.60-11.56, P < .00001) were significantly increased, as
measured by a 36-item Short Form survey (SF-36). In terms of psychological
health, Baduanjin exercise reduced patients’ anxiety (WMD = −8.02, 95% CI
−9.27 to −6.78, P < .00001) and depression (WMD = −4.45,
95% CI −5.62 to −3.28, P < .00001). Conclusions: Baduanjin is an effective exercise, which can significantly improve the
quality of life and psychological health of breast cancer patients after
operation.
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Affiliation(s)
- Xin-Xin Ye
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zi-Yang Ren
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Somayeh Vafaei
- Department of Molecular Medicine, Faculty of advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Jun-Meng Zhang
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yuan Song
- School of Nursing, Henan University of Traditional Chinese Medicine, Zhengzhou, Henan, China
| | - Yang-Xin Wang
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Pei-Ge Song
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Klein I, Kalichman L, Chen N, Susmallian S. A comprehensive approach to risk factors for upper arm morbidities following breast cancer treatment: a prospective study. BMC Cancer 2021; 21:1251. [PMID: 34800988 PMCID: PMC8605604 DOI: 10.1186/s12885-021-08891-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/19/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND 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. METHODS A 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. RESULTS A 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). CONCLUSIONS Upper 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 REGISTRATION The study was registered in Clinical trial with the ID number: NCT03389204 .
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Affiliation(s)
- Ifat Klein
- Department of Physical Therapy, Assuta Medical Center, Tel Aviv, Israel.,Department of physical therapy, Faculty of Health Sciences, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Leonid Kalichman
- Department of physical therapy, Faculty of Health Sciences, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Noy Chen
- Department of Physical Therapy, Assuta Medical Center, Tel Aviv, Israel
| | - Sergio Susmallian
- Department of Surgery, Assuta Medical Center, 20 Habarzel Street, 69710, Tel Aviv, Israel. .,Faculty of Medicine, Ben Gurion University of the Negev, Beer Sheva, Israel.
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Exercise after Breast Reconstruction Surgery: Evaluating Current Trends and Practices of U.S. Plastic Surgeons. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3857. [PMID: 34646725 PMCID: PMC8500580 DOI: 10.1097/gox.0000000000003857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/19/2021] [Indexed: 11/26/2022]
Abstract
Breast cancer patients have reported restricted mobility, pain, lymphedema, and impaired sensation and strength after breast reconstruction surgery. Many studies have demonstrated benefits of early exercise intervention (within the first 2 weeks) for functional recovery after breast surgery. From the surgeon's perspective, there is a concern that early postoperative exercise can potentially lead to complications or even reconstruction failure. The purpose of this study was to evaluate current trends and practices related to patient exercise after breast reconstruction among plastic surgeons in the United States. Methods An anonymous, electronic survey was sent to a random cohort of 2336 active members of the American Society of Plastic Surgeons. The survey consisted of 23 questions and was used to assess how plastic surgeons currently manage patients postoperatively after breast reconstruction. Results Responses were received from 228 plastic surgeons. Thirty-six (18%) respondents reported never prescribing physical therapy (PT) postoperatively. In total, 154 (76%) prescribe PT to less than 50% of their patients, and those who do most commonly prescribe it more than 3 weeks postoperatively. There was no difference in perceived rate of complications by respondents who prescribe early versus late exercise (χ 2 (5) = 8.815, P = 0.117). Conclusions Based on our survey results, only a small percentage of plastic and reconstructive surgeons support early initiation of exercise, and PT is being prescribed to a minority of patients. Surgeons and physical therapists must work together to devise a recovery program that maximizes functional outcomes for patients while also limiting complications.
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Post-Breast Surgery Pain Syndrome: Shifting a Surgical Paradigm. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3720. [PMID: 34316427 PMCID: PMC8301281 DOI: 10.1097/gox.0000000000003720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/04/2021] [Indexed: 11/26/2022]
Abstract
Post-mastectomy pain syndrome and the less well-described post-breast surgery pain syndrome are long-term neuropathic pain conditions that may affect more than 50% of patients after mastectomy and breast surgery. While the etiology, risk factors, and management have been reviewed in our literature, we offer here a focused outline that will gear the plastic surgeon with tools to lead a multidisciplinary, algorithmic approach to the care of patients with post-mastectomy pain syndrome/post-breast surgery pain syndrome. After reading this article, we hope the reader will have improved awareness of post-mastectomy pain syndrome/post-breast surgery pain syndrome, and thus be able to incorporate appropriate treatments and preventative steps into their primary surgical routine.
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Klein I, Kalichman L, Chen N, Susmallian S. A pilot study evaluating the effect of early physical therapy on pain and disabilities after breast cancer surgery: Prospective randomized control trail. Breast 2021; 59:286-293. [PMID: 34340163 PMCID: PMC8342784 DOI: 10.1016/j.breast.2021.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/08/2021] [Accepted: 07/16/2021] [Indexed: 12/24/2022] Open
Abstract
Background Morbidity of the shoulders after breast cancer (BC) surgery is a common side effect that includes; persistent pain, function limitation, and decreased range of motion (ROM). This study examines the effect of early physical therapy (PT) and patient's education on these morbidities. Methods A prospective, randomized clinical trial was conducted at a single medical center from October 2018 until April 2019. Women scheduled for breast cancer surgery were divided into intervention or control as standard care. The intervention included a PT treatment that included exercise instructions from the first postoperative day. Pain levels, upper limb function, ROM, and complications were measured. Results The study includes 157 women (mean age, 52.2 ± 12.9). Early PT reduced pain levels at the first month (NPRS 1.5 ± 1.2) and six months (NPRS 0.5 ± 0.8), compared with control (NPRS 2.1 ± 1.4, 1.0 ± 1.2), p = 0.019 and p = 0.011, respectively. Subdivision of the sample into small and extensive surgeries revealed additional positive effect for the intervention six months postoperatively on functional disabilities, p = 0.004 and p = 0.032 respectively. No complications attributable to the intervention were recorded. Conclusions Early PT and patient education reduces pain levels, and may improve function disabilities, without causing postoperative complications, although a larger study is needed to achieve unequivocal results. In breast cancer surgeries frequently delay the start of physical activities, arguing that it involves complications. The shoulder after breast surgery may provoke prolonged pain, disabilities, and prolongs recovery time. Physical therapy given the day after surgery, does not cause postoperative complications. Early onset of exercise regarding function and pain during recovery, may help reduce pain levels.
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Affiliation(s)
- Ifat Klein
- Department of Physical Therapy, Assuta Medical Center, Tel Aviv, Israel; Department of Physical Therapy. Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Leonid Kalichman
- Department of Physical Therapy. Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Noy Chen
- Department of Physical Therapy, Assuta Medical Center, Tel Aviv, Israel
| | - Sergio Susmallian
- Department of Surgery, Assuta Medical Center, Tel Aviv, Israel; Faculty of Medicine, Ben Gurion University of the Negev, Beer Sheva, Israel.
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Takuwa H, Izaki E, Yamashiro H, Takeuchi M. Can the dissection device with low thermal injury prevent breast cancer-related arm lymphedema? A retrospective cohort study. Asian J Surg 2021; 44:1220-1221. [PMID: 34193385 DOI: 10.1016/j.asjsur.2021.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Haruko Takuwa
- Departments of Breast Surgery, Mitsubishi Kyoto Hospital, 1, Katsuragoshomachi, Nishikyo-ku, Kyoto, 615-8087, Japan.
| | - Emi Izaki
- Departments of Breast Surgery, Mitsubishi Kyoto Hospital, 1, Katsuragoshomachi, Nishikyo-ku, Kyoto, 615-8087, Japan
| | - Hiroyasu Yamashiro
- Department of Breast Surgery, Tenri Yorozu Sodansho Hospital, 200, Mishima-cho, Tenri-city, Nara, 632-8552, Japan
| | - Megumi Takeuchi
- Departments of Breast Surgery, Mitsubishi Kyoto Hospital, 1, Katsuragoshomachi, Nishikyo-ku, Kyoto, 615-8087, Japan
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Shao YW, Shu Q, Xu D, Teng H, Wu GS, Hou JX, Tian J. Effect of different rehabilitation training timelines to prevent shoulder dysfunction among postoperative breast cancer patients: study protocol for a randomized controlled trial. Trials 2021; 22:16. [PMID: 33407753 PMCID: PMC7789409 DOI: 10.1186/s13063-020-04954-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 12/08/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction Due to advancements in treatment, the survival of breast cancer (BC) patients has significantly improved. Improving the postoperative quality of life has become a widespread concern for patients and doctors. At present, the staged rehabilitation training program for postoperative BC patients has been recognized. However, there is not yet a consensus about the optimal time to initiate rehabilitation training. We designed this study to investigate the optimal intervention times for postoperative BC patients to begin different stages of rehabilitation. Design This is a randomized controlled trial. Female participants with BC who are scheduled to undergo mastectomy, including unilateral total breast or breast-conserving surgery plus axillary lymph node dissection, will be enrolled in this study. The intervention includes the following: 200 participants will be allocated using a 1:1:1:1 ratio to the A, B, C, and D groups, which have four different rehabilitation timelines for four phases of rehabilitation exercises. A therapist will evaluate the patient’s overall health and then adjust the training intensity before initiating training. The assessments include upper limb mobility, grip, limb circumference, postoperative drainage volume (PDV), and pain. The training will last for 12 weeks, and patients will undergo follow-up twice within 6 weeks after discharge. Outcomes include the following: Constant-Murley Score (CMS) is the primary parameter. European Organization Research and Treatment of Cancer Quality of Life Questionnaire-BR23 (EORTC QLQ-BR23), SF-36, range of motion (ROM), strength, grip, circumference, PDV, and pain are the secondary parameters. All enrolled subjects will be assessed at 1 day, 3 days, 1 week, and 2, 3, 6, 9, 12, and 18 weeks after the surgery. Discussion This is a randomized controlled trial to evaluate the effect of different rehabilitation training timelines to prevent shoulder dysfunction among postoperative patients with BC. If the results are confirmed, this study will establish an optimal timeline for postoperative BC rehabilitation. Trial registration ClinicalTrials.gov NCT03658265. Registered on September 2018.
