A comprehensive approach to risk factors for upper arm morbidities following breast cancer treatment: a prospective study

Ifat Klein, Leonid Kalichman, Noy Chen, Sergio Susmallian, Ifat Klein, Leonid Kalichman, Noy Chen, Sergio Susmallian

Abstract

Background: Breast cancer surgery frequently causes deficiencies in shoulder functioning. The study pourpode is to identify risk factors for prolonged pain, reduction in function, and decrease in range of motion (ROM) in BC patients.

Methods: A prospective cohort study was designed in a private hospital; between October 2018 and April 2019 with a follow-up of 6 months. Patients following BC surgery, were divided by arm morbidities, and the different risk facrors were evaluated using univariate analysis and logistic regression.

Results: A total of 157 patients were included in the study. Risk factors for functional disabilities included; pain levels during hospitalization NPRS 1.2 (±0.8) compared to patients with no disabilities 0.5 ± 0.7 (p = .006), the size of tumors more than 1.4 ± 0.8 cm. compared with no morbidities 0.8 ± 0.9 cm. (p = .046), and breast reconstructions (p = .030). Risk factors for prolonged pain includes mastectomy (p = .006), breast reconstruction (p = .011), more than three dissected lymph nodes (p = .002), the presence of preoperative pain (p < .001), in-hospital pain (p < .001), axillary web syndrome (p < .001) and lymphedema (p < .001). Risk factors for decreased ROM were more than three dissected lymph nodes (p = .027), radiation (p = .018), and the size of dissected tissue (p = .035). Postoperative physical therapy appears to reduce the incidence of prolonged pain (p = .013) and regular physical activity may reduce long term functional disabilities (p = .021).

Conclusions: Upper arm morbidity following BC treatments affect up to 70% of the patients. Identifying the different risk and beneficial factors may improve awareness among physicians to refer patients to early rehabilitation programs and thus avoid chronic morbidity and improve the course of recovery.

Trial registration: The study was registered in Clinical trial with the ID number: NCT03389204 .

Keywords: Functional limitations; Pain; Physical activity; Physical therapy.

Conflict of interest statement

The authors declare no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Arm morbidity six-month postoperative after breast cancer treatments. A 29.3% of the patients did not present morbidity at 6 months of follow-up, 70.7% still had some type of morbidity, among the most common: pain and ROM restriction, it was also possible to verify the existence of more than one morbidity in more than 42% of the participants. Abbreviations: ROM- Range of motion, Flex- Flexion, Abd- abduction, AWS- Axillary web syndrome, MOR- Morbidities

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