Abstract:Objective: The objective is to evaluate the effect of limiting shoulder range of motion (ROM) for 15 or 30 days on surgical complications and on shoulder ROM, pain, and upper limb function of breast cancer patients following conservative oncoplastic surgery.Materials and Methods: A randomized clinical trial was conducted with 60 women with breast cancer who underwent conservative oncoplastic surgery. The day after surgery, all patients started an exercise protocol with shoulder exercises limited to 90 degrees.… Show more
“…Most studies (39 of 57) were RCT [ 19 – 57 ], five were controlled non randomized clinical trials [ 58 – 63 ], four were prospective cohort studies [ 61 , 64 – 66 ], one was a retrospective cohort study [ 67 ], two was a case–control study [ 68 , 69 ], four were quasi-experimental [ 70 – 73 ], one was a pilot study [ 74 ] and one was a feasibility study [ 75 ]. The studies originated from 22 countries distributed across 4 continents (i.e., Americas, Europe, Asia and Oceania), most of which were high income countries [ 19 – 26 , 29 , 31 , 33 – 36 , 39 – 41 , 44 – 47 , 50 , 52 – 54 , 56 , 57 , 59 , 61 – 69 , 71 , 73 – 75 ] or upper-middle income countries [ 27 , 28 , 30 , 32 , 37 , 38 , 42 , 43 , 48 , 49 , 58 , 60 , 72 ], with only three studies conducted in lower-middle income countries [ 51 , 55 , 70 ]. The body of literature on this topic turned out to be quite recent, with 71.9% (41 of 57) of studies published between 2010 and 2022 and 22.8% (13 out of 57) between 2000 and 2009.…”
Section: Resultsmentioning
confidence: 99%
“…Exercises targeting upper limb tissues and function were predominant. Fewer studies adopted a more global approach, providing aerobic exercises [ 21 , 23 , 52 , 66 , 71 ] or yoga [ 41 , 55 ], as well as strengthening or stretching of the lower extremity [ 19 – 21 ] or neck muscles [ 28 , 44 , 57 , 58 , 60 – 63 , 66 , 72 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Prevention and lymphedema awareness, skincare routine, risks of postoperative complications, and physical activity or nutrition counseling were the cornerstones of these strategies. Nine studies also reported prescribing shoulder ROM limitations and activity restrictions (e.g., avoiding lifting, carrying heavier items, running, jumping, or other strenuous activities) up to 6 weeks following surgery [22,32,39,51,57] or upon surgical drains removal [36,53,54,75].…”
Background
Mastectomy is the first-line treatment approach for more than 90% of breast cancer patients. The numerous physical impairments associated with this surgical procedure negatively impact the patient’s quality of life. To date, rehabilitation resources available for breast cancer patients undergoing mastectomy within the institutions affiliated to the Centre intégré universitaire de soins de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS-MCQ) are lacking and do not always seem to reflect the particularities of breast cancer care pathways. The purpose of this review was to identify and describe the conservative interventions and the clinical outcome measures used in the perioperative physical rehabilitation of women with breast cancer who are awaiting or have undergone mastectomy. We also aimed to report on the barriers and facilitators to study participation and completion.
Methods
MEDLINE, CINAHL, and the Cochrane Library were searched from inception to January 2021, and we updated the search on July 11, 2022. We included peer-reviewed English and French literature with quantitative designs, describing conservative interventions and clinical outcome measures used within rehabilitation programs designed for women who were awaiting or had undergone mastectomy. Paired reviewers independently reviewed all citations and articles using a two-phase screening process and independently extracted the data.
Results
Of the 6080 articles identified, 57 met the inclusion criteria. Most interventions were multimodal, which combined exercise with patient education, manual therapy, and/or lymphatic drainage. The most frequently used objective measures of physical function were shoulder range of motion, muscle strength, and signs of lymphedema. In contrast, the primary patient-reported outcome measures were quality of life, shoulder function, and pain. Undergoing another breast surgery, death, and cancer recurrence were the most reported barriers to study completion.