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Affiliation(s)
- Yu-Wei Shao
- The Second Clinical College of Wuhan University, Wuhan, Hubei, China.,Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Qing Shu
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Dan Xu
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Hui Teng
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Gao-Song Wu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jin-Xuan Hou
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jun Tian
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
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Li X, Meng M, Zhao J, Zhang X, Yang D, Fang J, Wang J, Han L, Hao Y. Shared Decision-Making in Breast Reconstruction for Breast Cancer Patients: A Scoping Review. Patient Prefer Adherence 2021; 15:2763-2781. [PMID: 34916786 PMCID: PMC8670888 DOI: 10.2147/ppa.s335080] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/12/2021] [Indexed: 12/14/2022] Open
Abstract
For most breast cancer (BC) patients who have undergone a mastectomy, the decision whether to proceed with breast reconstruction (BR) is complicated and requires deliberation. Shared decision-making (SDM) helps to address those needs and promote informed value-based decisions. However, little is known about the SDM status for BR in BC patients. This scoping review describes: 1) basic characteristics of studies on BR SDM in BC patients; 2) factors influencing BR SDM in BC patients; 3) experience and perception of BR SDM in BC patients; and 4) outcome measures reported. This review was performed in accordance with the Arksey and O'Malley methodology. A total of 5 English and 4 Chinese databases were searched, as well as different sources from grey literature. The data extraction form was developed by referring to the objectives and the Ottawa Decision Support Framework (ODSF). Data was analyzed using thematic analysis, framework analysis and descriptive statistics, with findings presented in the tables and diagrams. A total of 1481 records were retrieved and 42 of these included after screening. In 21 (21/42, 50%) of the studies, patient decision aids (PDAs) were utilized, and in 17 (17/42, 40.48%) of the studies, the factors influencing the implementation of SDM were explored. Of these 17 studies, the factors influencing the implementation of SDM were categorized into the following: the patient level (17/17, 100%), the healthcare level (2/17, 11.76%) and the organizational and system level (7/17, 41.18%). A total of 8 (19.05%) of the 42 studies focused on patients' experiences and perceptions of SDM, and all studies used qualitative research methods. Of these 8 studies, a total of 7 (7/8, 87.50%) focused on patients' experiences of SDM participation, and 4 (4/8, 50.00%) focused on patients' perceptions of SDM. A total of 24 studies (24/42, 57.14%) involved quantitative outcome measures, where 49 items were divided into three classifications according to the outcomes of ODSF: the quality of the decision (17/24, 70.83%), the quality of the decision-making process (20/24, 83.33%), and impact (13/24, 54.17%). Although researchers have paid less attention to other research points in the field of SDM, compared to the design and application of SDM interventional tools, the research team still presents some equally noteworthy points through scoping review. For instance, the various factors influencing BC patients' participation in SDM for BR (especially at the healthcare provider level and at the organizational system level), patients' experiences and perceptions. Systematic reviews (SRs) should be conducted to quantify the impact of these different factors on BR SDM. Implementation of scientific theories and methods can inform the exploration and integration of these factors.
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Affiliation(s)
- Xuejing Li
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
| | - Meiqi Meng
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
| | - Junqiang Zhao
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
- Center for Research on Health and Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Xiaoyan Zhang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
| | - Dan Yang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
| | - Jiaxin Fang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
| | - Junxin Wang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
| | - Liu Han
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, People’s Republic of China
| | - Yufang Hao
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
- Correspondence: Yufang Hao Liangxiang High Education Park, Fangshan District, Beijing, 102488, People’s Republic of ChinaTel +86-13552850210 Email
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20
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Carreira H, Williams R, Funston G, Stanway S, Bhaskaran K. Associations between breast cancer survivorship and adverse mental health outcomes: A matched population-based cohort study in the United Kingdom. PLoS Med 2021; 18:e1003504. [PMID: 33411711 PMCID: PMC7822529 DOI: 10.1371/journal.pmed.1003504] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 01/22/2021] [Accepted: 12/18/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Breast cancer is the most common cancer diagnosed in women globally, and 5-year net survival probabilities in high-income countries are generally >80%. A cancer diagnosis and treatment are often traumatic events, and many women struggle to cope during this period. Less is known, however, about the long-term mental health impact of the disease, despite many women living several years beyond their breast cancer and mental health being a major source of disability in modern societies. The objective of this study was to quantify the risk of several adverse mental health-related outcomes in women with a history of breast cancer followed in primary care in the United Kingdom National Health Service, compared to similar women who never had cancer. METHODS AND FINDINGS We conducted a matched cohort study using data routinely collected in primary care across the UK to quantify associations between breast cancer history and depression, anxiety, and other mental health-related outcomes. All women with incident breast cancer in the Clinical Practice Research Datalink (CPRD) GOLD primary care database between 1988 and 2018 (N = 57,571, mean = 62 ± 14 years) were matched 1:4 to women with no prior cancer (N = 230,067) based on age, primary care practice, and eligibility of the data for linkage to hospital data sources. Cox models were used to estimate associations between breast cancer survivorship and each mental health-related outcome, further adjusting for diabetes, body mass index (BMI), and smoking and drinking status at baseline. Breast cancer survivorship was positively associated with anxiety (adjusted hazard ratio (HR) = 1.33; 95% confidence interval (CI): 1.29-1.36; p < 0.001), depression (1.35; 1.32-1.38; p < 0.001), sexual dysfunction (1.27; 1.17-1.38; p < 0.001), and sleep disorder (1.68; 1.63-1.73; p < 0.001), but not with cognitive dysfunction (1.00; 0.97-1.04; p = 0.88). Positive associations were also found for fatigue (HR = 1.28; 1.25-1.31; p < 0.001), pain (1.22; 1.20-1.24; p < 0.001), receipt of opioid analgesics (1.86; 1.83-1.90; p < 0.001), and fatal and nonfatal self-harm (1.15; 0.97-1.36; p = 0.11), but CI was wide, and the relationship was not statistically significant for the latter. HRs for anxiety and depression decreased over time (p-interaction <0.001), but increased risks persisted for 2 and 4 years, respectively, after cancer diagnosis. Increased levels of pain and sleep disorder persisted for 10 years. Younger age was associated with larger HRs for depression, cognitive dysfunction, pain, opioid analgesics use, and sleep disorders (p-interaction <0.001 in each case). Limitations of the study include the potential for residual confounding by lifestyle factors and detection bias due to cancer survivors having greater healthcare contact. CONCLUSIONS In this study, we observed that compared to women with no prior cancer, breast cancer survivors had higher risk of anxiety, depression, sleep problems, sexual dysfunction, fatigue, receipt of opioid analgesics, and pain. Relative risks estimates tended to decrease over time, but anxiety and depression were significantly increased for 2 and 4 years after breast cancer diagnosis, respectively, while associations for fatigue, pain, and sleep disorders were elevated for at least 5-10 years after diagnosis. Early diagnosis and increased awareness among patients, healthcare professionals, and policy makers are likely to be important to mitigate the impacts of these raised risks.
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Affiliation(s)
- Helena Carreira
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Rachael Williams
- Clinical Practice Research Datalink (CPRD), Medicines and Healthcare products Regulatory Agency, London, United Kingdom
| | - Garth Funston
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Susannah Stanway
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - Krishnan Bhaskaran
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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21
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Caputo GG, Zingaretti N, Kiprianidis I, Zanfisi C, Domenici L, Parodi PC, Governa M. Quality of Life and Early Functional Evaluation in Direct-to-Implant Breast Reconstruction After Mastectomy: A Comparative Study Between Prepectoral Versus Dual-Plane Reconstruction. Clin Breast Cancer 2020; 21:344-351. [PMID: 33308993 DOI: 10.1016/j.clbc.2020.11.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/12/2020] [Accepted: 11/14/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND In conservative mastectomies, in which the native skin envelope is preserved, positioning an implant in the submuscular plane commonly leads to functional consequences like upper limb movement impairment and animation phenomena. In recent years, however, a new conservative prepectoral breast reconstruction technique has been proposed, with demonstrated surgical safety and aesthetic effectiveness. The aim of our study was to explore and compare the functional and aesthetic outcomes of the prepectoral/acellular dermal matrix (ADM)-wrapped implant procedure versus subpectoral/ADM-assisted reconstruction. PATIENTS AND METHODS A retrospective nonrandomized comparative study of 94 patients (121 breasts) undergoing direct-to-implant breast reconstruction after skin-/nipple-sparing and skin reduction was conducted from February 2013 to October 2017. Fifty-five patients (group A) received subpectoral ADM-assisted reconstruction with dual-plane implant positioning, and 39 patients (group B) received prepectoral partially or totally ADM-wrapped implant reconstruction. Patients were allocated to either group A or B depending on the mastectomy flap thickness and vitality, as assessed clinically during the operation. Details of rehabilitation program, postoperative pain at 72 hours, postoperative analgesic therapies, demographic data, and complications were recorded. Upper limb function was assessed before and 1 month after surgery by a physiatrist according to a precise protocol. Patients were asked to fill in the BREAST-Q reconstruction questionnaire after surgery to evaluate outcomes. RESULTS Differences in upper limb function between groups, namely flexion (P = .03), abduction (P = .003), internal rotation (P = .02), and external rotation (P = .05), were statistically significant. Although most patients required postoperative rehabilitation, the individual rehabilitation intervention frequency was greater in the subpectoral group (91% in group A vs 74% in group B). There was also a significant difference in postoperative pain (within 72 hours), with less pain perceived in the prepectoral group (P = .01). Furthermore, prepectoral patients reported slightly better postoperative quality of life than subpectoral patients, particularly in the domains of sexual well-being (P = .005) and satisfaction with breast (P = .002). CONCLUSION In our case series, prepectoral implant positioning with partial or total ADM coverage led to less impairment of upper limb function in terms of flexion, abduction, and internal and external rotation, and also reduce the need for rehabilitation. Furthermore, as a result of the less invasive procedure, prepectoral patients had less immediate postoperative pain and were more satisfied with breast appearance.
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Affiliation(s)
- Glenda Giorgia Caputo
- Department of Plastic and Reconstructive Surgery, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
| | - Nicola Zingaretti
- Department of Plastic and Reconstructive Surgery, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | | | - Chiara Zanfisi
- Department of Physical Medicine and Rehabilitation, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Lavinia Domenici
- Gynecology and Obstetrics 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Pier Camillo Parodi
- Department of Plastic and Reconstructive Surgery, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Maurizio Governa
- Department of Plastic and Reconstructive Surgery and Burn Center
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22
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Ostos-Díaz B, Casuso-Holgado MJ, Muñoz-Fernández MJ, Carazo AF, Martín-Valero R, Medrano-Sánchez EM. Early Physical Rehabilitation after Sentinel Lymph Node Biopsy in Breast Cancer: Is It Feasible and Safe? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228382. [PMID: 33198359 PMCID: PMC7697742 DOI: 10.3390/ijerph17228382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/07/2020] [Accepted: 11/09/2020] [Indexed: 12/17/2022]
Abstract
The primary purpose of this research was to investigate the feasibility and safety of delivering an early supervised physical therapy intervention to women after sentinel lymph node biopsy (SLNB); furthermore, we aimed to provide explorative data on its effects. This was a single-site feasibility study. Pre- and post-evaluation was conducted from baseline to follow-up at 6 months. Primary outcomes were participant recruitment, participant retention, compliance with the intervention, and safety. Secondary outcomes were shoulder range of motion, handgrip strength, upper limb pain and disability, scar recovery, quality of life, and the incidence of axillary web syndrome (AWS) and/or lymphoedema. A total of 43 participants (mean age 55.37 years) completed the trial and the follow-up period. A total of 91% of women who met the inclusion criteria agreed to participate, and the adherence rate was 80%. No adverse events were reported. Incidence of AWS was 9.3%, and there was no incidence of lymphoedema at 6 months. Our results support that this intervention is feasible and safe. The results presented in this study also provide preliminary evidence for the use of a rehabilitation program as a supportive intervention after SLNB, but future research on effectiveness is needed.
