Effects of breast cancer surgery and surgical side effects on body image over time

Background: There is little systematic research on the efficacy and tolerability of the addition of adjunctive analgesic agents in paravertebral analgesia. The addition of adjunctive analgesics, such as fentanyl and clonidine, to local anesthetics has been shown to enhance the quality and duration of sensory neural blockades, and decrease the dose of local anesthetic and supplemental analgesia. Objectives: Investigation of the safety and the analgesic efficacy of adding 1 µg/kg dexmedetomidine to bupivacaine 0.25% in thoracic paravertebral blocks (PVB) in patients undergoing modified radical mastectomy. Study Design: A randomized, double-blind trial. Setting: Academic medical center. Methods: Sixty American Society of Anesthesiologists physical status –I – III patients were randomly assigned to receive thoracicPVB with either 20 mL of bupivacaine 0.25% (Group B, n = 30), or 20 mL of bupivacaine 0.25% + 1 µg/kg dexmedetomidine (Group BD, n= 30). Assessment parameters included hemodynamics, sedation score, pain severity, time of first analgesics request, total analgesic consumption, and side effects in the first 48 hours. Results: There was a significant reduction in pulse rate and diastolic blood pressure starting at 30 minutes in both groups, but more evidenced in group BD (P < 0.001). Intraoperative Systolic blood pressure showed a significant reduction at 30 minutes in both groups (P < 0.001) then returned to baseline level at 120 minutes in both groups. There was a significant increase in pulse rate starting 2 hours postoperative until 48 hours postoperatively in group B but only after 12 hours until 48 hours in group BD (P < 0.001). The time of the first rescue analgesic requirement was significantly prolonged in the group BD (8.16 ± 42 hours) in comparison to group B (6.48 ± 5.24 hours) (P = 0.04). The mean total consumption of intravenous tramadol rescue analgesia in the postanesthesia care unit in the firtst 48 hours postoperatively was significantly decreased in group BD (150.19 ± 76.98 mg) compared to group B (194.44 ± 63.91 mg) (P = 0.03). No significant serious adverse effects were recorded during the study. Limitations: This study is limited by its sample size. Conclusion: The addition of dexmedetomidine 1 µg/kg to bupivacaine 0.25% in thoracic PVB in patients undergoing modified radical mastectomy improves the quality and the duration of analgesia and also provides an analgesic sparing effect with no serious side effects. Key words: Dexmedetomidine, paravertebral block, postoperative analgesia, breast cancer surgery

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Quality of Life for Women with Breast Cancer-Related Lymphedema: The Importance of Collaboration between Physical Medicine and Rehabilitation and General Surgery Clinics

Archives of Breast Cancer ◽

10.32768/abc.202182119-126 ◽

2021 ◽

pp. 119-126

Author(s):

Türkan Turgay ◽

Pınar Günel Karadeniz ◽

Göktürk Maralcan

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Body Image ◽

Axillary Dissection ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Physical Medicine ◽

