Treatment Related Impairments in Arm and Shoulder in Patients with Breast Cancer: A Systematic Review

Abstract

BackgroundBreast cancer is the most common type of cancer in women in the developed world. As a result of breast cancer treatment, many patients suffer from serious complaints in their arm and shoulder, leading to limitations in activities of daily living and participation. In this systematic literature review we present an overview of the adverse effects of the integrated breast cancer treatment related to impairment in functions and structures in the upper extremity and upper body and limitations in daily activities. Patients at highest risk were defined.Methods and FindingsWe conducted a systematic literature search using the databases of PubMed, Embase, CINAHL and Cochrane from 2000 to October 2012, according to the PRISMA guidelines. Included were studies with patients with stage I–III breast cancer, treated with surgery and additional treatments (radiotherapy, chemotherapy and hormonal therapy). The following health outcomes were extracted: reduced joint mobility, reduced muscle strength, pain, lymphedema and limitations in daily activities. Outcomes were divided in within the first 12 months and >12 months post-operatively. Patients treated with ALND are at the highest risk of developing impairments of the arm and shoulder. Reduced ROM and muscle strength, pain, lymphedema and decreased degree of activities in daily living were reported most frequently in relation to ALND. Lumpectomy was related to a decline in the level of activities of daily living. Radiotherapy and hormonal therapy were the main risk factors for pain.ConclusionsPatients treated with ALND require special attention to detect and consequently address impairments in the arm and shoulder. Patients with pain should be monitored carefully, because pain limits the degree of daily activities. Future research has to describe a complete overview of the medical treatment and analyze outcome in relation to the treatment. Utilization of uniform validated measurement instruments has to be encouraged.

Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies

“…5,[10][11][12][13][14] We assessed the risk of bias in individual studies and used the GRADE approach to appraise the quality of evidence. We converted the intensity of persistent postsurgical pain to a 10-cm visual analogue scale across studies to optimize the interpretation of our findings.…”

“…[10][11][12][13] Systematic reviews summarizing proposed risk factors for persistent pain after breast cancer surgery -including demographic, intraoperative and postoperative factors -have had several limitations, including outdated searches, inadequate attention to risk-of-bias assessment, lack of statistical pooling of measures of association and failure to evaluate the quality of evidence.…”

“…[10][11][12][13] Systematic reviews summarizing proposed risk factors for persistent pain after breast cancer surgery -including demographic, intraoperative and postoperative factors -have had several limitations, including outdated searches, inadequate attention to risk-of-bias assessment, lack of statistical pooling of measures of association and failure to evaluate the quality of evidence. 5,[10][11][12][13][14] We conducted a systematic review and meta-analysis of observational studies to identify risk factors for persistent pain after breast cancer surgery, addressing the limitations of previous reviews.…”

Effects of Warm Acupuncture on Breast Cancer–Related Chronic Lymphedema: A Randomized Controlled Trial

“…The potential for further improving rom was thus limited. The greatest risk factors for reduced rom after bca surgery include mastectomy, radiotherapy to the axilla, axillary lymph node dissection, and radiotherapy to the chest wall 27 . As we observed, upper-arm lymphedema is not a major risk factor for reduced rom.…”

Effects of breast cancer related lymphedema on hand muscle strength, hand functions and sensory loss of hand

“…Bizim çalışmamızda omuz ağrısı sıklığının yüksek olmasına hastaların tamamına aksiler lenf nodu diseksiyonu yapılmış olması ve yarıdan fazlasının post-operatif dönemde radyoterapi almış olması katkıda bulunmuş olabilir. Aksiller lenf nodu diseksiyonu meme kanseri olan hastalarda omuz ve kolda sakatlık gelişmesinde en önemli risk faktörü olarak tanımlanmıştır 40 . Meme kanseri olan hastalarda post-operatif dönemde radyoterapi almış olmak da omuz ağrısı ile ilişkili bulunmuştur 41 .…”