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Affiliation(s)
- Beatriz Ostos-Díaz
- Department of Physiotherapy, University of Sevilla, 41009 Sevilla, Spain; (B.O.-D.); (M.J.M.-F.)
| | - María Jesús Casuso-Holgado
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, C/Avicena s/n, 41009 Seville, Spain;
- Correspondence: ; Tel.: +34-95-448-65-21; Fax: +34-95-448-65-27
| | | | - Ana F. Carazo
- Department of Economy, Quantitative Methods and Economy History, Pablo de Olavide University, 41013 Sevilla, Spain;
| | - Rocío Martín-Valero
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Málaga, Spain;
| | - Esther M. Medrano-Sánchez
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, C/Avicena s/n, 41009 Seville, Spain;
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23
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The effect of limb position on the reliability of leg circumference measurements in patients diagnosed with lower limb lymphoedema. Support Care Cancer 2020; 29:3183-3189. [PMID: 33089370 DOI: 10.1007/s00520-020-05835-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To establish the intrarater reliability of lower limb circumference measures in a sample of individuals who are diagnosed with lower limb lymphoedema and to evaluate if change in limb position has an effect on the reliability of circumferential measures. METHOD A sample of forty-one adults diagnosed with a lower limb lymphoedema were recruited. Participants had their affected leg measured three times by a qualified therapist during a standard outpatient appointment: twice in a lying position and once in sitting with knee flexed at 90°. To examine the intrarater reliability, interclass correlation coefficients (ICC) with 95% confident intervals were calculated. RESULTS Excellent intrarater reliability was established at each measurement point and for the sum of circumferential measures when the limb remeasured in the same position by the same therapist. Changing the position of the limb resulted in lower intrarater reliability values at 10 and 30 cm from the base of the foot. CONCLUSIONS The current study provides evidence for the intrarater reliability of lower limb circumference measures and highlights the need for consistency when remeasuring and monitoring the limb of those diagnosed with lower limb lymphoedema. IMPLICATIONS FOR CANCER SURVIVORS Lymphoedema is a significant problem for breast cancer survivors but also provides lifetime risk to all survivors of lymph node surgery for solid tumours. The monitoring and surveillance of leg circumference measures of people diagnosed with lower limb lymphoedema has been a valuable instrument when reviewing progress of this chronic condition.
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24
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Carreira H, Williams R, Dempsey H, Stanway S, Smeeth L, Bhaskaran K. Quality of life and mental health in breast cancer survivors compared with non-cancer controls: a study of patient-reported outcomes in the United Kingdom. J Cancer Surviv 2020; 15:564-575. [PMID: 33089480 PMCID: PMC8272697 DOI: 10.1007/s11764-020-00950-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/28/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE There is limited high-quality evidence on quality of life, anxiety, and depressive symptoms in breast cancer survivors and women with no history of cancer. We aimed to address this by comparing patient-reported outcomes between breast cancer survivors and women with no history of breast cancer. METHODS Breast cancer survivors and women with no prior cancer were selected from the UK Clinical Practice Research Datalink GOLD primary care database, which includes population-based primary care electronic health record data. Breast cancer survivors and controls were frequency matched by age and primary care practice. Outcomes were assessed with validated instruments via postal questionnaire. Linear and logistic regression models were fitted to estimate adjusted associations between breast cancer survivorship and outcomes. RESULTS A total of 356 breast cancer survivors (8.1 years post diagnosis) and 252 women with no prior cancer participated in the study. Compared with non-cancer controls, breast cancer survivors had poorer QoL in the domains of cognitive problems (adjusted β (aβ) = 1.4, p = 0.01), sexual function (aβ = 1.7, p = 0.02) and fatigue (aβ = 1.3, p = 0.01), but no difference in negative feelings, positive feelings, pain, or social avoidance. Breast cancer survivors had higher odds of borderline-probable anxiety (score ≥ 8) (adjusted OR = 1.47, 95%CI:1.15-1.87), but no differences in depression. Advanced stage at diagnosis and chemotherapy treatment were associated with poorer QoL. CONCLUSIONS Compared with women with no history of cancer, breast cancer survivors report more problems with cognition, sexual function, fatigue, and anxiety, particularly where their cancer was advanced and/or treated with chemotherapy. IMPLICATIONS FOR CANCER SURVIVORS Breast cancer survivors with more advanced disease and/or treated with chemotherapy should be closely monitored and, when possible, offered evidence-based intervention for fatigue, cognitive dysfunction, and sexual problems.
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Affiliation(s)
- Helena Carreira
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel street, London, WC1E 7HT, UK.
| | - Rachael Williams
- Clinical Practice Research Datalink (CPRD), Medicines and Healthcare products Regulatory Agency, 10th Floor, 10 South Colonnade, Canary Wharf, London, E14 4PU, UK
| | - Harley Dempsey
- Clinical Practice Research Datalink (CPRD), Medicines and Healthcare products Regulatory Agency, 10th Floor, 10 South Colonnade, Canary Wharf, London, E14 4PU, UK
| | - Susannah Stanway
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK.,Department of Medicine, The Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, Sutton, UK
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel street, London, WC1E 7HT, UK
| | - Krishnan Bhaskaran
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel street, London, WC1E 7HT, UK
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25
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de Menezes RF, Bergmann A, Thuler LCS. Alcohol consumption does not increase the risk of surgical wound complications in breast cancer patients. Int Wound J 2020; 17:1709-1716. [PMID: 32715640 DOI: 10.1111/iwj.13455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/24/2022] Open
Abstract
Alcohol consumption, despite influencing several organic processes, has been scarcely studied regarding the risk of developing surgical wound complications after surgical breast cancer treatment. The aim of this study was to analyse the association between alcohol consumption and the development of surgical wound complications in women undergoing surgical treatment for breast cancer. A prospective cohort study was conducted, comprising 486 women between 40 and 69 years old, interviewed during the preoperative period and followed up for 30 days. The occurrence of seroma, necrosis, surgical site infection (SSI), dehiscence, ecchymosis, and hematoma were considered as outcomes. Alcohol consumption during the 30 days prior to surgery was reported by 20.8% of the patients, with 8.4% being occasional consumers and 12.4% regular consumers. Binge drinking was reported by 10.2% of the women. The presence of surgical wound complications was observed in 65.2%. The most frequent complications were seroma (54.3%), necrosis (17.7%), and SSI (7.8%). No statistically significant association between alcohol consumption and the development of cicatricial complications was observed.
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Affiliation(s)
| | - Anke Bergmann
- Centro de Pesquisa, Instituto Nacional de Câncer-INCA, Rio de Janeiro, Brazil
| | - Luiz Claudio Santos Thuler
- Centro de Pesquisa, Instituto Nacional de Câncer-INCA, Rio de Janeiro, Brazil.,Programa de Pós Graduação em Neurologia, Universidade Federal do Estado do Rio de Janeiro-UNIRIO, Rio de Janeiro, Brazil
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26
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Gaskin KM, Peoples GE, McGhee DE. The Attachments of the Breast to the Chest Wall: A Dissection Study. Plast Reconstr Surg 2020; 146:11e-22e. [PMID: 32590636 DOI: 10.1097/prs.0000000000006954] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The anatomical descriptions of the attachments of the female breast to the chest wall vary in their structure, location, and terminology within the published literature. METHODS A dissection study of the attachments of the breast to the chest wall was conducted on 18 female embalmed breasts in the coronal (n = 15) and sagittal planes (n = 3). RESULTS Perimeter, posterior wall, and horizontal septum attachments were observed. The perimeter along its entire length was attached to the chest wall. Regional and anatomical variation was observed in this structure and location. Sharp dissection was required to remove it from the chest wall, in contrast to the blunt dissection required to remove the posterior wall and horizontal septum attachments. CONCLUSIONS The breast attaches to the chest wall along its entire perimeter, posterior wall, and horizontal septum, with the perimeter functioning as the primary anchor of the breast to the chest wall. The structure of the perimeter attachment is both periosteal and fascial and requires sharp dissection to remove it from the chest wall. The fascial structures of the posterior wall and horizontal septum require blunt dissection only. The structure of the perimeter has regional variation, and its location on the chest wall has anatomical variation. Detailed anatomical descriptions and illustrations are supported by photographic evidence of cadaver dissections in two planes. Clinical and anatomical terminology are linked, with clinical implications for medical anatomy education, breast modeling, and breast surgery.
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Affiliation(s)
- Kathryn M Gaskin
- From the Anatomy Laboratory, School of Medicine, University of Wollongong
| | - Gregory E Peoples
- From the Anatomy Laboratory, School of Medicine, University of Wollongong
| | - Deirdre E McGhee
- From the Anatomy Laboratory, School of Medicine, University of Wollongong
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27
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Mazuquin B, Sunemi MMDO, E Silva MPP, Sarian LOZ, Williamson E, Bruce J. Current physical therapy care of patients undergoing breast reconstruction for breast cancer: a survey of practice in the United Kingdom and Brazil. Braz J Phys Ther 2020; 25:175-185. [PMID: 32605886 DOI: 10.1016/j.bjpt.2020.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 03/12/2020] [Accepted: 05/25/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In both the United Kingdom (UK) and Brazil, women undergoing mastectomy should be offered breast reconstruction. Patients may benefit from physical therapy to prevent and treat muscular deficits. However, there are uncertainties regarding which physical therapy program to recommend. OBJECTIVE The aim was to investigate the clinical practice of physical therapists for patients undergoing breast reconstruction for breast cancer. A secondary aim was to compare physical therapy practice between UK and Brazil. METHODS Online survey with physical therapists in both countries. We asked about physical therapists' clinical practice. RESULTS 181 physical therapists completed the survey, the majority were from Brazil (77%). Respondents reported that only half of women having breast reconstruction were routinely referred to physical therapy postoperatively. Contact with patients varied widely between countries, the mean number of postoperative sessions was 5.7 in the UK and 15.1 in Brazil. The exercise programs were similar for different reconstruction operations. Therapists described a progressive loading structure over time: range of motion (ROM) was restricted to 90° of arm elevation in the first two postoperative weeks; by 2-4 weeks ROM was unrestricted; at 1-3 months muscle strengthening was initiated, and after three months the focus was on sports-specific activities. CONCLUSION Only half of patients having a breast reconstruction are routinely referred to physical therapy. Patients in Brazil have more intensive follow-up, with up to three times more face-to-face contact with a physical therapist than in the UK. Current practice broadly follows programs for mastectomy care rather than being specific to reconstruction surgery.
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Affiliation(s)
- Bruno Mazuquin
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, United Kingdom.
| | | | | | - Luís Otávio Zanatta Sarian
- Centre for Integral Attention to Women's Health, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Esther Williamson
- Nuffield Department of Orthopedics Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom
| | - Julie Bruce
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, United Kingdom
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28
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Physical side-effects following breast reconstructive surgery impact physical activity and function. Support Care Cancer 2020; 29:787-794. [PMID: 32468133 DOI: 10.1007/s00520-020-05534-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/14/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE To investigate the incidence and severity of physical side-effects experienced by women following breast reconstructive surgery and the effect of these side-effects on physical activity and function. METHODS Two hundred and thirty-one Australian women (55 years SD 6.5) who had previously had breast reconstruction surgery retrospectively self-reported the incidence and severity of eight physical side-effects and the perceived effect of these side effects on six physical functions, at three time points after their surgery. The frequency of the combined incidence/severity scores and their impact at the three time points were tabulated and compared using Chi-squared tests. A general linear regression was used to identify characteristics associated with moderate-very high (≥ 5/10) combined incidence/severity scores. RESULTS At 6 months following surgery, approximately 50% of respondents reported moderate to very high incidence/severity scores for physical side-effects across multiple body regions, which were perceived to limit their physical function and activity levels. The highest incidence/severity scores were associated with the following: (i) pre-existing physical problems before surgery, (ii) post-operative complications (seroma, infection, necrosis), and (iii) autologous rather than implant-based reconstructions. CONCLUSION A large percentage of women reported moderate to severe physical side-effects across multiple body regions following breast reconstructive surgery. These side-effects were perceived to negatively impact both physical function and activity. Early intervention, education and treatment are recommended to alleviate these issues and minimise their negative impact.
