Effect of different rehabilitation training timelines to prevent shoulder dysfunction among postoperative breast cancer patients: study protocol for a randomized controlled trial

Yu-Wei Shao, Qing Shu, Dan Xu, Hui Teng, Gao-Song Wu, Jin-Xuan Hou, Jun Tian, Yu-Wei Shao, Qing Shu, Dan Xu, Hui Teng, Gao-Song Wu, Jin-Xuan Hou, Jun Tian

Abstract

Introduction: Due to advancements in treatment, the survival of breast cancer (BC) patients has significantly improved. Improving the postoperative quality of life has become a widespread concern for patients and doctors. At present, the staged rehabilitation training program for postoperative BC patients has been recognized. However, there is not yet a consensus about the optimal time to initiate rehabilitation training. We designed this study to investigate the optimal intervention times for postoperative BC patients to begin different stages of rehabilitation.

Design: This is a randomized controlled trial. Female participants with BC who are scheduled to undergo mastectomy, including unilateral total breast or breast-conserving surgery plus axillary lymph node dissection, will be enrolled in this study. The intervention includes the following: 200 participants will be allocated using a 1:1:1:1 ratio to the A, B, C, and D groups, which have four different rehabilitation timelines for four phases of rehabilitation exercises. A therapist will evaluate the patient's overall health and then adjust the training intensity before initiating training. The assessments include upper limb mobility, grip, limb circumference, postoperative drainage volume (PDV), and pain. The training will last for 12 weeks, and patients will undergo follow-up twice within 6 weeks after discharge. Outcomes include the following: Constant-Murley Score (CMS) is the primary parameter. European Organization Research and Treatment of Cancer Quality of Life Questionnaire-BR23 (EORTC QLQ-BR23), SF-36, range of motion (ROM), strength, grip, circumference, PDV, and pain are the secondary parameters. All enrolled subjects will be assessed at 1 day, 3 days, 1 week, and 2, 3, 6, 9, 12, and 18 weeks after the surgery.

Discussion: This is a randomized controlled trial to evaluate the effect of different rehabilitation training timelines to prevent shoulder dysfunction among postoperative patients with BC. If the results are confirmed, this study will establish an optimal timeline for postoperative BC rehabilitation.

Trial registration: ClinicalTrials.gov NCT03658265 . Registered on September 2018.

Keywords: Breast cancer; Randomized controlled trial; Rehabilitation training; Shoulder dysfunction problems; Timeline.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of this study
Fig. 2
Fig. 2
The study design