Significant Difference ◽

Breast Cancer Related Lymphedema

Background: The aim of this study was to examine the clinical characteristics and quality of life (QOL) of patients with BCRL (breast cancer-related lymphedema).Methods: In this cross-sectional descriptive study, patients' characteristics such as age, body mass index (BMI: kg/m²), history of chemotherapy (CT), radiotherapy (RT), hormone replacement therapy (HRT), neoadjuvant therapy (NT), cancer stages, and types of surgery were recorded. Patients were evaluated using the ‘Disabilities of the Arm, Shoulder and Hand questionnaire’ (DASH), the ‘Lymphedema Quality of Life Questionnaire’ (LYMQOL-ARM), and a visual analogue scale (VAS). Results: A total of 68 women with the mean age of 52.50±9.33 and BMI 29.240 ± 5.05 kg/m² were recruited after breast cancer surgery in this study: thirty-three patients (48.5%) in Stage 0; 24 (35.3%) in Stage 1; 10 (14.7%) in Stage 2; and 1 (1.5%) in Stage 3. No statistically significant difference was found in the QOL according to treatments received after the diagnosis of breast cancer surgery, RT (except the appearance domain of QOL), CT, HRT, or NT. In patients who had received axillary dissection in combination with RT, a statistically significant association was observed between QOL related to body image and symptoms (p=0.009 and p=0.017, respectively). A statistically significant difference was found only in body image and clinical symptom domains according to the lymphedema stage (p=0.027 and p=0.002, respectively). It was observed that as shoulder pain (VAS) and disability (DASH) scores increased, scores of all domains of QOL increased except the overall domain in QOL (p<0.05). Conclusion: It was observed that clinical symptoms and body image parameters in QOL were associated with the lymphedema stage and the number of lymph nodes dissected. It was concluded that axillary dissection with axillary RT and RT alone after breast cancer surgery is associated with body image. Our study revealed that body image perception is related to the quality of life in patients with BCRL. Optimal management of the negative effects of self-reported lymphedema evaluated in the latency phase on quality of life requires coordination between Physical Medicine and Rehabilitation and General Surgery Clinics.

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Pectoralis-II Myofascial Block and Analgesia in Breast Cancer Surgery

Anesthesiology ◽

10.1097/aln.0000000000002822 ◽

2019 ◽

Vol 131 (3) ◽

pp. 630-648 ◽

Cited By ~ 12

Author(s):

Nasir Hussain ◽

Richard Brull ◽

Colin J. L. McCartney ◽

Patrick Wong ◽

Nicolas Kumar ◽

...

Keyword(s):

Breast Cancer ◽

Side Effects ◽

Area Under Curve ◽

Relative Effectiveness ◽

Cancer Surgery ◽

Paravertebral Block ◽

Morphine Consumption ◽

Breast Cancer Surgery ◽

Rest Pain ◽

Pain Area

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Thoracic paravertebral block is the preferred regional anesthetic technique for breast cancer surgery, but concerns over its invasiveness and risks have prompted search for alternatives. Pectoralis-II block is a promising analgesic technique and potential alternative to paravertebral block, but evidence of its absolute and relative effectiveness versus systemic analgesia (Control) and paravertebral block, respectively, is conflicting. This meta-analysis evaluates the analgesic effectiveness of Pectoralis-II versus Control and paravertebral block for breast cancer surgery. Methods Databases were searched for breast cancer surgery trials comparing Pectoralis-II with Control or paravertebral block. Postoperative oral morphine consumption and difference in area under curve for pooled rest pain scores more than 24 h were designated as coprimary outcomes. Opioid-related side effects, effects on long-term outcomes, such as chronic pain and opioid dependence, were also examined. Results were pooled using random-effects modeling. Results Fourteen randomized trials (887 patients) were analyzed. Compared with Control, Pectoralis-II provided clinically important reductions in 24-h morphine consumption (at least 30.0 mg), by a weighted mean difference [95% CI] of −30.5 mg [−42.2, −18.8] (P < 0.00001), and in rest pain area under the curve more than 24 h, by −4.7cm · h [−5.1, −4.2] or −1.2cm [−1.3, −1.1] per measurement. Compared with paravertebral block, Pectoralis-II was not statistically worse (not different) for 24-h morphine consumption, and not clinically worse for rest pain area under curve more than 24 h. No differences were observed in opioid-related side effects or any other outcomes. Conclusions We found that Pectoralis-II reduces pain intensity and morphine consumption during the first 24 h postoperatively when compared with systemic analgesia alone; and it also offers analgesic benefits noninferior to those of paravertebral block after breast cancer surgery. Evidence supports incorporating Pectoralis-II into multimodal analgesia and also using it as a paravertebral block alternative in this population.