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29
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Ryans K, Davies CC, Gaw G, Lambe C, Henninge M, VanHoose L. Incidence and predictors of axillary web syndrome and its association with lymphedema in women following breast cancer treatment: a retrospective study. Support Care Cancer 2020; 28:5881-5888. [PMID: 32270312 DOI: 10.1007/s00520-020-05424-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/17/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Axillary web syndrome (AWS) presents as a common postsurgical complication in individuals with breast cancer. Breast cancer-related lymphedema (BCRL) contributes to the shoulder and arm morbidity common in breast cancer survivors and often associated to cancer treatment. A paucity of literature exists evaluating the risk factors for developing AWS and the association between AWS and BCRL. The purposes of this study were (1) to identify risk factors for AWS in individuals with breast cancer, (2) to examine the association between BCRL and AWS, and (3) to determine if AWS increases the risk for developing BCRL. METHODS A retrospective study of 354 women who underwent breast cancer treatment and received physical therapy was included. RESULTS Axillary web syndrome developed in a third of women and predominately occurred in the first 8 postoperative weeks. The odds of AWS development were 73% greater for participants over the age of 60 (OR = 1.73, CI 95% 1.05-2.84). Women with AWS had 44% greater risk to develop lymphedema during the first postoperative year (RR = 1.44, CI 95% 1.12-1.84, p = 0.002). If AWS developed within the first postoperative month, women were almost 3 times more likely to develop lymphedema within the first 3 postoperative months compared with other women with AWS (RR = 2.75, CI 95% 1.199-6.310, p = 0.007). CONCLUSIONS Our findings suggest that 30% of breast cancer survivors will have AWS during the first year of survivorship. As institutions prioritize screening efforts, early postoperative prospective surveillance is needed for women over 60 due to high risk for AWS development and any women with AWS for increased risk of lymphedema development based on our findings.
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Affiliation(s)
- Kathryn Ryans
- Department of Physical Therapy, Mercy College, Dobbs Ferry, NY, USA. .,Department of Oncology Rehabilitation & Lymphedema Management, Atlantic Health System, Morristown, NJ, USA.
| | - Claire C Davies
- Nursing and Allied Health Research Office, Baptist Health Lexington, Lexington, KY, USA
| | - Gizela Gaw
- Department of Oncology Rehabilitation & Lymphedema Management, Atlantic Health System, Morristown, NJ, USA
| | - Caroline Lambe
- Department of Oncology Rehabilitation, Regional Cancer Center at Lee Health , Cape Coral, FL, USA
| | - Morgan Henninge
- Physical Therapy and Rehabilitation, United Health Services, Vestal, NY, USA
| | - Lisa VanHoose
- Department of Physical Therapy, University of Louisiana Monroe, Monroe, LA, USA
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30
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Nori P, Kline-Quiroz C, Stubblefield MD. Cancer Rehabilitation:: Acute and Chronic Issues, Nerve Injury, Radiation Sequelae, Surgical and Chemo-Related, Part 2. Med Clin North Am 2020; 104:251-262. [PMID: 32035567 DOI: 10.1016/j.mcna.2019.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cancer affects millions of individuals, and approximately half will develop functional impairments. Cancers that commonly, either from direct effects or from its treatments, result in functional impairments include breast, head and neck, brain, and spinal cord tumors. There is a plethora of potential impairments including pain, spasticity, dystonia, weakness, and neurogenic bowel or bladder. This article reviews the functional impairments frequently encountered in breast, head and neck, brain, and spinal cord tumors. The authors also discuss management and treatment options incorporated in comprehensive cancer rehabilitation to address these impairments to maximize and maintain function and quality of life.
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Affiliation(s)
- Phalgun Nori
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA
| | - Cristina Kline-Quiroz
- MedStar Health/Georgetown, National Rehabilitation Hospital, 102 Irving Street Northwest, Washington, DC 20010, USA
| | - Michael D Stubblefield
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Select Medical, Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA.
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31
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McGhee DE, Mikilewicz KL, Steele JR. Effect of external breast prosthesis mass on bra strap loading and discomfort in women with a unilateral mastectomy. Clin Biomech (Bristol, Avon) 2020; 73:86-91. [PMID: 31958702 DOI: 10.1016/j.clinbiomech.2019.12.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 09/03/2019] [Accepted: 12/27/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND A common complaint of women who wear external breast prostheses following mastectomy is that they are too heavy. This study aimed to investigate the effect of external breast prosthesis mass on bra strap loading, discomfort and perceived pressure in women with a unilateral mastectomy. METHODS Pressures exerted at the bra strap-shoulder interface and ratings of discomfort and perceived pressure (visual analogue scales; 0-12 cm) were recorded for 17 women (mean 68 (SD 5.7) years) who had a unilateral mastectomy. Data were collected during standing and walking while the women wore a Lightweight prosthesis and Standard-weight prosthesis. Pressure, discomfort and perceived pressure between the two prosthesis conditions were compared using Wilcoxon Signed Ranks and the sum of the pressure values during walking and standing were correlated with discomfort and perceived pressure scores using Spearman's Rho tests. FINDINGS Mean peak bra strap pressures were significantly less when the participants wore the Lightweight prosthesis compared to the Control prosthesis during walking (0.28 (SD 0.14) N/cm2 versus 0.35 (SD 0.20) N/cm2; P < 0.05) but not during standing. No significant main effect of prosthesis mass on the participants' ratings of discomfort or perceived pressure were found, which were highly variable. INTERPRETATION Reducing external breast prosthesis mass decreased mean peak bra strap pressures during walking but this was not accompanied with reductions in bra strap-shoulder discomfort or perceived pressure. Treatment strategies to decrease bra strap-shoulder interface loading due to external breast prostheses mass could assist women who complain of prosthesis heaviness during physical activity.
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Affiliation(s)
- Deirdre E McGhee
- Biomechanics Research Laboratory, School of Medicine, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Avenue, Wollongong, New South Wales 2522, Australia.
| | - Katelyn L Mikilewicz
- Biomechanics Research Laboratory, School of Medicine, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Avenue, Wollongong, New South Wales 2522, Australia
| | - Julie R Steele
- Biomechanics Research Laboratory, School of Medicine, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Avenue, Wollongong, New South Wales 2522, Australia.
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Domaszewska K, Pieńkowski T, Janiak A, Bukowska D, Laurentowska M. The Influence of Soft Tissue Therapy on Respiratory Efficiency and Chest Mobility of Women Suffering from Breast Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16245092. [PMID: 31847158 PMCID: PMC6950070 DOI: 10.3390/ijerph16245092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/27/2019] [Accepted: 12/07/2019] [Indexed: 11/18/2022]
Abstract
The aim of the following paper was to determine the influence of soft tissue therapy on respiratory efficiency and chest mobility of women suffering from breast cancer. This study was a controlled, randomized trial. Tests were carried out in a group of patients (n = 49) who were hospitalized in the Province Polyclinic Hospital, Konin, Poland. In the study group, irrespective of the standard physical therapy program, an additional therapy program was run. The program consisted of applying specific techniques of soft tissue treatment. All patients in each term were subject to pulmonary function tests, chest mobility, and pain assessment. Statistical analysis of the obtained results of spirometry and chest mobility assessment has revealed no differences in the analyzed parameters between the examined groups in the period of joint therapeutic treatment. In the period between the third examination and the end of the 11-month-rehabilitation treatment, statistically significant differences were observed in the analyzed spirometry parameters; however, there was no difference in the parameters describing airflow in small airways (maximal expiratory flow at 50% (MEF50), peak expiratory flow (PEF) between individual groups during consecutive examinations in the course of diversified therapeutic treatment. Chest mobility assessment of the patients, performed during diversified therapeutic treatment, revealed statistically significant differences between the groups. However, there was no difference between the examined groups as far as pain sensation is concerned. Enhancing the regular rehabilitation program by including additional therapeutic methods, which are based on myofascial release and post-isometric relaxation techniques, had beneficial effects regarding respiratory system efficiency.
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Affiliation(s)
- Katarzyna Domaszewska
- Faculty of Health Sciences, Poznan University of Physical Education, 61-871 Poznań, Poland;
- Correspondence:
| | | | - Arkadiusz Janiak
- Faculty of Rehabilitation and Sport, The President Stanislaw Wojciechowski State University of Applied Sciences in Kalisz, 62-800 Kalisz, Poland;
| | - Dorota Bukowska
- Department of Neurobiology, Poznan University of Physical Education, 61-871 Poznań, Poland;
| | - Maria Laurentowska
- Faculty of Health Sciences, Poznan University of Physical Education, 61-871 Poznań, Poland;
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Antunes P, Esteves D, Nunes C, Amarelo A, Fonseca-Moutinho J, Afreixo V, Costa H, Alves A, Joaquim A. Effects of physical exercise on outcomes of cardiac (dys)function in women with breast cancer undergoing anthracycline or trastuzumab treatment: study protocol for a systematic review. Syst Rev 2019; 8:239. [PMID: 31651372 PMCID: PMC6813963 DOI: 10.1186/s13643-019-1154-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 09/10/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cardiotoxicity is a known complication and one of the most adverse effects from the use of conventional treatments such as anthracyclines and trastuzumab in breast cancer (BC) care. This phenomenon has been associated with the restriction of therapeutic options and the increase of cardiovascular complications, which may compromise the survival of patients. Implementation of preventive strategies is an important approach for the management of this issue. Physical exercise has been proposed as a non-pharmacological strategy to counteracting cardiotoxicity. The aim of this protocol is to describe the rationale and methods for a systematic review of published randomized controlled trials (RCTs) that have analysed the effects of physical exercise on outcomes of cardiac (dys)function in women with BC undergoing neoadjuvant or adjuvant treatment containing anthracyclines and/or trastuzumab. METHODS AND ANALYSIS This is a protocol for a systematic review reported according to the PRISMA-P 2015 checklist. Randomized controlled trials (RCTs) will be included. The literature will be screened on MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, ISI Web of Science and Scopus. The risk of bias of the included RCTs will be assessed using the Cochrane Collaboration's tool. The primary outcomes will be systolic function (left ventricular ejection fraction), diastolic function (E/A' ratio, deceleration time of early left ventricular filling, isovolumetric relaxation time, E/E' septal and lateral ratio) and myocardial deformation imaging outcomes (strain and strain rate [measured in longitudinal, radial, or circumferential directions]). Secondary outcomes will be cardiac biomarkers (troponin I or T, high-sensitivity troponin I or T, brain natriuretic peptide, amino terminal of B-type natriuretic peptide). Data will be descriptively reported, and quantitative synthesis will also be considered if the included studies are sufficiently homogenous. DISCUSSION This systematic review will help to understand the effectiveness of physical exercise on counteracting cardiotoxicity related to anticancer therapies in women with BC. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018096060.
