Abstract
Objectives
To assess the changes in shoulder strength of patients with breast cancer during the
first year after surgery; and to compare the effect of sentinel lymph node biopsy
(SLNB) and axillary lymph node dissection (ALND) on shoulder strength.
Design
Prospective longitudinal observational study from presurgery to 1 year after.
Setting
Tertiary hospital.
Participants
Of 129 consecutive patients examined for eligibility, a sample of women (N=112) with
breast cancer were included (44 underwent ALND, and 68 underwent SLNB).
Interventions
Not applicable.
Main Outcomes Measures
Difference between the affected and unaffected arm in strength of shoulder external
rotators, internal rotators, abductors, and serratus anterior, measured by dynamometry.
Evaluations were performed prior to surgery and at 1, 6, and 12 months after surgery.
Results
After breast cancer ALND surgery, strength decreased significantly at the first month
for internal rotators, without having recovered presurgery values after 1 year of
follow-up, with a mean difference of 2.26kg (P=.011). There was no significant loss of strength for patients treated with SLNB.
The loss of shoulder range of motion was only significant the first month for the
ALND group. The factors identified as associated with strength loss in the general
estimating equation models were the ALND surgery and having received physical/occupational
therapy during follow-up.
Conclusions
One year after breast cancer surgery, patients treated with ALND had not recovered
their previous shoulder internal rotators strength, whereas those who underwent SLNB
presented no significant loss of strength. This provides important information for
designing rehabilitation programs targeted specifically at the affected muscle group
after nodal surgical approach.
Keywords
List of abbreviations:
ALND (axillary lymph node dissection), OT (occupational therapy), PT (physical therapy), SLNB (sentinel lymph node biopsy)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Shoulder and arm morbidity in sentinel node-negative breast cancer patients: a systematic review.Breast Cancer Res Treat. 2014; 144: 21-31
- Quality-of-life impact of sentinel lymph node biopsy versus axillary lymph node dissection in breast cancer patients.Value Health. 2012; 15: 907-915
- Upper-body morbidity following breast cancer treatment is common, may persist longer-term and adversely influences quality of life.Health Qual Life Outcomes. 2010; 8: 92
- Arm/shoulder problems in breast cancer survivors are associated with reduced health and poorer physical quality of life.Acta Oncol. 2010; 49: 347-353
- Long-term morbidity of patients with early breast cancer after sentinel lymph node biopsy compared to axillary lymph node dissection.J Surg Oncol. 2006; 93: 109-119
- Lymphedema predictor factors after breast cancer surgery: a survival analysis.Lymphat Res Biol. 2015; 13: 268-274
- Lymphedema after breast cancer: incidence, risk factors, and effect on upper body function.J Clin Oncol. 2008; 26: 3536-3542
- Morbidity after sentinel lymph node biopsy in primary breast cancer: results from a randomized controlled trial.J Clin Oncol. 2005; 23: 4312-4321
- A longitudinal comparison of arm morbidity in stage I-II breast cancer patients treated with sentinel lymph node biopsy, sentinel lymph node biopsy followed by completion lymph node dissection, or axillary lymph node dissection.Ann Surg Oncol. 2010; 17: 2384-2394
- Comparison of shoulder flexibility, strength, and function between breast cancer survivors and healthy participants.J Cancer Surviv. 2011; 5: 167-174
- Physical Activity Guidelines Advisory Committee report, 2008.U.S. Department of Health and Human Services, Washington (DC)2008
- Food, nutrition, physical activity, and the prevention of cancer: a global perspective.American Institute for Cancer Research, Washington (DC)2007: 198-209
- Physical activity and survival after colorectal cancer diagnosis.J Clin Oncol. 2006; 24: 3527-3534
- Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803.J Clin Oncol. 2006; 24: 3535-3541
- Physical activity's impact on the association of fat and fiber intake with survival after breast cancer.Am J Epidemiol. 2009; 170: 1250-1256
- Influence of pre- and postdiagnosis physical activity on mortality in breast cancer survivors: the health, eating, activity, and lifestyle study.J Clin Oncol. 2008; 26: 3958-3964
- American College of Sports Medicine roundtable on exercise guidelines for cancer survivors.Med Sci Sports Exerc. 2010; 42: 1409-1426
- Decreased muscle strength following management of breast cancer.Disabil Rehabil. 2008; 30: 1098-1105
- Shoulder-arm morbidity in patients with sentinel node biopsy and complete axillary dissection–data from a prospective randomised trial.Eur J Surg Oncol. 2009; 35: 696-701
- 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. 2013; 139: 125-134
- Treatment related impairments in arm and shoulder in patients with breast cancer: a systematic review.PLoS One. 2014; 9: e96748
- 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. 2006; 32: 148-152
- American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer.J Clin Oncol. 2005; 23: 7703-7720
OncoGuía de mama: Agència d’Avaluació de Teconologia i Recerca Mèdiques. CatSalut. Departament de Sanitat i Seguretat Social. Generalitat de Catalunya. Noviembre 2003 (OG04/2003). Available at: http://www.gencat.cat/salut/depsan/pdf/og0304es.pdf. Accessed January 24, 2016.
- Assessment of shoulder strength in professional baseball pitchers.J Orthop Sports Phys Ther. 2000; 30: 544-551
- 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. 2004; 11: 1018-1024
- Pre-operative assessment enables early diagnosis and recovery of shoulder function in patients with breast cancer.Breast Cancer Res Treat. 2010; 120: 135-147
Article info
Publication history
Published online: January 04, 2016
Footnotes
Supported by the Instituto de Salud Carlos III Fondo Europeo de Desarrollo Regional (grant no. PI06/90070).
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
