Shoulder function and health outcomes in newly diagnosed breast cancer patients receiving surgery: a prospective study

Min, Jihee; Yeon, Sujin; Ryu, Jiin; Kim, Jee Ye; Yang, Eun Joo; Kim, Seung il; Park, Seho; Jeon, Justin Y.

doi:10.1016/j.clbc.2023.03.001

Cited by 3 publications

(10 citation statements)

References 47 publications

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“…There was a 18% reduction in shoulder strength on the unaffected side within the usual care group at 6 months postsurgery, and this finding is consistent with our previous research. 9 In contrast, the exercise intervention led to a significant improvement in shoulder strength of unaffected side, increasing by up to 44.8% compared to presurgery levels. In comparison, the usual care group experienced a decline in shoulder strength by 17.5% from presurgery levels (eTable 7 in Supplement 2).…”

Section: Discussionmentioning

confidence: 87%

“…Although many patients with breast cancer experience shoulder dysfunction, most surgeons and medical personnel have assumed that shoulder dysfunction after breast cancer surgery is a common and inevitable part of the healing process. 8,9,17,43 Only patients with breast cancer who experience substantial shoulder dysfunction are referred to physiatrists or physiotherapists, and these referrals most often happen several months to years after breast cancer surgery. Of note, we observed a significant reduction in ROM and strength on the unaffected side in patients in the usual care group.…”

Section: Discussionmentioning

confidence: 99%

“…This hybrid approach with video and smartphone assistance could be more cost-effective and less labor intensive. Although many patients with breast cancer experience shoulder dysfunction, most surgeons and medical personnel have assumed that shoulder dysfunction after breast cancer surgery is a common and inevitable part of the healing process . Only patients with breast cancer who experience substantial shoulder dysfunction are referred to physiatrists or physiotherapists, and these referrals most often happen several months to years after breast cancer surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Advances in surgical treatment have positively impacted breast cancer survivorship, although breast cancer surgery still has adverse outcomes ranging from acute discomfort to chronic complications . Approximately one-third of women experience surgery-induced adverse effects, such as restricted shoulder range of motion (ROM), decreased shoulder strength, pain, lymphedema, and axillary web syndrome, which may lead to depression and nervousness . Other common adverse effects of breast cancer surgery include arm weakness, fatigue, and general impairment of daily activities .…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6][7][8] Approximately one-third of women experience surgery-induced adverse effects, such as restricted shoulder range of motion (ROM), decreased shoulder strength, pain, lymphedema, and axillary web syndrome, which may lead to depression and nervousness. [9][10][11][12][13] Other common adverse effects of breast cancer surgery include arm weakness, fatigue, and general impairment of daily activities. 14,15 Complications after surgery or a prolonged recovery period may even delay the start of adjuvant treatment.…”

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confidence: 99%

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Early Implementation of Exercise to Facilitate Recovery After Breast Cancer Surgery

Min,

Kim,

Ryu

et al. 2024

JAMA Surg

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ImportanceRecovery of shoulder function following breast cancer surgery is crucial for physical functioning and quality of life. While early implementation of shoulder rehabilitation exercises may enhance recovery, the optimal timing and exercise program remain unclear.ObjectiveTo investigate whether an early exercise intervention, initiated 1 day postsurgery and continued for 1 month through subsequent visits, could improve shoulder range of motion (ROM) and strength in patients with breast cancer.Design, Setting, and ParticipantsA parallel-group, 2-arm randomized clinical trial was conducted between June 2020 and October 2021 at the Breast Cancer Center in Seoul, South Korea. Fifty-six patients (of 119 screened) with early-stage breast cancer who were scheduled for partial or total mastectomy were randomized into a tailored resistance exercise group (n = 28) or a usual care group (n = 28). Data were analyzed from November 2021 to June 2022.InterventionsThe exercise intervention commenced 1 day postsurgery and consisted of 4 supervised exercise education sessions corresponding with surgeon visits and daily home-based exercises for the first postoperative month. Tailored programs, including stretching and strength exercises, were adjusted based on individual shoulder function recovery status.Main Outcomes and MeasuresPrimary end points were shoulder ROM and strength at 1 and 6 months postsurgery. Physical activity, body composition, and quality of life were assessed at 6 months.ResultsOf 56 patients randomized (mean [SD] age, 50.3 [6.6] years), 54 completed the trial (96%), with 100% and 97% compliance to supervised and home-based exercise sessions, respectively. At 1 month postsurgery, 19 (67.9%) in the exercise group had fully recovered shoulder strength compared to 1 (3.6%) in the usual care group (P &lt; .001). At 6 months, 22 (78.6%) in the exercise group had fully recovered shoulder ROM and 24 (85.7%) had fully recovered strength compared to 6 (21.4%) and 5 (17.9%), respectively, in the usual care group (P &lt; .001). The exercise group exhibited less loss in muscle mass and improved physical activity and quality of life compared to the usual care group.Conclusion and RelevanceIn this trial, 1-month tailored exercise program, initiated immediately after breast cancer surgery and supplemented with supervised sessions coinciding with surgeon visits, significantly improved shoulder function in patients with breast cancer.Trial RegistrationWHO International Clinical Trials Registry identifier: KCT0006997