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Affiliation(s)
- Pedro Antunes
- Research Center in Sport Sciences, Health and Human Development (CIDESD) & Sport Sciences Department, Universidade da Beira Interior, Covilhã, Portugal
- Associação de Cuidados de Suporte em Oncologia, Sanfins, Portugal
| | - Dulce Esteves
- Research Center in Sport Sciences, Health and Human Development (CIDESD) & Sport Sciences Department, Universidade da Beira Interior, Covilhã, Portugal
| | - Célia Nunes
- Mathematics Department, Universidade da Beira Interior, Covilhã, Portugal
| | - Anabela Amarelo
- Associação de Cuidados de Suporte em Oncologia, Sanfins, Portugal
- Oncology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova Gaia, Portugal
| | | | - Vera Afreixo
- CIDMA - Center for Research and Development in Mathematics and Applications, iBiMED - Institute for Biomedicine, Department of Mathematics, Universidade de Aveiro, Aveiro, Portugal
| | - Henrique Costa
- Psychiatry and Mental Health Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Alberto Alves
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD) & Instituto Universitário da Maia, Maia, Portugal
| | - Ana Joaquim
- Associação de Cuidados de Suporte em Oncologia, Sanfins, Portugal
- Oncology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova Gaia, Portugal
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Sweeney FC, Demark-Wahnefried W, Courneya KS, Sami N, Lee K, Tripathy D, Yamada K, Buchanan TA, Spicer DV, Bernstein L, Mortimer JE, Dieli-Conwright CM. Aerobic and Resistance Exercise Improves Shoulder Function in Women Who Are Overweight or Obese and Have Breast Cancer: A Randomized Controlled Trial. Phys Ther 2019; 99:1334-1345. [PMID: 31309977 PMCID: PMC6821226 DOI: 10.1093/ptj/pzz096] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 07/09/2019] [Accepted: 02/27/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND Adverse upper limb musculoskeletal effects occur after surgical procedures and radiotherapy for breast cancer and can interfere with activities of daily living. OBJECTIVE The objective of this study was to examine the effects of a 16-week exercise intervention on shoulder function in women who are overweight or obese and have breast cancer. DESIGN This study was a randomized controlled trial. SETTING The study was performed at the Division of Biokinesiology and Physical Therapy at the University of Southern California. PARTICIPANTS One hundred women with breast cancer were randomly allocated to exercise or usual-care groups. The mean (SD) age of the women was 53.5 (10.4) years, 55% were Hispanic white, and their mean (SD) body mass index was 33.5 (5.5) kg/m2. INTERVENTION The 16-week exercise intervention consisted of supervised, progressive, moderate to vigorous aerobic and resistance exercise 3 times per week. MEASUREMENTS Shoulder active range of motion, isometric muscular strength, and patient-reported outcome measures (including Disabilities of the Arm, Shoulder, and Hand and the Penn Shoulder Scale) were assessed at baseline, after the intervention, and at the 3-month follow-up (exercise group only). Differences in mean changes for outcomes were evaluated using mixed-model repeated-measures analysis. RESULTS Compared with the usual-care group, the exercise group experienced significant increases in shoulder active range of motion (the mean between-group differences and 95% confidence intervals (CIs) were as follows: shoulder flexion = 36.6° [95% CI = 55.2-20.7°], external rotation at 0° = 23.4° [95% CI = 31.1-12.5°], and external rotation at 90° = 34.3° [95% CI = 45.9-26.2°]), improved upper extremity isometric strength, and improved Disabilities of the Arm, Shoulder, and Hand and Penn Shoulder Scale scores. LIMITATIONS Limitations include a lack of masking of assessors after the intervention, an attention control group, and statistical robustness (shoulder function was a secondary end point). CONCLUSIONS A 16-week exercise intervention effectively improved shoulder function following breast cancer treatment in women who were overweight or obese, who were ethnically diverse, and who had breast cancer.
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Affiliation(s)
- Frank C Sweeney
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | | | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Nathalie Sami
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Kyuwan Lee
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kimiko Yamada
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Thomas A Buchanan
- Division of Endocrinology and Diabetes, Keck School of Medicine, University of Southern California
| | - Darcy V Spicer
- Department of Medicine, Keck School of Medicine, University of Southern California
| | - Leslie Bernstein
- Division of Biomarkers of Early Detection and Prevention, Beckman Research Institute, City of Hope, Duarte, California
| | - Joanne E Mortimer
- Division of Medical Oncology and Experimental Therapeutics, City of Hope
| | - Christina M Dieli-Conwright
- Department of Supportive Care Medicine, City of Hope, 1500 East Duarte Road, Duarte, CA 91010 (USA),Address all correspondence to Dr Dieli-Conwright at:
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Ribeiro IL, Moreira RFC, Ferrari AV, Alburquerque-Sendín F, Camargo PR, Salvini TF. Effectiveness of early rehabilitation on range of motion, muscle strength and arm function after breast cancer surgery: a systematic review of randomized controlled trials. Clin Rehabil 2019; 33:1876-1886. [PMID: 31480855 DOI: 10.1177/0269215519873026] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective was to evaluate the effectiveness of early rehabilitation on arm range of motion (ROM), strength and function after breast cancer surgery (BCS). Data sources: PubMed, MEDLINE, Bireme, Embase, LILACS and CINAHL databases were searched. METHODS Two independent reviewers selected randomized controlled trials evaluating women who underwent early rehabilitation to restore arm ROM, strength or function after BCS. Cochrane Collaboration recommendations and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Methodological quality was assessed by the PEDro scale. The International Classification of Functioning, Disability and Health was considered to analyze results. Effect size (ES) was calculated for clinical relevance interpretation of the outcomes of interest, and the evidence was summarized through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS Up to June 2019, a total of 1658 references were identified and 15 studies were included. Twelve of them presented adequate methodological quality. A total of 1710 patients were evaluated. Few studies performed the simultaneous assessment of variables related to body structure and function and patient-reported outcomes. A moderate level of evidence was synthesized regarding the effectiveness of ROM exercises for improving arm flexion, abduction and external rotation (ES: 0.45-2.5). A low level of evidence was synthesized regarding the effectiveness of isolated strengthening exercises for patient-reported arm function. ROM exercises associated with muscle strengthening exhibited a moderate level of evidence for improving shoulder flexion (ES: 1.4-2.4). CONCLUSION Both ROM and strengthening exercises associated with ROM exercises improved shoulder flexion, abduction and external rotation ROM after BCS. Shoulder abduction and external rotation showed less recovery, irrespective of the intervention applied.
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Affiliation(s)
- Ivana Leão Ribeiro
- Department of Kinesiology, Faculty of Health Sciences, Universidad Católica del Maule, Talca, Chile.,Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil
| | | | | | - Francisco Alburquerque-Sendín
- Department of Socio-Sanitary Sciences, Radiology and Physical Medicine, Universidad de Córdoba, Córdoba, Spain.,Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Paula Rezende Camargo
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Tania Fátima Salvini
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil
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Uhm KE, Lee S, Kurillo G, Han JJ, Yang JH, Yoo YB, Lee J. Usefulness of Kinect sensor-based reachable workspace system for assessing upper extremity dysfunction in breast cancer patients. Support Care Cancer 2019; 28:779-786. [PMID: 31144172 DOI: 10.1007/s00520-019-04874-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/14/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Recently, the utility of the Kinect sensor-based reachable workspace analysis system for measuring upper extremity outcomes of neuromuscular and musculoskeletal diseases has been demonstrated. Here, we investigated its usefulness for assessing upper extremity dysfunction in breast cancer patients. METHODS Twenty unilateral breast cancer patients were enrolled. Upper extremity active range of motion was captured by the Kinect sensor, and reachable workspace relative surface areas (RSAs) were obtained. The QuickDASH was completed to assess upper extremity disability. General and breast cancer-specific quality of life (QOL) were assessed by the EORTC QLQ-C30 and EORTC QLQ-BR23. RESULTS The total RSA ratio of the affected and unaffected sides ranges from 0.64 to 1.11. Total RSA was significantly reduced on the affected versus unaffected side (0.659 ± 0.105 vs. 0.762 ± 0.065; p = 0.001). Quadrant 1 and 3 RSAs were significantly reduced (0.135 ± 0.039 vs. 0.183 ± 0.040, p < 0.001; 0.172 ± 0.058 vs. 0.217 ± 0.031, p = 0.006). Total RSA of the affected side was strongly correlated with the numeric pain rating scale during movement (r = - 0.812, p < 0.001) and moderately with the QuickDASH (r = - 0.494, p = 0.027). Further, quadrant 3 RSA was correlated with EORTC QLQ-C30 role functioning (r = 0.576, p = 0.008) and EORTC QLQ-BR23 arm symptoms (r = - 0.588, p = 0.006) scales. CONCLUSIONS The Kinect sensor-based reachable workspace analysis system was effectively applied to assess upper extremity dysfunction in breast cancer patients. This system could potentially serve as a quick and simple outcome measure that provides quantitative data for breast cancer patients.
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Affiliation(s)
- Kyeong Eun Uhm
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, South Korea
| | - Seunghwan Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, South Korea
| | - Gregorij Kurillo
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Jay J Han
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of California at Irvine, Orange, CA, USA
| | - Jung-Hyun Yang
- Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Young Bum Yoo
- Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, South Korea. .,Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, South Korea.
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Iwamoto N, Aruga T, Horiguchi S, Asami H, Saita C, Onishi M, Goto R, Ishiba T, Honda Y, Miyamoto H, Kuroi K. Ultrasound-guided fine-needle aspiration of axillary lymph nodes in breast cancer: Diagnostic accuracy and role in surgical management. Diagn Cytopathol 2019; 47:788-792. [PMID: 31041851 DOI: 10.1002/dc.24203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/08/2019] [Accepted: 04/22/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the accuracy of fine needle aspiration cytology (FNAC) of axillary lymph nodes (LN) in breast cancer, to compare the results of FNAC and pathological examination, and to distinguish patients with 1 to 2 metastatic LNs from those with ≥3 metastatic LNs in patients with FNAC-positive patients. PATIENTS AND METHODS This study included 198 breasts of 196 patients with breast cancer who underwent FNAC and surgery for the primary and axilla without neoadjuvant chemotherapy from January 2010 to August 2016. Axillary nodal status was assessed by ultrasound (US), and whether FNAC-positive had three or more suspicious LNs on US imaging was examined. RESULTS The results of FNAC were positive in 75 (38%), negative in 97 (49%), suspicious in 2 (1%), indeterminate in 5 (2.5%), and insufficient in 19 patients (9.5%). FNAC sensitivity, specificity, positive predictive value, and negative predictive value were 62.6%, 100%, 100%, and 62.0%, respectively. Whereas 53% (18/34) of patients with false-negative FNAC had one metastatic LN on final pathology, 61% (47/77) patients who were FNAC-positive had three or more metastatic LNs. In the FNAC-positive patients, all patients had ≥3 metastatic LNs if they had ≥3 suspicious LNs on US imaging. CONCLUSION Patients with positive cytology were more likely to have ≥3 positive LNs compared to false-negative cytology patients. Patients with ≥3 abnormal LNs on US and positive FNAC might require axillary dissection.
