Magnitude of late effects of breast cancer treatments on shoulder function: a systematic review
- 453 Downloads
Late effects of treatment for breast cancer on shoulder function have been documented by a number of investigators; however, many studies include only prevalence data. When comparisons are provided that assess differences between treatment groups, only P-values without magnitudes of effect are often reported. The purpose of this systematic review was to identify literature that could be used to examine the magnitude of late effects of breast cancer treatments on shoulder function with a particular focus on axillary lymph node dissection (ALND) and on radiotherapy. A comprehensive search of online databases was performed for research papers published between 1980 and 2008 that provided comparison data between treatment groups, between the affected and unaffected side of individuals, or between pre-operative and subsequent assessments 12 months or more after diagnosis of breast cancer. Papers that met inclusion criteria were reviewed using a methodological checklist. Standardized effect sizes were computed for continuous data; odds ratios and 95% confidence intervals were computed for dichotomous data if not already available. Twenty-two papers met the inclusion criteria. With a few exceptions, most analyses showed excess shoulder morbidity with breast cancer treatment, ALND, or radiotherapy. Although effect sizes varied, moderate to large effects predominated across the different outcomes. There is sufficient evidence of late effects of ALND or radiotherapy post-breast cancer to warrant careful attention to shoulder function across time in individuals who have had breast cancer. Implications for future shoulder dysfunction are discussed.
KeywordsBreast neoplasm Shoulder morbidity Radiotherapy Lymph node biopsy Effect size Odds ratio
The authors would like to thank Lucinda Pfalzer, PT, PhD of University of Michigan—Flint and Tygre Whittington, BS of Oakland University, Rochester, MI. Dr. Pflazer assisted with conceptualization, literature search and article retrieval. Ms. Whittington assisted with literature search and article retrieval.
- 6.Caban ME, Freeman JL, Zhang DD, Jansen C, Ostir G, Hatch SS, Goodwin JS (2006) The relationship between depressive symptoms and shoulder mobility among older women: assessment at one year after breast cancer diagnosis. Clin Rehabil 20:513–522. doi: 10.1191/0269215506cr966oa PubMedCrossRefGoogle Scholar
- 9.Cohen J (1988) Statistical power analysis for the social sciences. Earlbaum, Hillsdale, NJGoogle Scholar
- 12.Fleissig A, Fallowfield LJ, Langridge CI, Johnson L, Newcombe RG, Dixon JM, Kissin M, Mansel RE (2005) Post-operative arm morbidity and quality of life. 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. doi: 10.1007/s10549-005-9025-7 PubMedCrossRefGoogle Scholar
- 19.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. doi: 10.1097/01.sla.0000245472.47748.ec PubMedCrossRefGoogle Scholar
- 23.Ludewig PM, Borstad JD (2005) The shoulder complex. In: Levangie PK, Norkin CC (eds) Joint structure and function: a comprehensive analysis. F.A. Davis, PhiladelphiaGoogle Scholar
- 25.Mansel RE, Fallowfield L, Kissin M, Goyal A, Newcombe RG, Dixon JM, Yiangou C, Horgan K, Bundred N, Monypenny I, England D, Sibbering M, Abdullah TI, Barr L, Chetty U, Sinnett DH, Fleissig A, Clarke D, Ell PJ (2006) Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC trial. J Natl Cancer Inst 98:599–609PubMedCrossRefGoogle Scholar
- 30.Rietman J, Dijkstra P, Debreczeni R, Geertzen J, Robinson D, De Vries J (2004) Impairments, disabilities and health related quality of life after treatment for breast cancer: a follow-up study 2.7 years after surgery. Disabil Rehabil 26:78–84. doi: 10.1080/09638280310001629642 PubMedCrossRefGoogle Scholar
- 31.Rietman JS, Dijkstra PU, Geertzen JH, Baas P, de Vries J, Dolsma WV, Groothoff JW, Eisma WH, Hoekstra HJ (2004) Treatment-related upper limb morbidity 1 year after sentinel lymph node biopsy or axillary lymph node dissection for stage I or II breast cancer. Ann Surg Oncol 11:1018–1024. doi: 10.1245/ASO.2004.03.512 PubMedCrossRefGoogle Scholar
- 33.Rietman JS, Geertzen JH, Hoekstra HJ, Baas P, Dolsma WV, de Vries J, Groothoff JW, Eisma WH, Dijkstra PU (2006) Long term treatment related upper limb morbidity and quality of life after sentinel lymph node biopsy for stage I or II breast cancer. Eur J Surg Oncol 32:148–152. doi: 10.1016/j.ejso.2005.11.008 PubMedCrossRefGoogle Scholar
- 34.Rosenthal R (1994) Parametric measures of effect size. In: Cooper H, Hedges LV (eds) The handbook of research synthesis. Russell Sage Foundation, New York, pp 231–244Google Scholar
- 45.Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, Intra M, Veronesi P, Robertson C, Maisonneuve P, Renne G, De Cicco C, De Lucia F, Gennari R (2003) A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 349:546–553. doi: 10.1056/NEJMoa012782 PubMedCrossRefGoogle Scholar