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Presurgery Expectancies and Distress Predict Side Effects of Breast Cancer Surgery

PsycEXTRA Dataset ◽

10.1037/e351322004-001 ◽

2003 ◽

Author(s):

Guy Montgomery

Keyword(s):

Breast Cancer ◽

Side Effects ◽

Cancer Surgery ◽

Breast Cancer Surgery

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Framing Lymphoedema Following Breast Cancer Surgery: Women’s Experiences and Perceptions of Body Image, QOL and Support

The International Journal of Interdisciplinary Social Sciences Annual Review ◽

10.18848/1833-1882/cgp/v05i11/51934 ◽

2011 ◽

Vol 5 (11) ◽

pp. 113-126 ◽

Cited By ~ 1

Author(s):

Karen Chun ◽

Eileen O’Connor

Keyword(s):

Breast Cancer ◽

Body Image ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Women’S Experiences ◽

Women's Experiences

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Physical Rehabilitation: A Gap in Care Following all Types of Breast Cancer Surgery.

10.21203/rs.3.rs-220536/v1 ◽

2021 ◽

Author(s):

Deirdre E McGhee ◽

Julie R Steele

Keyword(s):

Breast Cancer ◽

Side Effects ◽

Breast Conserving Surgery ◽

Physical Rehabilitation ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Chi Square ◽

Entire Cohort ◽

Operative Care ◽

Significant Difference

Abstract Purpose: To investigate the access to and content of physical rehabilitation received by women after different types of breast cancer surgery. Methods: On-line survey of 632 Australia women (59.8 years SD 9.6) grouped according to their last reported breast cancer surgery: (i) breast conserving surgery (BCS; n=228), (ii) mastectomy (n=208; MAST), and (iii) breast reconstruction (BRS; n=196). Respondents retrospectively reported the physical rehabilitation education and treatment they received for six physical side-effects. Chi square of analysis of the percentage of respondents who received any form of physical rehabilitation for each physical side-effect amongst the three groups. Tabulation of the percentage of the entire cohort (n=632) that had lymph nodes removed, post-operative complications, or pre-existing musculoskeletal issues who received any form of physical rehabilitation as part of standard post-operative care.Results: No significant difference was found in the percentage of respondents who received any form of physical rehabilitation across the three groups, except for the physical side-effects of lymphoedema and breast support issues. Substantial variation was found in the percentage that received physical rehabilitation across the different physical side-effects. Physical rehabilitation for shoulder issues and lymphoedema was received by 75% and 70% of respondents respectively as part of standard care, compared to scar and torso issues and physical discomfort disturbing sleep, where less than 50% received any form of physical rehabilitation. Conclusion: Access to physical rehabilitation is poor following all types of breast cancer surgery, with gaps in the physical rehabilitation provided for specific physical side-effects.

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The relationship between body image, age, and distress in women facing breast cancer surgery

Palliative & Supportive Care ◽

10.1017/s1478951513000321 ◽

2013 ◽

Vol 12 (5) ◽

pp. 363-367 ◽

Cited By ~ 8

Author(s):

Sarah J. Miller ◽

Julie B. Schnur ◽

Sarah L. Weinberger-Litman ◽

Guy H. Montgomery

Keyword(s):

Breast Cancer ◽

Body Image ◽

Emotional Distress ◽

Past Research ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Surgical Interventions ◽

Younger Women ◽

Increased Risk ◽

The Relationship

AbstractObjectives:Research suggests that the strength of the relationship between body image and emotional distress decreases with age. Past research has focused on expected aging-related body changes, and has not yet examined unexpected body changes (e.g., breast cancer surgery). The present post-hoc study assessed relationships between age, body image, and emotional distress in women facing breast cancer surgery.Methods:Older (≥65 years, n = 40) and younger (<65 years, n = 40) women were matched on race/ethnicity, marital status, and surgery type. Within one week prior to surgery, participants completed measures of demographics, aspects of body image, and emotional distress (general and surgery-specific).Results:Results indicated that: (1) body image did not differ by age (p > 0.999); (2) older women reported less pre-surgical emotional distress than younger women (p's < 0.01); and, (3) age moderated the relationship between body image and emotional distress (p's < 0.06).Significance of results:The results suggest that younger women, particularly those with poor body image, are at an increased risk for pre-surgical emotional distress. These women may benefit from pre-surgical interventions designed to improve body image or to reduce pre-surgical emotional distress.

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