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Affiliation(s)
- Naoko Iwamoto
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Tomoyuki Aruga
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Shinichiro Horiguchi
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Hidekazu Asami
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Chiaki Saita
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Mai Onishi
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Risa Goto
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Toshiyuki Ishiba
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yayoi Honda
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Hiromi Miyamoto
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Katsumasa Kuroi
- Department of Breast Surgery, Tokyo Metropolitan Health and Hospitals Corporation Ebara Hospital, Tokyo, Japan
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Tetik B, Songür K, Aşkın A. Aksiller web sendromu: omuz ağrısının gözden kaçan nedeni. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.457220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Estimating the Reliability and Validity of the Upper Extremity Functional Index in Women After Breast Cancer Surgery. Clin Breast Cancer 2018; 18:e1261-e1267. [DOI: 10.1016/j.clbc.2018.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 02/13/2018] [Accepted: 02/13/2018] [Indexed: 12/22/2022]
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40
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The effect of preoperative exercise on upper extremity recovery following breast cancer surgery: a systematic review. Int J Rehabil Res 2018; 41:189-196. [PMID: 29683834 DOI: 10.1097/mrr.0000000000000288] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Prehabilitation benefits among patients undergoing various oncological surgeries have been demonstrated. However, the effects of presurgical exercise and fitness on postoperative ipsilateral upper extremity recovery outcomes in patients with breast cancer surgery are less evident. A systematic review was performed to assess the effects of preoperative exercise and fitness on postmastectomy recovery. Systematic literature search was performed in 12 electronic databases. Study eligibility was accessed using the PICOS (Participants, Interventions, Comparison, Outcome and Study Design) criteria. Six eligible studies were found: three cohort-control and three prospective observational studies. One randomized-controlled trial showed that prehabilitation was beneficial in shoulder range of motion (ROM) and upper extremity functional recovery. One cohort-control study demonstrated that preoperative exercises reduced postoperative pain without increasing the risk of developing a seroma. A prospective cohort study showed that preoperatively active individuals had a significantly better chance of feeling recovered physically at 3 weeks after surgery. Baseline ipsilateral grip strength, shoulder flexion, and abduction ROM were reliable predictors of shoulder flexion and abduction ROM and grip strength improvements at 1 month following breast cancer surgery. One study showed that preoperative conditioning alone without postoperative rehabilitation was insufficient to aid recovery. Implementing exercise program and optimizing preoperative fitness, especially shoulder ROM, before breast cancer surgery in conjunction with individualized rehabilitation program may benefit postmastectomy ipsilateral upper extremity recovery.
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Ibrahim M, Lau GJ, Smirnow N, Buono AT, Cooke A, Gartshore K, Loiselle CG, Johnson K. A Multidisciplinary Preoperative Teaching Session for Women Awaiting Breast Cancer Surgery: A Quality Improvement Initiative. Rehabil Process Outcome 2018. [DOI: 10.1177/1179572718790937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: Most of the breast cancer diagnoses are recommended for breast surgery. Unfortunately, many patients report preoperative anxiety, which can affect postoperative recovery. Preoperative teaching sessions have been shown to reduce anxiety and improve recovery for the patients with breast cancer. To better support the patients at our cancer center, a multidisciplinary preoperative teaching session was developed and delivered as a quality improvement initiative. Methods: Participants scheduled for breast surgery were invited to attend a group-delivered preoperative teaching session, either for breast-conserving surgery or mastectomy. The sessions were presented by a nurse, occupational therapist, and physiotherapist. Data were collected through a researcher-developed 2-item questionnaire administered before and after sessions to compare self-reported anxiety and knowledge levels, along with qualitative feedback. Results: A total of 94 participants attended the preoperative sessions, piloted over a year. The majority were scheduled for breast-conserving surgery. Wilcoxon signed rank tests showed that after session, self-reported levels of anxiety decreased, whereas levels of knowledge increased. Most participants found the session to be very helpful and would recommend it to other patients/families awaiting surgery. Conclusions: Patients awaiting surgery for breast cancer may be better supported through a multidisciplinary group teaching session by decreasing anxiety and improving knowledge related to the procedure. Future directions could explore the effect of specific session elements on anxiety, knowledge, and postoperative complications using psychometrically sound instruments and additional time points. Implications for cancer survivors: Standardization of these preoperative teaching sessions may enhance breast cancer care, reduce postoperative complications, and improve patient recovery.
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Affiliation(s)
- Marize Ibrahim
- Rehabilitation & Exercise Oncology Program, Hope & Cope, Jewish General Hospital, Montréal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montréal, QC, Canada
- Department of Oncology, McGill University, Montréal, QC, Canada
- Breast & Bone Health Program, Hope & Cope, Jewish General Hospital, Montréal, QC, Canada
| | - Garnet J Lau
- Breast & Bone Health Program, Hope & Cope, Jewish General Hospital, Montréal, QC, Canada
| | - Nadia Smirnow
- Rehabilitation & Exercise Oncology Program, Hope & Cope, Jewish General Hospital, Montréal, QC, Canada
| | - Anna T Buono
- Segal Cancer Centre, Jewish General Hospital, Montréal, QC, Canada
| | - Andrea Cooke
- Segal Cancer Centre, Jewish General Hospital, Montréal, QC, Canada
- Ingram School of Nursing, McGill University, Montréal, QC, Canada
| | - Kimberley Gartshore
- Segal Cancer Centre, Jewish General Hospital, Montréal, QC, Canada
- Ingram School of Nursing, McGill University, Montréal, QC, Canada
| | - Carmen G Loiselle
- Department of Oncology and Ingram School of Nursing, McGill University, Montréal, QC, Canada
- Hope & Cope, Jewish General Hospital, Montréal, QC, Canada
| | - Kyla Johnson
- Occupational Therapy Department, Segal Cancer Centre, Jewish General Hospital, Montréal, QC, Canada
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Santa Mina D, Brahmbhatt P, Lopez C, Baima J, Gillis C, Trachtenberg L, Silver JK. The Case for Prehabilitation Prior to Breast Cancer Treatment. PM R 2018; 9:S305-S316. [PMID: 28942905 DOI: 10.1016/j.pmrj.2017.08.402] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 12/22/2022]
Abstract
Cancer rehabilitation in breast cancer survivors is well established, and there are many studies that focus on interventions to treat impairments as well as therapeutic exercise. However, very little is known about the role of prehabilitation for people with breast cancer. In this narrative review, we describe contemporary clinical management of breast cancer and associated treatment-related morbidity and mortality considerations. Knowing the common short- and long-term sequelae, as well as less frequent but serious sequelae, informs our rationale for multimodal breast cancer prehabilitation. We suggest 5 core components that may help to mitigate short- and long-term sequelae that align with consensus opinion of prehabilitation experts: total body exercise; locoregional exercise pertinent to treatment-related deficits; nutritional optimization; stress reduction/psychosocial support; and smoking cessation. In each of these categories, we review the literature and discuss how they may affect outcomes for women with breast cancer.
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Affiliation(s)
- Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, The University of Toronto, 55 Harbord St, Toronto, ON, M5S 2W6, Canada; Cancer Rehabilitation and Survivorship, Princess Margaret Cancer Centre, Toronto, ON, Canada(∗).
| | - Priya Brahmbhatt
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada; Cancer Rehabilitation and Survivorship, Princess Margaret Cancer Centre, Toronto, ON, Canada(†)
| | - Christian Lopez
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada; Cancer Rehabilitation and Survivorship, Princess Margaret Cancer Centre, Toronto, ON, Canada(‡)
| | - Jennifer Baima
- University of Massachusetts Medical School, Worcester, MA(§)
| | - Chelsia Gillis
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada(‖)
| | - Lianne Trachtenberg
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Applied Psychology and Human Development, University of Toronto, Toronto, ON, Canada(¶)
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA; Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Boston, MA(#)
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Bruce J, Williamson E, Lait C, Richmond H, Betteley L, Lall R, Petrou S, Rees S, Withers EJ, Lamb SE, Thompson AM. Randomised controlled trial of exercise to prevent shoulder problems in women undergoing breast cancer treatment: study protocol for the prevention of shoulder problems trial (UK PROSPER). BMJ Open 2018; 8:e019078. [PMID: 29574439 PMCID: PMC5875650 DOI: 10.1136/bmjopen-2017-019078] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
UNLABELLED Musculoskeletal shoulder problems are common after breast cancer treatment. Early postoperative exercises targeting the upper limb may improve shoulder function. This protocol describes a National Institute for Health Research-funded randomised controlled trial (RCT) to evaluate the clinical and cost-effectiveness of an early supervised structured exercise programme compared with usual care, for women at high risk of developing shoulder problems after breast cancer surgery. METHODS This pragmatic two-armed, multicentre RCT is underway within secondary care in the UK. PRevention Of Shoulder ProblEms tRial (PROSPER) aims to recruit 350 women from approximately 15 UK centres with follow-up at 6 weeks, 6 and 12 months after randomisation. Recruitment processes and intervention development were optimised through qualitative research during a 6-month internal pilot phase. Participants are randomised to the PROSPER intervention or best practice usual care only. The PROSPER intervention is delivered by physiotherapists and incorporates three main components: shoulder-specific exercises targeting range of movement and strength; general physical activity and behavioural strategies to encourage adherence and support exercise behaviour. The primary outcome is upper arm function assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire at 12 months postrandomisation. Secondary outcomes include DASH subscales, acute and chronic pain, complications, health-related quality of life and healthcare resource use. We will interview a subsample of 20 participants to explore their experiences of the trial interventions. DISCUSSION The PROSPER study is the first multicentre UK clinical trial to investigate the clinical and cost-effectiveness of supported exercise in the prevention of shoulder problems in high-risk women undergoing breast cancer surgery. The findings will inform future clinical practice and provide valuable insight into the role of physiotherapy-supported exercise in breast cancer rehabilitation. PROTOCOL VERSION Version 2.1; dated 11 January 2017 TRIAL REGISTRATION NUMBER: ISRCTN35358984; Pre-results.
