Risk factors of impairment of shoulder function after axillary dissection for breast cancer

Kikuuchi, Masato; Akezaki, Yoshiteru; Nakata, Eiji; Yamashita, Natsumi; Tominaga, Ritsuko; Kurokawa, Hideaki; Hamada, Minako; Aogi, Kenjiro; Ohsumi, Shozo; Tsuji, Takao; Sugihara, Shinsuke

doi:10.1007/s00520-020-05533-7

Cited by 13 publications

(9 citation statements)

References 21 publications

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“…Conversely, in multivariate models, the risk decreased for axillary LN dissection (Additional file 1 : Table S3), possibly due to its association with BC surgery (92% of axillary LN dissections were performed during breast surgery in our study, data not shown) and with antalgic drug deliveries. Axillary LN dissection was previously associated with shoulder function impairment that may lead to chronic pain and complaints [ 29 , 30 ]. Therefore, adjustment for drug deliveries is likely to be a mediator between axillary LN dissection and RTW, and this could partly explain the non-significant results in multivariate models.…”

Section: Discussionmentioning

confidence: 99%

Impact of breast cancer care pathways and related symptoms on the return-to-work process: results from a population-based French cohort study (CONSTANCES)

et al. 2023

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Background Breast cancer (BC) treatments and related symptoms may affect return to work (RTW). The objective of this study was to investigate the impact of BC care pathways (timing and sequence of treatments) and related symptoms on RTW. Methods The study population included working-age women with BC who were enrolled in the French CONSTANCES cohort from 2012 to 2018. BC treatments, antidepressant/anxiolytic and antalgic drug deliveries (used as proxies of depression and pain, respectively) and statutory sick pay (used to estimate RTW and time to RTW) were assessed monthly using data from the French national healthcare system database. BC care pathways were identified with the sequence analysis method. Cox models with time-dependent covariates were used to investigate the impact of BC care pathways and related symptoms on RTW and time to RTW, after adjusting for age and socioeconomic characteristics. Results 73.2% (231/303) of women returned to work within 2 years after BC diagnosis. Five BC care pathway patterns were identified: (i) BC surgery only, (ii) BC surgery and radiotherapy, (iii) BC surgery and chemotherapy, (iv) BC surgery and chemotherapy and radiotherapy, and (v) BC surgery and long-term alternative chemotherapy/radiotherapy. The hazards ratios of non-RTW were significantly higher for women who received BC surgery and long-term alternative chemotherapy/radiotherapy and for > 55-year-old women. Time to RTW was significantly longer in women who received chemotherapy (patterns iii to v) and in women with antidepressant/anxiolytic and antalgic drug deliveries. Conclusion This study highlights the value of considering the dynamic, cumulative and temporal features of BC care pathways and related symptoms to facilitate the RTW of women with BC.

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Section: Discussionmentioning

confidence: 99%

Impact of breast cancer care pathways and related symptoms on the return-to-work process: results from a population-based French cohort study (CONSTANCES)

et al. 2023

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“…It was found that treatment to the contralateral side can have an effect on upper body functional impairments [39] and ROM of the effected arm [68].…”

Section: Treatment On the Dominant Sidementioning

confidence: 99%

“…The effect of radiation therapy was evaluated in 25 trials including 24,195 patients and was found to be a risk factor for persistent pain [24,32,65,92,97], shoulder stiffness [32,60,71], decreased ROM [17,37,68], and lymphedema [3, 17, 36, 37, 42, 43, 46, 47, 61-63, 70, 84, 88, 98] (See Table 7 and Figure 5A).…”

Section: Radiation Therapymentioning

confidence: 99%

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

Klein,

Friger,

David

et al. 2023

Oncotarget

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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.

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“…Three individual studies are identified reporting an association between the side of surgery (i.e., dominant versus non‐dominant limb side) and shoulder ROM (Fisher et al, 2020; Kikuuchi et al, 2021; Levy et al, 2012). Results seem conflicting, that is, one prospective study reports surgery at the dominant limb side to be a risk factor for impaired shoulder flexion and abduction ROM at 3 months after surgery (Kikuuchi et al, 2021), while cross‐sectional analyses report a reduced shoulder flexion and external rotation ROM (Fisher et al, 2020) and a reduced shoulder abduction ROM (Levy et al, 2012) among BCS whose affected side was the non‐dominant limb.…”

Section: Factors Associated With Upper Limb Movement Behaviormentioning

confidence: 99%

Altered upper limb motor behavior in breast cancer survivors and its relation to pain: A narrative review

Baets

Vets

Emmerzaal

et al. 2022

The Anatomical Record

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Breast cancer is the most commonly diagnosed cancer among women and many women suffer from persistent physical and psychological complaints following their cancer treatment. Altered motor behavior at the shoulder region and upper limb, that is, alterations in movement patterns, spatiotemporal movement characteristics and muscle activation patterns, is a common physical consequence of breast cancer treatment, that can have a clear impact on daily life functioning and quality of life. Furthermore, altered upper limb motor behavior is suggested to relate to upper limb pain, which is very commonly reported in breast cancer survivors (BCS). This review, prepared according to the SANRA guidelines, looks into the current understanding of alterations in motor behavior at shoulder and upper limb in BCS, by discussing the factors related to this altered behavior. In this, we specifically focus on the relation between motor behavior and pain. Results of our search show that cancer treatment modality is predictive for shoulder range of motion. Furthermore, single prospective studies show depressive symptoms, living alone, being non‐white and low physical activity levels as predicting factors for reduced shoulder range of motion. Pain as factor related to altered motor behavior is only assessed in cross‐sectional research, limiting its interpretation in context of being cause or consequence of motor behavioral adaptations, and on the underlying mechanism explaining their relation. It is concluded that studies which explain the mechanisms how and in which subgroup of BCS motor behavioral alterations are associated with pain at the upper limb, are necessary in future.

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Risk factors of impairment of shoulder function after axillary dissection for breast cancer

Cited by 13 publications

References 21 publications

Impact of breast cancer care pathways and related symptoms on the return-to-work process: results from a population-based French cohort study (CONSTANCES)

Impact of breast cancer care pathways and related symptoms on the return-to-work process: results from a population-based French cohort study (CONSTANCES)

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

Altered upper limb motor behavior in breast cancer survivors and its relation to pain: A narrative review

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