Conclusion
This scoping review reports on the heterogeneity and wide range of conservative interventions and clinical outcome measures used in the physical rehabilitation of breast cancer patients who had undergone or were scheduled to undergo mastectomy. Tailoring interventions to breast cancer patients’ needs and promoting outpatient rehabilitation interventions appear to be better suited to the particularities of breast cancer care pathways. Further research is needed to better identify barriers and facilitators to study participation and completion.
“…Most studies (39 of 57) were RCT [ 19 – 57 ], five were controlled non randomized clinical trials [ 58 – 63 ], four were prospective cohort studies [ 61 , 64 – 66 ], one was a retrospective cohort study [ 67 ], two was a case–control study [ 68 , 69 ], four were quasi-experimental [ 70 – 73 ], one was a pilot study [ 74 ] and one was a feasibility study [ 75 ]. The studies originated from 22 countries distributed across 4 continents (i.e., Americas, Europe, Asia and Oceania), most of which were high income countries [ 19 – 26 , 29 , 31 , 33 – 36 , 39 – 41 , 44 – 47 , 50 , 52 – 54 , 56 , 57 , 59 , 61 – 69 , 71 , 73 – 75 ] or upper-middle income countries [ 27 , 28 , 30 , 32 , 37 , 38 , 42 , 43 , 48 , 49 , 58 , 60 , 72 ], with only three studies conducted in lower-middle income countries [ 51 , 55 , 70 ]. The body of literature on this topic turned out to be quite recent, with 71.9% (41 of 57) of studies published between 2010 and 2022 and 22.8% (13 out of 57) between 2000 and 2009.…”
Section: Resultsmentioning
confidence: 99%
“…Exercises targeting upper limb tissues and function were predominant. Fewer studies adopted a more global approach, providing aerobic exercises [ 21 , 23 , 52 , 66 , 71 ] or yoga [ 41 , 55 ], as well as strengthening or stretching of the lower extremity [ 19 – 21 ] or neck muscles [ 28 , 44 , 57 , 58 , 60 – 63 , 66 , 72 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Prevention and lymphedema awareness, skincare routine, risks of postoperative complications, and physical activity or nutrition counseling were the cornerstones of these strategies. Nine studies also reported prescribing shoulder ROM limitations and activity restrictions (e.g., avoiding lifting, carrying heavier items, running, jumping, or other strenuous activities) up to 6 weeks following surgery [22,32,39,51,57] or upon surgical drains removal [36,53,54,75].…”
Background
Mastectomy is the first-line treatment approach for more than 90% of breast cancer patients. The numerous physical impairments associated with this surgical procedure negatively impact the patient’s quality of life. To date, rehabilitation resources available for breast cancer patients undergoing mastectomy within the institutions affiliated to the Centre intégré universitaire de soins de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS-MCQ) are lacking and do not always seem to reflect the particularities of breast cancer care pathways. The purpose of this review was to identify and describe the conservative interventions and the clinical outcome measures used in the perioperative physical rehabilitation of women with breast cancer who are awaiting or have undergone mastectomy. We also aimed to report on the barriers and facilitators to study participation and completion.
Methods
MEDLINE, CINAHL, and the Cochrane Library were searched from inception to January 2021, and we updated the search on July 11, 2022. We included peer-reviewed English and French literature with quantitative designs, describing conservative interventions and clinical outcome measures used within rehabilitation programs designed for women who were awaiting or had undergone mastectomy. Paired reviewers independently reviewed all citations and articles using a two-phase screening process and independently extracted the data.
Results
Of the 6080 articles identified, 57 met the inclusion criteria. Most interventions were multimodal, which combined exercise with patient education, manual therapy, and/or lymphatic drainage. The most frequently used objective measures of physical function were shoulder range of motion, muscle strength, and signs of lymphedema. In contrast, the primary patient-reported outcome measures were quality of life, shoulder function, and pain. Undergoing another breast surgery, death, and cancer recurrence were the most reported barriers to study completion.
