Risk factors for long-term arm morbidities following breast cancer treatments: A systematic review

Abstract

Purpose: To examine the risk factors for arm morbidity following breast cancer treatments, taking a broad view of all types of physical morbidity, including prolonged pain, lymphedema, decreased range of motion, and functional limitations.Methods: A systematic literature review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. Studies exploring the risk factors for prolonged arm morbidity following breast cancer surgery and treatments were included. The studies were assessed independently according to pre-eligibility criteria, following data extraction and methodological quality assessment.Results: 1,242 articles were identified. After removing duplicates, the full texts of 1,153 articles were examined. Sixty-nine of these articles met the criteria and were included in the review. These 69 articles identified 29 risk factors for arm morbidity following treatments for breast cancer. The risk of bias was evaluated using NIH study quality assessment tools. The studies reviewed were published between 2001 and 2021 and included a total of 22,886 patients who were followed up for between three months and 10 years.Conclusions: The main risk factors for long-term morbidity are removal of lymph nodes from the axilla, body mass index >30, having undergone a mastectomy, the stage of the disease, radiation therapy, chemotherapy, infection and trauma to the affected arm after surgery. An understanding of the risk factors for prolonged arm morbidity after surgery can help doctors and therapists in making personalized decisions about the need and timing of rehabilitation treatments.

Early post-mastectomy upper limb kinesiotherapy plan

“…La mastectomía, puede generar una disfunción de hombro ipsolateral, debido a las alteraciones de estructuras musculares, tendinosas y nerviosas; provocando debilidad muscular, limitación de movimiento y deterioro de la función de hombro. (13,14) En este contexto la fisioterapia ha demostrado la capacidad de reducir morbilidades asociadas a la cirugía del cáncer de mama. (38) Por lo que, a través del plan de kinesioterapia propuesto de 6 semanas, basado en ejercicios respiratorios, movilidad activa de repetición progresiva y estiramientos de grupos musculares comprometidos, se logrará un mejoramiento en la funcionalidad global del hombro a través de la restauración de la movilidad y el fortalecimiento de la musculatura del hombro; además de la prevención de linfedema y control de dolor que son síntomas discapacitantes en esta población.…”

“…(11,12) Pese a este logro, las pacientes con cáncer de mama a menudo experimentan complicaciones musculoesqueléticas en el brazo y el hombro ipsilateral debido a la misma enfermedad o a los tratamientos, especialmente luego de una mastectomía. (13,14) La alteración en la función y estabilidad del hombro en pacientes mastectomizadas, puede estar asociada a afectación del manguito rotador, tendinopatías, miopatías, neuropatías, capsulitis, entre otras; (15,16) evidenciado por cambios estructurales en la musculatura y tejidos intra y extracapsulares del hombro. (17) Además, de la cicatriz que también puede influir en el dolor y la movilidad de hombro.…”

Shoulder function following oncoplastic breast conserving surgery—a narrative review

“…During the last decades, increased focus has been on late effects following the treatment of BC ( 1 , 2 ). The most important and prevalent late effects following BC surgery are lymphoedema, pain, as well as shoulder and arm morbidity ( 3 - 10 ). Besides, the cosmetic outcome is important to the women ( 11 , 12 ).…”

“…The risk of shoulder and arm morbidity following mastectomy with or without reconstruction is described in a recent review by Klein et al ( 10 ). They found increased risk of locoregional morbidity following mastectomy compared to breast conserving surgery (BCS), and a risk of pain and functional deficits following mastectomy with reconstruction.…”

“…Axillary surgery, especially axillary lymph node dissection (ALND), is known to be a risk factor for shoulder morbidity ( 1 , 14 ). Especially if followed by radiotherapy ( 4 , 10 ). Axillary surgery has been de-escalated during the last decades, and RT has been optimized by improved targeting and dose reduction.…”