Prospective study of shoulder strength, shoulder range of motion, and lymphedema in breast cancer patients from pre-surgery to 5 years after ALND or SLNB
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Determine the changes in shoulder strength, shoulder range of motion, and arm volume in breast cancer patients treated with sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND)
Sixty-eight SLNB and 44 ALND patients were followed up from pre-surgery to 5 years after surgery. Primary outcomes were the differences between affected and non-affected sides for the following: shoulder strength measured by dynamometry, shoulder range of motion measured by goniometry, and lymphedema measured by volume. As a secondary outcome, health-related quality of life (HRQL) was assessed by the Short Form-36 Health Survey (SF-36) and the Functional Assessment of Cancer Therapy for breast cancer (FACT-B+4) questionnaires. Changes over time were tested for SLNB and ALND using univariate repeated measures analysis of variance. Generalized estimating equation models were constructed to assess the effect of SLNB and ALND over time.
After 5 years, the ALND group had significant loss of strength for internal rotators (1.39 kg, p = 0.001) and significant arm volume increase (132.45 mL, p = 0.031). The ALND group had a greater number of patients with clinically relevant internal rotator strength loss (38.7 vs. 13.6%, p = 0.012) and a greater number of lymphedema requiring treatment (33.3 vs. 3.4%, p < 0.001) than the SLNB group. A loss of strength for shoulder external rotators, shoulder range of motion, and HRQL in physical and arm domains persisted at 5 years in both SLNB and ALND groups.
These results could help understand and plan the prevention, needs, and long-term care of breast cancer patients.
KeywordsBreast cancer Lymphedema Shoulder Quality of life
Compliance with ethical standards
The Research Ethics Committee approved the study and it was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from participants before being included.
Conflict of interest
The authors declare that they have no conflict of interest.
- 4.Sato F, Arinaga Y, Sato N, Ishida T, Ohuchi N (2016) The perioperative educational program for improving upper arm dysfunction in patients with breast cancer at 1-year follow-up: a prospective, controlled trial. Tohoku J Exp Med 238:229–236. https://doi.org/10.1620/tjem.238.229 CrossRefPubMedGoogle Scholar
- 6.Fleissig A, Fallowfield LJ, Langridge CI, Johnson L, Newcombe RG, Dixon JM, Kissin M, Mansel RE (2006) Post-operative arm morbidity and HRQL. Results of the ALMANAC randomised trial comparing sentinel node biopsy with standard axillary treatment in the management of patients with early breast cancer. Breast Cancer Res Treat 95:279–293. https://doi.org/10.1007/s10549-005-9025-7 CrossRefPubMedGoogle Scholar
- 7.Rietman JS, Dijkstra PU, Debreczeni R, Geertzen JHB, Robinson DPH, de Vries J (2004) Impairments, disabilities and health related HRQL after treatment for breast cancer: a follow-up study 2.7 years after surgery. Disabil Rehabil 26:78–84. https://doi.org/10.1080/09638280310001629642 CrossRefPubMedGoogle Scholar
- 14.Kootstra JJ, Dijkstra PU, Rietman H, de Vries J, Baas P, Geertzen JHB, Hoekstra HJ, Hoekstra-Weebers JEHM (2013) A longitudinal study of shoulder and arm morbidity in breast cancer survivors 7 years after sentinel lymph node biopsy or axillary lymph node dissection. Breast Cancer Res Treat 139:125–134. https://doi.org/10.1007/s10549-013-2509-y CrossRefPubMedGoogle Scholar
- 16.Hidding JT, Beurskens CHG, van der Wees PJ, van Laarhoven HWM, Nijhuis-van der Sanden MWG (2014) Treatment related impairments in arm and shoulder in patients with breast cancer: a systematic review. PLoS One 9:e96748. https://doi.org/10.1371/journal.pone.0096748 CrossRefPubMedPubMedCentralGoogle Scholar