Conclusion
This scoping review reports on the heterogeneity and wide range of conservative interventions and clinical outcome measures used in the physical rehabilitation of breast cancer patients who had undergone or were scheduled to undergo mastectomy. Tailoring interventions to breast cancer patients’ needs and promoting outpatient rehabilitation interventions appear to be better suited to the particularities of breast cancer care pathways. Further research is needed to better identify barriers and facilitators to study participation and completion.
“…Previously, there have been some efforts to apply physical therapy and exercise in patients who underwent breast cancer surgery. Physical therapy including passive mobilization, stretching, and exercise programs introduced as early as 7 days after surgery can be effective for improvement of shoulder ROM and postoperative pain [25,26]. A randomized controlled trial showed that addition of scapular stabilization exercises and Thera-band strengthening exercises can be beneficial for shoulder function and quality of life in post-mastectomy patients with adhesive capsulitis [16].…”
Purpose To investigate the effects of intra-articular glenohumeral joint triamcinolone injection in treating secondary adhesive capsulitis after breast cancer surgery.Methods This study prospectively enrolled 37 participants, 22 of the breast cancer surgery group and 15 of the idiopathic group. All participants received intra-articular glenohumeral joint injection in the affected shoulder joint and received physiotherapy for 12 week. The clinical assessment evaluated before, and 1, 3, and 6 months after the intervention. The primary outcome was the change in the Shoulder Pain and Disability Index (SPADI).Results The total SPADI(%) in both groups showed significant decrease from baseline to 1, 3, and 6 months after the intervention. There was no significant difference in the differences of the total SPADI from baseline to 1, 3, and 6 months between two groups. However, the improvement in the SPADI pain subscale and the PROM of abduction at 3 and 6 months post-injection in the breast cancer group were inferior to the idiopathic group.Conclusion Intra-articular triamcinolone injection for adhesive capsulitis after breast cancer surgery significantly improved in significant improvements of pain, shoulder function and the PROM. The effects were similar to idiopathic adhesive capsulitis, but in the breast cancer surgery group, appropriate pain and ROM management and monitoring are required even 3 months after injection. With a standardized injection protocol, intra-articular triamcinolone injection could be an effective and safe treatment option for secondary adhesive capsulitis after breast cancer surgery.
“…We applied the following pragmatic search terms to identify studies; searched on 8 August 2022: {Exercise[tiab] AND shoulder[ti] AND (impairment [tiab] OR pain [tiab]) AND (("breast cancer" OR breast) AND cancer)}. We found 19 records in database searching, from which 8 records corresponded to randomised trials [28,[33][34][35][36][37][38][39]. Thus, the result of the present randomised trial is expected to have a high impact in the health system to in terms of having more focus on late-term shoulder impairments and improving the quality of physiotherapeutic rehabilitation, especially for physiotherapists involved in the management of breast cancer and late-term shoulder impairments.…”
Background
In breast cancer patients, late-term upper limb sequelae, such as shoulder pain and impaired shoulder function, remain common after primary breast cancer surgery. The aim of this trial is to evaluate whether an expert assessment of shoulder impairments, followed by an individualised treatment plan, is superior to a minimal physiotherapeutic rehabilitation program in reducing shoulder symptoms, among women with late-term shoulder impairments after primary breast cancer.
Methods/design
The study is designed as a stratified, parallel-group, assessor-blinded, randomised, controlled trial conducted in Denmark; 130 participants with late-term shoulder impairments 3–7 years after primary surgery for breast cancer will be recruited. Participants will be randomised (allocation 1:1) to either an expert assessment of shoulder impairments followed by an individualised treatment plan or to follow a minimal physiotherapeutic rehabilitation program delivered in a pamphlet. The primary outcome will be a change in shoulder pain and function from baseline to 12 weeks after initiating the treatment, as measured by the patient-reported outcome Shoulder Pain and Disability Index (SPADI) questionnaire.
Discussion
There has been an insufficient focus in research and clinical practice on late-term shoulder impairment in women following surgery for breast cancer. This trial will focus on interventions towards late-term shoulder impairments and is expected to provide evidence-based knowledge to physiotherapists and women about the management of shoulder pain and impaired shoulder function.
Trial registration
ClinicalTrials.gov NCT05277909. Registered on 11 March 2022.
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