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Early Implementation of Exercise to Facilitate Recovery After Breast Cancer Surgery

Min,

Kim,

Ryu

et al. 2024

JAMA Surg

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Evaluation and Management of Shoulder Dysfunction in Cancer Survivors

Lee,

Stubblefield

2024

Curr Phys Med Rehabil Rep

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Purpose of Review Shoulder dysfunction widely affects function and quality of life of cancer survivors. This paper discusses the etiology, identification, evaluation, and management of the common shoulder impairments seen in cancer survivors, particularly those with breast cancer, head and neck cancer, and Hodgkin lymphoma. Recent Findings Shoulder dysfunction can be caused by a wide range of sources, often as a sequelae of cancer treatments including surgery, systemic therapy, and radiation therapy. These can change the shoulder biomechanics leading to musculoskeletal disorders such as rotator cuff disease and adhesive capsulitis. Other etiologies include neuromuscular complications, such as post-breast surgery pain syndrome and radiation fibrosis syndrome, and lymphovascular disorders such as lymphedema and axillary web syndrome. Metastatic bone disease and primary bone cancer should be considered for those with intense shoulder pain. Detailed history and physical exam, and in some cases, imaging can assist with evaluation of shoulder issues. Exercise, physical and occupation therapy are essential in managing shoulder dysfunction. Summary Shoulder dysfunction can limit function and quality of life for cancer survivors. It is important to consider the possible etiologies as accurate diagnosis is critical for optimal treatment.

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The Efficacy of Muscle Energy and Mulligan Mobilization Techniques for the Upper Extremities and Posture after Breast Cancer Surgery with Axillary Dissection: A Randomized Controlled Trial

Elabd,

Etoom,

Jahan

et al. 2024

JCM

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Background: Breast cancer surgeries affect the upper extremities and posture. This study aimed to examine the efficacy of muscle energy and Mulligan mobilization techniques on the upper extremities and posture after breast cancer surgery with axillary dissection. Methods: A total of 90 female participants who had undergone breast cancer surgery with axillary dissection were recruited and randomly assigned to three groups. Group A received a combination of the Mulligan and muscle energy techniques, while Groups B and C received either the Mulligan or muscle energy techniques for six weeks, respectively. The study measured the shoulders’ range of motion, posture, and upper-extremity disabilities. Outcome measurements were taken at three different time points: baseline, post-intervention, and at eight-week follow-up. Results: All the interventions significantly improved the study outcomes. The combination of the Mulligan and muscle energy techniques was significantly better than a single intervention. Mulligan mobilization was superior to the muscle energy techniques in terms of improving the shoulders’ range of motion and disability. The interventions showed a significant effect pre-post-treatment and pre-follow-up but not post-follow-up. Conclusions: The Mulligan mobilization and muscle energy techniques have been found beneficial in improving the postural changes and shoulder outcomes after breast cancer surgery with axillary dissection. The superior effectiveness of the combined interventions points out the importance of integrating multiple therapeutic approaches for optimal outcomes. Regular examination and long-term follow-up assessment are important for studying the effect of rehabilitation interventions in people after the late stages of breast surgery.

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Shoulder function and health outcomes in newly diagnosed breast cancer patients receiving surgery: a prospective study

Cited by 3 publications

References 47 publications

Early Implementation of Exercise to Facilitate Recovery After Breast Cancer Surgery

Early Implementation of Exercise to Facilitate Recovery After Breast Cancer Surgery

Evaluation and Management of Shoulder Dysfunction in Cancer Survivors

The Efficacy of Muscle Energy and Mulligan Mobilization Techniques for the Upper Extremities and Posture after Breast Cancer Surgery with Axillary Dissection: A Randomized Controlled Trial

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