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Affiliation(s)
- Julie Bruce
- Division of Health Sciences, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Esther Williamson
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, UK
| | - Clare Lait
- Gloucestershire Care Services NHS Trust, Gloucester, UK
| | - Helen Richmond
- Division of Health Sciences, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Lauren Betteley
- Division of Health Sciences, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Ranjit Lall
- Division of Health Sciences, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Stavros Petrou
- Division of Health Sciences, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Sophie Rees
- Division of Health Sciences, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Emma J Withers
- Division of Health Sciences, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Sarah E Lamb
- Division of Health Sciences, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, UK
| | - Alastair M Thompson
- Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Abstract
BACKGROUND Metastatic breast cancer is not a curable disease, but women with metastatic disease are living longer. Surgery to remove the primary tumour is associated with an increased survival in other types of metastatic cancer. Breast surgery is not standard treatment for metastatic disease, however several recent retrospective studies have suggested that breast surgery could increase the women's survival. These studies have methodological limitations including selection bias. A systematic review mapping all randomised controlled trials addressing the benefits and potential harms of breast surgery is ideal to answer this question. OBJECTIVES To assess the effects of breast surgery in women with metastatic breast cancer. SEARCH METHODS We conducted searches using the MeSH terms 'breast neoplasms', 'mastectomy', and 'analysis, survival' in the following databases: the Cochrane Breast Cancer Specialised Register, CENTRAL, MEDLINE (by PubMed) and Embase (by OvidSP) on 22 February 2016. We also searched ClinicalTrials.gov (22 February 2016) and the WHO International Clinical Trials Registry Platform (24 February 2016). We conducted an additional search in the American Society of Clinical Oncology (ASCO) conference proceedings in July 2016 that included reference checking, citation searching, and contacting study authors to identify additional studies. SELECTION CRITERIA The inclusion criteria were randomised controlled trials of women with metastatic breast cancer at initial diagnosis comparing breast surgery plus systemic therapy versus systemic therapy alone. The primary outcomes were overall survival and quality of life. Secondary outcomes were progression-free survival (local and distant control), breast cancer-specific survival, and toxicity from local therapy. DATA COLLECTION AND ANALYSIS Two review authors independently conducted trial selection, data extraction, and 'Risk of bias' assessment (using Cochrane's 'Risk of bias' tool), which a third review author checked. We used the GRADE tool to assess the quality of the body of evidence. We used the risk ratio (RR) to measure the effect of treatment for dichotomous outcomes and the hazard ratio (HR) for time-to-event outcomes. We calculated 95% confidence intervals (CI) for these measures. We used the random-effects model, as we expected clinical or methodological heterogeneity, or both, among the included studies. MAIN RESULTS We included two trials enrolling 624 women in the review. It is uncertain whether breast surgery improves overall survival as the quality of the evidence has been assessed as very low (HR 0.83, 95% CI 0.53 to 1.31; 2 studies; 624 women). The two studies did not report quality of life. Breast surgery may improve local progression-free survival (HR 0.22, 95% CI 0.08 to 0.57; 2 studies; 607 women; low-quality evidence), while it probably worsened distant progression-free survival (HR 1.42, 95% CI 1.08 to 1.86; 1 study; 350 women; moderate-quality evidence). The two included studies did not measure breast cancer-specific survival. Toxicity from local therapy was reported by 30-day mortality and did not appear to differ between the two groups (RR 0.99, 95% CI 0.14 to 6.90; 1 study; 274 women; low-quality evidence). AUTHORS' CONCLUSIONS Based on existing evidence from two randomised clinical trials, it is not possible to make definitive conclusions on the benefits and risks of breast surgery associated with systemic treatment for women diagnosed with metastatic breast cancer. Until the ongoing clinical trials are finalised, the decision to perform breast surgery in these women should be individualised and shared between the physician and the patient considering the potential risks, benefits, and costs of each intervention.
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Affiliation(s)
- Giuliano Tosello
- Iamada HospitalCassemiro Boscoli 236, Jd IcarayPresidente PrudenteSao PauloBrazil19060‐530
| | - Maria Regina Torloni
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilRua Borges Lagoa, 564 cj 63São PauloSão PauloBrazil04038‐000
| | - Bruna S Mota
- Instituto do câncer de São Paulo (ICESP/FMUSP)Department of Obstetrics and GynecologyAv. Dr Arnaldo 251Sao PauloSao PauloBrazil01246‐000
| | - Teresa Neeman
- The Australian National UniversityStatistical Consulting Unit, John Dedman BuildingCanberraACTAustralia0220
| | - Rachel Riera
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilRua Borges Lagoa, 564 cj 63São PauloSão PauloBrazil04038‐000
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Martins TNDO, Santos LFD, Petter GDN, Ethur JNDS, Braz MM, Pivetta HMF. Reconstrução mamária imediata versus não reconstrução pós-mastectomia: estudo sobre qualidade de vida, dor e funcionalidade. FISIOTERAPIA E PESQUISA 2017. [DOI: 10.1590/1809-2950/17580224032017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Com a evolução das técnicas oncoplásticas que permitem a reconstrução da mama no mesmo instante da mastectomia, sem comprometer a segurança oncológica, torna-se pertinente investigar as implicações da reconstrução imediata com expansor ou prótese de silicone sobre a dor, a funcionalidade do membro superior homolateral à cirurgia e a qualidade de vida (QV) das mulheres. O objetivo deste estudo foi comparar a dor, a funcionalidade e a QV de mulheres submetidas à mastectomia radical modificada com reconstrução mamária imediata e sem reconstrução. Trata-se de um estudo transversal, comparativo e descritivo com abordagem quantitativa, que avaliou 22 voluntárias pós-mastectomia radical modificada, divididas igualmente em dois grupos, de acordo com a realização da reconstrução mamária imediata (RI) ou sem reconstrução (SR). As voluntárias responderam ao questionário sociodemográfico, clínico e de tratamento oncológico, a EVA, para mensurar a dor, DASH para avaliar a funcionalidade do membro superior e, para avaliar a QV, foi utilizado o questionário EORTC QLQ-C30 com seu módulo específico para o CA de mama. Houve alta prevalência de dor, moderada limitação funcional e satisfatória QV. No entanto, não foram encontradas diferenças significativas intergrupos para dor (p=0,586), funcionalidade (p=0,399) e QV (p>0,05). Para a amostra avaliada, fazer ou não a reconstrução da mama com expansor ou implante de silicone no ato da mastectomia não implicou sobre a dor, funcionalidade e QV.
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Wang H, Shen L, Liu T, Shao P, Dylke ES, Jia J, Kilbreath SL. Circumference-Based Criteria for Detection of Secondary Arm Lymphedema for Chinese Women. Lymphat Res Biol 2017; 15:262-267. [PMID: 28749717 DOI: 10.1089/lrb.2017.0002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Hewei Wang
- Rehabilitation Department, Huanshan Hospital, Fudan University, Shanghai, China
| | - Li Shen
- Rehabilitation Department, Huanshan Hospital, Fudan University, Shanghai, China
| | - Tao Liu
- Ma Qiao Community Health Service Center, Shanghai, China
| | - Peng Shao
- Rehabilitation Department, Huanshan Hospital, Fudan University, Shanghai, China
| | | | - Jie Jia
- Rehabilitation Department, Huanshan Hospital, Fudan University, Shanghai, China
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Reliable prediction of postmastectomy lymphedema: The Risk Assessment Tool Evaluating Lymphedema. Am J Surg 2017; 213:1125-1133.e1. [DOI: 10.1016/j.amjsurg.2016.08.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/10/2016] [Accepted: 08/14/2016] [Indexed: 01/05/2023]
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Pusic AL, Matros E, Fine N, Buchel E, Gordillo GM, Hamill JB, Kim HM, Qi J, Albornoz C, Klassen AF, Wilkins EG. Patient-Reported Outcomes 1 Year After Immediate Breast Reconstruction: Results of the Mastectomy Reconstruction Outcomes Consortium Study. J Clin Oncol 2017; 35:2499-2506. [PMID: 28346808 DOI: 10.1200/jco.2016.69.9561] [Citation(s) in RCA: 208] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose The goals of immediate postmastectomy breast reconstruction are to minimize deformity and optimize quality of life as perceived by patients. We prospectively evaluated patient-reported outcomes (PROs) in women undergoing immediate implant-based or autologous reconstruction. Methods Women undergoing immediate postmastectomy reconstruction for invasive cancer and/or carcinoma in situ were enrolled at 11 sites. Women underwent implant-based or autologous tissue reconstruction. Patients completed the BREAST-Q, a condition-specific PRO measure for breast surgery patients, and Patient-Reported Outcomes Measurement Information System-29, a generic PRO measure, before and 1 year after surgery. Mean changes in PRO scores were summarized. Mixed-effects regression models were used to compare PRO scores across procedure types. Results In total, 1,632 patients (n = 1,139 implant, n = 493 autologous) were included; 1,183 (72.5%) responded to 1-year questionnaires. After analysis was controlled for baseline values, patients who underwent autologous reconstruction had greater satisfaction with their breasts than those who underwent implant-based reconstruction (difference, 6.3; P < .001), greater sexual well-being (difference, 4.5; P = .003), and greater psychosocial well-being (difference, 3.7; P = .02) at 1 year. Patients in the autologous reconstruction group had improved satisfaction with breasts (difference, 8.0; P = .002) and psychosocial well-being (difference, 4.6; P = .047) compared with preoperative baseline. Physical well-being of the chest was not fully restored in either the implant group (difference, -3.8; P = .001) or autologous group (-2.2; P = .04), nor was physical well-being of the abdomen in patients who underwent autologous reconstruction (-13.4; P < .001). Anxiety and depression were mitigated at 1 year in both groups. Compared with their baseline reports, patients who underwent implant reconstruction had decreased fatigue (difference, -1.4; P = .035), whereas patients who underwent autologous reconstruction had increased pain interference (difference, 2.0; P = .006). Conclusion At 1 year after mastectomy, patients who underwent autologous reconstruction were more satisfied with their breasts and had greater psychosocial and sexual well-being than those who underwent implant reconstruction. Although satisfaction with breasts was equal to or greater than baseline levels, physical well-being was not fully restored. This information can help patients better understand expected outcomes and may guide innovations to improve outcomes.
