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

  • Roser Belmonte
  • Monique Messaggi-Sartor
  • Montse Ferrer
  • Angels Pont
  • Ferran Escalada
Original Article
First Online:
Received:
Accepted:
  • 18 Downloads

Abstract

Objective

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)

Method

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.

Results

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.

Conclusion

These results could help understand and plan the prevention, needs, and long-term care of breast cancer patients.

Keywords

Breast cancer Lymphedema Shoulder Quality of life 
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Notes

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.

Supplementary material

520_2018_4186_MOESM1_ESM.docx (32 kb)
ESM 1 (DOCX 31 kb)
520_2018_4186_MOESM2_ESM.docx (53 kb)
ESM 2 (DOCX 53 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Hospital Mar-Esperança, Parc de Salut MarBarcelonaSpain
  2. 2.Universitat Autònoma de BarcelonaBellaterraSpain
  3. 3.IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
  4. 4.CIBER en Epidemiología y Salud Pública, CIBERESPMadridSpain

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