References

    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7–30. doi: 10.3322/caac.21442.
    1. Porter P. “Westernizing” women’s risks? Breast cancer in lower-income countries. N Engl J Med. 2008;358(3):213–216. doi: 10.1056/NEJMp0708307.
    1. Hortobagyi GN, de la Garza SJ, Pritchard K, Amadori D, Haidinger R, Hudis CA, et al. The global breast cancer burden: variations in epidemiology and survival. Clin Breast Cancer. 2005;6(5):391–401. doi: 10.3816/CBC.2005.n.043.
    1. Li T, Mello-Thoms C, Brennan PC. Descriptive epidemiology of breast cancer in China: incidence, mortality, survival and prevalence. Breast Cancer Res Treat. 2016;159(3):395–406. doi: 10.1007/s10549-016-3947-0.
    1. McDonald ES, Clark AS, Tchou J, Zhang P, Freedman GM. Clinical diagnosis and management of breast cancer. J Nucl Med. 2016;57(Suppl 1):9S–16S. doi: 10.2967/jnumed.115.157834.
    1. Manca G, Rubello D, Tardelli E, Giammarile F, Mazzarri S, Boni G, et al. Sentinel lymph node biopsy in breast cancer: indications, contraindications, and controversies. Clin Nucl Med. 2016;41(2):126–133. doi: 10.1097/RLU.0000000000000985.
    1. Lyman GH, Somerfield MR, Bosserman LD, Perkins CL, Weaver DL, Giuliano AE. Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017;35(5):561–564. doi: 10.1200/JCO.2016.71.0947.
    1. Wang Z, Wu LC, Chen JQ. Sentinel lymph node biopsy compared with axillary lymph node dissection in early breast cancer: a meta-analysis. Breast Cancer Res Treat. 2011;129(3):675–689. doi: 10.1007/s10549-011-1665-1.
    1. Rao R, Euhus D, Mayo HG, Balch C. Axillary node interventions in breast cancer: a systematic review. JAMA. 2013;310(13):1385–1394. doi: 10.1001/jama.2013.277804.
    1. McNeely ML, Binkley JM, Pusic AL, Campbell KL, Gabram S, Soballe PW. A prospective model of care for breast cancer rehabilitation: postoperative and postreconstructive issues. Cancer. 2012;118(8 Suppl):2226–2236. doi: 10.1002/cncr.27468.
    1. Mejdahl MK, Andersen KG, Gartner R, Kroman N, Kehlet H. Persistent pain and sensory disturbances after treatment for breast cancer: six year nationwide follow-up study. BMJ. 2013. 10.1136/bmj.f1865.
    1. De Groef A, Van Kampen M, Dieltjens E, Christiaens MR, Neven P, Geraerts I, et al. Effectiveness of postoperative physical therapy for upper-limb impairments after breast cancer treatment: a systematic review. Arch Phys Med Rehabil. 2015;96(6):1140–1153. doi: 10.1016/j.apmr.2015.01.006.
    1. Cheville AL, Tchou J. Barriers to rehabilitation following surgery for primary breast cancer. J Surg Oncol. 2007;95(5):409–418. doi: 10.1002/jso.20782.
    1. Chan DN, Lui LY, So WK. Effectiveness of exercise programmes on shoulder mobility and lymphoedema after axillary lymph node dissection for breast cancer: systematic review. J Adv Nurs. 2010;66(9):1902–1914.
    1. Stubblefield MD, Keole N. Upper body pain and functional disorders in patients with breast cancer. PM R. 2014;6(2):170–183. doi: 10.1016/j.pmrj.2013.08.605.
    1. McNeely ML, Campbell K, Ospina M, Rowe BH, Dabbs K, Klassen TP, et al. Exercise interventions for upper-limb dysfunction due to breast cancer treatment. Cochrane Database Syst Rev. 2010. 10.1002/14651858.CD005211.pub2.
    1. Galantino ML, Stout NL. Exercise interventions for upper limb dysfunction due to breast cancer treatment. Phys Ther. 2013;93(10):1291–1297. doi: 10.2522/ptj.20120049.
    1. Harris SR, Schmitz KH, Campbell KL, McNeely ML. Clinical practice guidelines for breast cancer rehabilitation: syntheses of guideline recommendations and qualitative appraisals. Cancer. 2012;118(8 Suppl):2312–2324. doi: 10.1002/cncr.27461.
