Late effects of treatment for breast cancer on shoulder function have been documented by a number of investigators; however, many studies include only prevalence data. When comparisons are provided that assess differences between treatment groups, only P-values without magnitudes of effect are often reported. The purpose of this systematic review was to identify literature that could be used to examine the magnitude of late effects of breast cancer treatments on shoulder function with a particular focus on axillary lymph node dissection (ALND) and on radiotherapy. A comprehensive search of online databases was performed for research papers published between 1980 and 2008 that provided comparison data between treatment groups, between the affected and unaffected side of individuals, or between pre-operative and subsequent assessments 12 months or more after diagnosis of breast cancer. Papers that met inclusion criteria were reviewed using a methodological checklist. Standardized effect sizes were computed for continuous data; odds ratios and 95% confidence intervals were computed for dichotomous data if not already available. Twenty-two papers met the inclusion criteria. With a few exceptions, most analyses showed excess shoulder morbidity with breast cancer treatment, ALND, or radiotherapy. Although effect sizes varied, moderate to large effects predominated across the different outcomes. There is sufficient evidence of late effects of ALND or radiotherapy post-breast cancer to warrant careful attention to shoulder function across time in individuals who have had breast cancer. Implications for future shoulder dysfunction are discussed.

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BACKGROUND.Erythrocyte changes from aerobic exercise training were examined during radiation treatment of breast cancer.METHODS.Twenty sedentary females with breast carcinoma who were ages 35 to 65 years were randomized to aerobic exercise (AE) of walking for 20 to 45 minutes, 3 to 5 times per week, at 50% to 70% of measured maximum heart rates or to placebo stretching (PS) activities 3 to 5 days per week during 7 weeks of radiation treatment. Measures were obtained 1 week before and after the radiation regimen. Serum blood analyses, through complete blood counts, measured red blood cell counts (RBC), hematocrit (HCT), and hemoglobin (HB). Peak aerobic capacity (peak VO2) was measured by exercise testing with oxygen uptake analysis to assess training. A Wilcoxon Mann‐Whitney U test examined changes between groups (P ≤ .05 for significance).RESULTS.AE peak VO2 increased by 6.3% (P = .001) and PS decreased by 4.6% (P = .083). RBC increased in AE from 4.10 to 4.21 million cells/μL and declined in PS from 4.30 to 4.19 million cells/μL; the between‐group differences were significant (P = .014). HCT increased in AE from 38.0% to 38.8% and declined in PS from 37.40% to 36.50%; the between‐group differences were significant (P = .046). HB increased in AE from 12.3 to 12.4 g/dL and declined in PS from 12.25 to 11.77 g/dL; the between‐group differences were significant (P = .009).CONCLUSIONS.The results of the current study suggest that moderate intensity aerobic exercise appears to maintain erythrocyte levels during radiation treatment of breast cancer compared with the declines observed in nontraining individuals. These findings suggest a safe, economical method to improve fitness and maintain erythrocytes in women during radiation treatment of breast cancer. Cancer 2006. © 2006 American Cancer Society.