- 18.McLaughlin SA, Wright MJ, Morris KT et al (2008) Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements. J Clin Oncol 26:5213–5219. https://doi.org/10.1200/JCO.2008.16.3725 CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Rietman JS, Geertzen JHB, Hoekstra HJ, Baas P, Dolsma WV, de Vries J, Groothoff JW, Eisma WH, Dijkstra PU (2006) Long term treatment related upper limb morbidity and HRQL after sentinel lymph node biopsy for stage I or II breast cancer. Eur J Surg Oncol 32:148–152. https://doi.org/10.1016/j.ejso.2005.11.008 CrossRefPubMedGoogle Scholar
- 24.Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, Cannady RS, Pratt-Chapman ML, Edge SB, Jacobs LA, Hurria A, Marks LB, LaMonte SJ, Warner E, Lyman GH, Ganz PA (2016) American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. J Clin Oncol 34:611–635. https://doi.org/10.1200/JCO.2015.64.3809 CrossRefPubMedGoogle Scholar
- 25.Kvale EA, Huang C-HS, Meneses KM, Demark-Wahnefried W, Bae S, Azuero CB, Rocque GB, Bevis KS, Ritchie CS (2016) Patient-centered support in the survivorship care transition: outcomes from the patient-owned survivorship care plan intervention. Cancer 122:3232–3242. https://doi.org/10.1002/cncr.30136 CrossRefPubMedGoogle Scholar
- 27.Khatcheressian JL, Hurley P, Bantug E, Esserman LJ, Grunfeld E, Halberg F, Hantel A, Henry NL, Muss HB, Smith TJ, Vogel VG, Wolff AC, Somerfield MR, Davidson NE, American Society of Clinical Oncology (2013) Breast cancer follow-up and management after primary treatment: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 31:961–965. https://doi.org/10.1200/JCO.2012.45.9859 CrossRefPubMedGoogle Scholar
- 28.Grunfeld E, Julian JA, Pond G, Maunsell E, Coyle D, Folkes A, Joy AA, Provencher L, Rayson D, Rheaume DE, Porter GA, Paszat LF, Pritchard KI, Robidoux A, Smith S, Sussman J, Dent S, Sisler J, Wiernikowski J, Levine MN (2011) Evaluating survivorship care plans: results of a randomized, clinical trial of patients with breast cancer. J Clin Oncol 29:4755–4762. https://doi.org/10.1200/JCO.2011.36.8373 CrossRefPubMedGoogle Scholar
- 30.Pusic AL, Cemal Y, Albornoz C, Klassen A, Cano S, Sulimanoff I, Hernandez M, Massey M, Cordeiro P, Morrow M, Mehrara B (2013) HRQL among breast cancer patients with lymphedema: a systematic review of patient-reported outcome instruments and outcomes. J Cancer Surviv 7:83–92. https://doi.org/10.1007/s11764-012-0247-5 CrossRefPubMedGoogle Scholar
- 32.De Lisa JA (1993) Rehabilitation medicine, Chapter 4 Clinical evaluation, 2nd edn. JB Lippincott Company Philadelphia. ISBN0-397-51262-7Google Scholar
- 34.Alonso J, Regidor E, Barrio G, Prieto L, Rodríguez C, de la Fuente L (1998) Population reference values of the Spanish version of the Health Questionnaire SF-36. Med Clin 111:410–416Google Scholar
- 38.Belmonte Martinez R, Garin Boronat O, Segura Badia M et al Functional Assessment of Cancer Therapy Questionnaire for Breast Cancer (FACT-B+4). Spanish version validation. Med Clin 137:685–688. https://doi.org/10.1016/j.medcli.2010.11.028
- 39.Hislop HJ, Montgomery J (2007) Techniques of manual examination, Daniels & Wortinghan’s muscle testing, 8th edn. Saunders Elsevier, St. LouisGoogle Scholar
- 40.Sagen A, Kaaresen R, Sandvik L, Thune I, Risberg MA (2014) Upper limb physical function and adverse effects after breast cancer surgery: a prospective 2.5-year follow-up study and preoperative measures. Arch Phys Med Rehabil 95:875–881. https://doi.org/10.1016/j.apmr.2013.12.015 CrossRefPubMedGoogle Scholar
- 42.Langer I, Guller U, Berclaz G, Koechli OR, Schaer G, Fehr MK, Hess T, Oertli D, Bronz L, Schnarwyler B, Wight E, Uehlinger U, Infanger E, Burger D, Zuber M (2007) Morbidity of sentinel lymph node biopsy (SLN) alone versus SLN and completion axillary lymph node dissection after breast cancer surgery: a prospective Swiss multicenter study on 659 patients. Ann Surg 245:452–461. https://doi.org/10.1097/01.sla.0000245472.47748.ec CrossRefPubMedPubMedCentralGoogle Scholar