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Affiliation(s)
- Andrea L Pusic
- Andrea L. Pusic, Evan Matros, and Claudia Albornoz, Memorial Sloan Kettering Cancer Center, New York, NY; Neil Fine, Northwestern Specialists in Plastic Surgery, Chicago, IL; Edward Buchel, University of Manitoba, Winnipeg, Manitoba; Anne F. Klassen, McMaster University, Hamilton, Ontario, Canada; Gayle M. Gordillo, The Ohio State University Wexner Medical Center, Columbus, OH; and Jennifer B. Hamill, Hyungjin M. Kim, Ji Qi, and Edwin G. Wilkins, University of Michigan, Ann Arbor, MI
| | - Evan Matros
- Andrea L. Pusic, Evan Matros, and Claudia Albornoz, Memorial Sloan Kettering Cancer Center, New York, NY; Neil Fine, Northwestern Specialists in Plastic Surgery, Chicago, IL; Edward Buchel, University of Manitoba, Winnipeg, Manitoba; Anne F. Klassen, McMaster University, Hamilton, Ontario, Canada; Gayle M. Gordillo, The Ohio State University Wexner Medical Center, Columbus, OH; and Jennifer B. Hamill, Hyungjin M. Kim, Ji Qi, and Edwin G. Wilkins, University of Michigan, Ann Arbor, MI
| | - Neil Fine
- Andrea L. Pusic, Evan Matros, and Claudia Albornoz, Memorial Sloan Kettering Cancer Center, New York, NY; Neil Fine, Northwestern Specialists in Plastic Surgery, Chicago, IL; Edward Buchel, University of Manitoba, Winnipeg, Manitoba; Anne F. Klassen, McMaster University, Hamilton, Ontario, Canada; Gayle M. Gordillo, The Ohio State University Wexner Medical Center, Columbus, OH; and Jennifer B. Hamill, Hyungjin M. Kim, Ji Qi, and Edwin G. Wilkins, University of Michigan, Ann Arbor, MI
| | - Edward Buchel
- Andrea L. Pusic, Evan Matros, and Claudia Albornoz, Memorial Sloan Kettering Cancer Center, New York, NY; Neil Fine, Northwestern Specialists in Plastic Surgery, Chicago, IL; Edward Buchel, University of Manitoba, Winnipeg, Manitoba; Anne F. Klassen, McMaster University, Hamilton, Ontario, Canada; Gayle M. Gordillo, The Ohio State University Wexner Medical Center, Columbus, OH; and Jennifer B. Hamill, Hyungjin M. Kim, Ji Qi, and Edwin G. Wilkins, University of Michigan, Ann Arbor, MI
| | - Gayle M Gordillo
- Andrea L. Pusic, Evan Matros, and Claudia Albornoz, Memorial Sloan Kettering Cancer Center, New York, NY; Neil Fine, Northwestern Specialists in Plastic Surgery, Chicago, IL; Edward Buchel, University of Manitoba, Winnipeg, Manitoba; Anne F. Klassen, McMaster University, Hamilton, Ontario, Canada; Gayle M. Gordillo, The Ohio State University Wexner Medical Center, Columbus, OH; and Jennifer B. Hamill, Hyungjin M. Kim, Ji Qi, and Edwin G. Wilkins, University of Michigan, Ann Arbor, MI
| | - Jennifer B Hamill
- Andrea L. Pusic, Evan Matros, and Claudia Albornoz, Memorial Sloan Kettering Cancer Center, New York, NY; Neil Fine, Northwestern Specialists in Plastic Surgery, Chicago, IL; Edward Buchel, University of Manitoba, Winnipeg, Manitoba; Anne F. Klassen, McMaster University, Hamilton, Ontario, Canada; Gayle M. Gordillo, The Ohio State University Wexner Medical Center, Columbus, OH; and Jennifer B. Hamill, Hyungjin M. Kim, Ji Qi, and Edwin G. Wilkins, University of Michigan, Ann Arbor, MI
| | - Hyungjin M Kim
- Andrea L. Pusic, Evan Matros, and Claudia Albornoz, Memorial Sloan Kettering Cancer Center, New York, NY; Neil Fine, Northwestern Specialists in Plastic Surgery, Chicago, IL; Edward Buchel, University of Manitoba, Winnipeg, Manitoba; Anne F. Klassen, McMaster University, Hamilton, Ontario, Canada; Gayle M. Gordillo, The Ohio State University Wexner Medical Center, Columbus, OH; and Jennifer B. Hamill, Hyungjin M. Kim, Ji Qi, and Edwin G. Wilkins, University of Michigan, Ann Arbor, MI
| | - Ji Qi
- Andrea L. Pusic, Evan Matros, and Claudia Albornoz, Memorial Sloan Kettering Cancer Center, New York, NY; Neil Fine, Northwestern Specialists in Plastic Surgery, Chicago, IL; Edward Buchel, University of Manitoba, Winnipeg, Manitoba; Anne F. Klassen, McMaster University, Hamilton, Ontario, Canada; Gayle M. Gordillo, The Ohio State University Wexner Medical Center, Columbus, OH; and Jennifer B. Hamill, Hyungjin M. Kim, Ji Qi, and Edwin G. Wilkins, University of Michigan, Ann Arbor, MI
| | - Claudia Albornoz
- Andrea L. Pusic, Evan Matros, and Claudia Albornoz, Memorial Sloan Kettering Cancer Center, New York, NY; Neil Fine, Northwestern Specialists in Plastic Surgery, Chicago, IL; Edward Buchel, University of Manitoba, Winnipeg, Manitoba; Anne F. Klassen, McMaster University, Hamilton, Ontario, Canada; Gayle M. Gordillo, The Ohio State University Wexner Medical Center, Columbus, OH; and Jennifer B. Hamill, Hyungjin M. Kim, Ji Qi, and Edwin G. Wilkins, University of Michigan, Ann Arbor, MI
| | - Anne F Klassen
- Andrea L. Pusic, Evan Matros, and Claudia Albornoz, Memorial Sloan Kettering Cancer Center, New York, NY; Neil Fine, Northwestern Specialists in Plastic Surgery, Chicago, IL; Edward Buchel, University of Manitoba, Winnipeg, Manitoba; Anne F. Klassen, McMaster University, Hamilton, Ontario, Canada; Gayle M. Gordillo, The Ohio State University Wexner Medical Center, Columbus, OH; and Jennifer B. Hamill, Hyungjin M. Kim, Ji Qi, and Edwin G. Wilkins, University of Michigan, Ann Arbor, MI
| | - Edwin G Wilkins
- Andrea L. Pusic, Evan Matros, and Claudia Albornoz, Memorial Sloan Kettering Cancer Center, New York, NY; Neil Fine, Northwestern Specialists in Plastic Surgery, Chicago, IL; Edward Buchel, University of Manitoba, Winnipeg, Manitoba; Anne F. Klassen, McMaster University, Hamilton, Ontario, Canada; Gayle M. Gordillo, The Ohio State University Wexner Medical Center, Columbus, OH; and Jennifer B. Hamill, Hyungjin M. Kim, Ji Qi, and Edwin G. Wilkins, University of Michigan, Ann Arbor, MI
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Blackburn NE, Mc Veigh JG, Mc Caughan E, Wilson IM. The musculoskeletal consequences of breast reconstruction using the latissimus dorsi muscle for women following mastectomy for breast cancer: A critical review. Eur J Cancer Care (Engl) 2017; 27:e12664. [PMID: 28185324 DOI: 10.1111/ecc.12664] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2016] [Indexed: 11/30/2022]
Abstract
Breast reconstruction using the latissimus dorsi (LD) flap following mastectomy is an important management option in breast cancer. However, one common, but often ignored, complication following LD flap is shoulder dysfunction. The aim of this critical review was to comprehensively assess the musculoskeletal impact of LD breast reconstruction and evaluate the functional outcome following surgery. Five electronic databases were searched including; Medline, Embase, CINAHL Plus (Cumulative Index to Nursing and Allied Health), PubMed and Web of Science. Databases were searched from 2006 to 2016, and only full text, English language articles were included. Twenty-two observational studies and two surveys were reviewed with sample sizes ranging from six to 206 participants. The majority of studies had small sample sizes and were retrospective in nature. Nevertheless, there is evidence to suggest that there is some degree of weakness and reduced mobility at the shoulder following LD muscle transfer. The literature demonstrates that there is considerable morbidity in the immediate post-operative period with functional recovery varying between studies. The majority of work tends to be limited and often gives conflicting results; therefore, further investigation is required in order to determine underlying factors that contribute to a reduction in function and activities of daily living.
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Zhevago NA, Zimin AA, Glazanova TV, Davydova NI, Bychkova NV, Chubukina ZV, Buinyakova AI, Ballyuzek MF, Samoilova KA. Polychromatic light (480-3400nm) similar to the terrestrial solar spectrum without its UV component in post-surgical immunorehabilitation of breast cancer patients. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2016; 166:44-51. [PMID: 27865134 DOI: 10.1016/j.jphotobiol.2016.10.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 10/19/2016] [Accepted: 10/21/2016] [Indexed: 10/20/2022]
Abstract
To this day, two methods of phototherapy (PT) have been successfully used in post-surgical immunorehabilitation of patients with breast cancer (BC): intravenous laser irradiation of the patients' blood and reinfusion of lympholeukosuspension of BC patients after single irradiation with HeNe laser. The objective of this pilot experimental study was to verify the effectiveness of the percutaneous use of polychromatic visible light combined with polychromatic infrared (pVIS+pIR) radiation similar to the major components of natural solar spectrum in post-surgical management of BC patients. Patients with BC (adenocarcinoma) of I-II stages, n=19 who had undergone mastectomy, were divided into 2 groups. The control group of patients (n=8) underwent a conventional course of post-surgical rehabilitation and sham irradiation. Patients of the PT group (n=11) additionally received 7days of daily treatment with polychromatic light on the sacral area, D=15cm. The PT course began on the day after mastectomy (Bioptron-2 device; Switzerland, 480-3400nm, 95% polarization, 40mW/cm2, 24J/cm2). Mastectomy produced many changes in cellular and humoral immunity, which was recorded on the 1st and 8th post-surgical days. The PT course resulted in a faster normalization of post-surgical leukocytosis and activation of cytotoxic CD8+ T-lymphocytes (Lym), reduced the elevated concentration in blood of immune complexes and in parallel promoted cytotoxic activity of CD16+/CD56+ NK-cells. The PT up-regulated the number of NK-cells in patients with its decrease on the 1st post-surgical day and prevented the decrease in the amount of monocytes, CD19+ B-Lym, CD3+ T-Lym, CD4+ T-helpers, activated CD3+/HLADR+ T-Lym, and the decrease of the phagocytotic capability of neutrophils. PT blocked the down-regulation of the IgM, IgA concentration and abnormally sharp increase of the proinflammatory cytokine IFN-γ content. Therefore, a 7-day course with polychromatic light prevented the development of immunosupression in the BC patients at the early post-mastectomy period.
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Affiliation(s)
- Natalia A Zhevago
- Institute of Cytology of the Russian Academy of Sciences, 4, Tikhoretsky Ave., Saint-Petersburg 194064, Russia
| | - Alexander A Zimin
- Institute of Cytology of the Russian Academy of Sciences, 4, Tikhoretsky Ave., Saint-Petersburg 194064, Russia
| | - Tatyana V Glazanova
- Russian Research Institute of Hematology and Transfusiology of Federal Medico-Biological Agency, Laboratory of Immunohematology, 16, 2nd Sovetskaia, 191024 Saint-Petersburg, Russia
| | - Natalia I Davydova
- Nikiforov All-Russian Center of Emergency and Radiation Medicine, Russian Federation Ministry of Emergency Situations, Laboratory of Clinical Immunology, 54,Optikov Street, Saint-Petersburg 197345, Russia
| | - Natalia V Bychkova
- Nikiforov All-Russian Center of Emergency and Radiation Medicine, Russian Federation Ministry of Emergency Situations, Laboratory of Clinical Immunology, 54,Optikov Street, Saint-Petersburg 197345, Russia
| | - Zhanna V Chubukina
- Russian Research Institute of Hematology and Transfusiology of Federal Medico-Biological Agency, Laboratory of Immunohematology, 16, 2nd Sovetskaia, 191024 Saint-Petersburg, Russia
| | - Anna I Buinyakova
- Clinical Hospital of the Russian Academy of Sciences, Mammology Department, 72, Toreza Ave., Saint-Petersburg 194017, Russia
| | - Marina F Ballyuzek
- Clinical Hospital of the Russian Academy of Sciences, Medical Administration, 72, Toreza Ave., Saint-Petersburg 194017, Russia
| | - Kira A Samoilova
- Institute of Cytology of the Russian Academy of Sciences, 4, Tikhoretsky Ave., Saint-Petersburg 194064, Russia.
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