    1. Richmond H, Lait C, Srikesavan C, Williamson E, Moser J, Newman M, et al. Development of an exercise intervention for the prevention of musculoskeletal shoulder problems after breast cancer treatment: the prevention of shoulder problems trial (UK PROSPER) BMC Health Serv Res. 2018;18(1):463. doi: 10.1186/s12913-018-3280-x.
    1. Ebaugh D, Spinelli B, Schmitz KH. Shoulder impairments and their association with symptomatic rotator cuff disease in breast cancer survivors. Med Hypotheses. 2011;77(4):481–487. doi: 10.1016/j.mehy.2011.06.015.
    1. Medeiros DM, Lima CS. Influence of chronic stretching on muscle performance: systematic review. Hum Mov Sci. 2017;54:220–229. doi: 10.1016/j.humov.2017.05.006.
    1. Costa PB, Herda TJ, Herda AA, Cramer JT. Effects of dynamic stretching on strength, muscle imbalance, and muscle activation. Med Sci Sports Exerc. 2014;46(3):586–593. doi: 10.1249/MSS.0000000000000138.
    1. Lotze MT, Duncan MA, Gerber LH, Woltering EA, Rosenberg SA. Early versus delayed shoulder motion following axillary dissection: a randomized prospective study. Ann Surg. 1981;193(3):288–295. doi: 10.1097/00000658-198103000-00007.
    1. Chan AW, Tetzlaff JM, Gotzsche PC, Altman DG, Mann H, Berlin JA, et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013;346:e7586. doi: 10.1136/bmj.e7586.
    1. DeLoach LJ, Higgins MS, Caplan AB, Stiff JL. The visual analog scale in the immediate postoperative period: intrasubject variability and correlation with a numeric scale. Anesth Analg. 1998;86(1):102–106.
    1. Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med. 2001;8(12):1153–1157. doi: 10.1111/j.1553-2712.2001.tb01132.x.
    1. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160–164.
    1. Rocourt MH, Radlinger L, Kalberer F, Sanavi S, Schmid NS, Leunig M, et al. Evaluation of intratester and intertester reliability of the Constant-Murley shoulder assessment. J Shoulder Elb Surg. 2008;17(2):364–369. doi: 10.1016/j.jse.2007.06.024.
    1. Angst F, Schwyzer HK, Aeschlimann A, Simmen BR, Goldhahn J. Measures of adult shoulder function: Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and its short version (QuickDASH), Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) Society standardized shoulder assessment form, Constant (Murley) Score (CS), Simple Shoulder Test (SST), Oxford Shoulder Score (OSS), Shoulder Disability Questionnaire (SDQ), and Western Ontario Shoulder Instability Index (WOSI) Arthritis Care Res (Hoboken) 2011;63 Suppl 11:S174–S188. doi: 10.1002/acr.20630.
    1. Dawson J, Hill G, Fitzpatrick R, Carr A. The benefits of using patient-based methods of assessment. Medium-term results of an observational study of shoulder surgery. J Bone Joint Surg Br. 2001;83(6):877–882. doi: 10.1302/0301-620X.83B6.0830877.
    1. Roy JS, MacDermid JC, Woodhouse LJ. A systematic review of the psychometric properties of the Constant-Murley score. J Shoulder Elb Surg. 2010;19(1):157–164. doi: 10.1016/j.jse.2009.04.008.
    1. Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life. Ann Intern Med. 1993;118(8):622–629. doi: 10.7326/0003-4819-118-8-199304150-00009.
    1. Sprangers MA, Groenvold M, Arraras JI, Franklin J, te Velde A, Muller M, et al. The European Organization for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module: first results from a three-country field study. J Clin Oncol. 1996;14(10):2756–2768. doi: 10.1200/JCO.1996.14.10.2756.
    1. Letellier ME, Dawes D, Mayo N. Content verification of the EORTC QLQ-C30/EORTC QLQ-BR23 with the International Classification of Functioning. Disability and Health Qual Life Res. 2015;24(3):757–768. doi: 10.1007/s11136-014-0791-8.
    1. Nguyen J, Popovic M, Chow E, Cella D, Beaumont JL, Chu D, et al. EORTC QLQ-BR23 and FACT-B for the assessment of quality of life in patients with breast cancer: a literature review. J Comp Eff Res. 2015;4(2):157–166. doi: 10.2217/cer.14.76.
    1. Jenkinson C, Coulter A, Wright L. Short form 36 (SF36) health survey questionnaire: normative data for adults of working age. BMJ. 1993;306(6890):1437–1440. doi: 10.1136/bmj.306.6890.1437.
    1. Li L, Wang HM, Shen Y. Chinese SF-36 Health Survey: translation, cultural adaptation, validation, and normalisation. J Epidemiol Community Health. 2003;57(4):259–263. doi: 10.1136/jech.57.4.259.
    1. Brazier JE, Harper R, Jones NM, O’Cathain A, Thomas KJ, Usherwood T, et al. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992;305(6846):160–164. doi: 10.1136/bmj.305.6846.160.
    1. Scaffidi M, Vulpiani MC, Vetrano M, Conforti F, Marchetti MR, Bonifacino A, et al. Early rehabilitation reduces the onset of complications in the upper limb following breast cancer surgery. Eur J Phys Rehabil Med. 2012;48(4):601–611.
    1. Yuan Q, Wu G, Xiao SY, Hou J, Ren Y, Wang H, et al. Identification and preservation of arm lymphatic system in axillary dissection for breast cancer to reduce arm lymphedema events: a randomized clinical trial. Ann Surg Oncol. 2019;26(11):3446–3454. doi: 10.1245/s10434-019-07569-4.
    1. Bendz I, Fagevik Olsen M. Evaluation of immediate versus delayed shoulder exercises after breast cancer surgery including lymph node dissection--a randomised controlled trial. Breast. 2002;11(3):241–248. doi: 10.1054/brst.2001.0412.
    1. Petrek JA, Peters MM, Nori S, Knauer C, Kinne DW, Rogatko A. Axillary lymphadenectomy. A prospective, randomized trial of 13 factors influencing drainage, including early or delayed arm mobilization. Arch Surg. 1990;125(3):378–382. doi: 10.1001/archsurg.1990.01410150100018.
    1. Chen SC, Chen MF. Timing of shoulder exercise after modified radical mastectomy: a prospective study. Changgeng Yi Xue Za Zhi. 1999;22(1):37–43.
    1. Williams KJ, Ayekoloye O, Moore HM, Davies AH. The calf muscle pump revisited. J Vasc Surg Venous Lymphat Disord. 2014;2(3):329–334. doi: 10.1016/j.jvsv.2013.10.053.
    1. Sjogaard G, Savard G, Juel C. Muscle blood flow during isometric activity and its relation to muscle fatigue. Eur J Appl Physiol Occup Physiol. 1988;57(3):327–335. doi: 10.1007/BF00635992.
    1. Cheema B, Gaul CA, Lane K, Fiatarone Singh MA. Progressive resistance training in breast cancer: a systematic review of clinical trials. Breast Cancer Res Treat. 2008;109(1):9–26. doi: 10.1007/s10549-007-9638-0.
    1. Cheema BS, Kilbreath SL, Fahey PP, Delaney GP, Atlantis E. Safety and efficacy of progressive resistance training in breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat. 2014;148(2):249–268. doi: 10.1007/s10549-014-3162-9.
    1. Kolden GG, Strauman TJ, Ward A, Kuta J, Woods TE, Schneider KL, et al. A pilot study of group exercise training (GET) for women with primary breast cancer: feasibility and health benefits. Psychooncology. 2002;11(5):447–456. doi: 10.1002/pon.591.
    1. Courneya KS, Segal RJ, Mackey JR, Gelmon K, Reid RD, Friedenreich CM, et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. J Clin Oncol. 2007;25(28):4396–4404. doi: 10.1200/JCO.2006.08.2024.
    1. Wright LE, Harhash AA, Kozlow WM, Waning DL, Regan JN, She Y, et al. Aromatase inhibitor-induced bone loss increases the progression of estrogen receptor-negative breast cancer in bone and exacerbates muscle weakness in vivo. Oncotarget. 2017;8(5):8406–8419. doi: 10.18632/oncotarget.14139.
    1. Lira FS, Antunes Bde M, Seelaender M, Rosa Neto JC. The therapeutic potential of exercise to treat cachexia. Curr Opin Support Palliat Care. 2015;9(4):317–324. doi: 10.1097/SPC.0000000000000170.

Source: PubMed

3
Abonneren