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

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.

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A Risk Factor Analysis of Axillary Web Syndrome in Patients After Breast Cancer Surgery: A Single Center Study in Korea

Annals of Rehabilitation Medicine ◽

10.5535/arm.21092 ◽

2021 ◽

Vol 45 (5) ◽

pp. 401-409

Author(s):

Sangah Jeong ◽

Byung Joo Song ◽

Jiyoung Rhu ◽

Cheolki Kim ◽

Sun Im ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Underlying Disease ◽

Disease Type ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Univariable Analysis ◽

Axillary Web Syndrome ◽

Single Center Study ◽

Type Of Surgery

Objective To investigate the prevalence and risk factors of axillary web syndrome (AWS) in Korean patients.Methods This retrospective study included a total of 189 women who underwent breast cancer surgery and received physical therapy between September 2019 and August 2020. We analyzed AWS and the correlation between the patients’ demographics, underlying disease, type of surgery and chemotherapy or radiation therapy, and lymphedema.Results The prevalence of AWS was found to be 30.6%. In the univariable analysis, age, chemotherapy, and hypertension were related to AWS. Finally, the multivariable logistic regression revealed that chemotherapy (odds ratio [OR]=2.84; 95% confidence interval [CI], 1.46–5.53) and HTN (OR=2.72; 95% CI, 1.18–6.30) were the strongest risk factors of AWS.Conclusion To the best of our knowledge, this was the first study that explored the risk factors of AWS in a Korean population after breast cancer surgery. As almost one-third of patients suffer from AWS after breast cancer surgery, it is essential to closely monitor the development of AWS in patients with hypertension or undergoing chemotherapy.

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Incidence and risk factors for axillary web syndrome after breast cancer surgery

Breast Cancer Research and Treatment ◽

10.1007/s10549-011-1805-7 ◽

2011 ◽

Vol 131 (3) ◽

pp. 987-992 ◽

Cited By ~ 32

Author(s):

Anke Bergmann ◽

Valéria Vasconcellos Mendes ◽

Ricardo de Almeida Dias ◽

Blenda do Amaral e Silva ◽

Maria Giseli da Costa Leite Ferreira ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Axillary Web Syndrome

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Metastatic status of sentinel lymph nodes in breast cancer determined with photoacoustic microscopy via dual-targeting nanoparticles

Light Science & Applications ◽

10.1038/s41377-020-00399-0 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Yanfeng Dai ◽

Xiang Yu ◽

Jianshuang Wei ◽

Fanxin Zeng ◽

Yiran Li ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Nodes ◽

Scavenger Receptor ◽

Intradermal Injection ◽

Sentinel Lymph Nodes ◽

Breast Cancer Surgery ◽

Photoacoustic Microscopy ◽

Dual Targeting ◽

Scavenger Receptor Class ◽

Distinct Distribution

Abstract Detection of sentinel lymph nodes (SLNs) is critical to guide the treatment of breast cancer. However, distinguishing metastatic SLNs from normal and inflamed lymph nodes (LNs) during surgical resection remains a challenge. Here, we report a CD44 and scavenger receptor class B1 dual-targeting hyaluronic acid nanoparticle (5K-HA-HPPS) loaded with the near-infra-red fluorescent dye DiR-BOA for SLN imaging in breast cancer. The small sized (~40 nm) self-assembled 5K-HA-HPPSs accumulated rapidly in the SLNs after intradermal injection. Compared with normal popliteal LNs (N-LN), there were ~3.2-fold and ~2.4-fold increases in fluorescence intensity in tumour metastatic SLNs (T-MLN) and inflamed LNs (Inf-LN), respectively, 6 h after nanoparticle inoculation. More importantly, photoacoustic microscopy (PAM) of 5K-HA-HPPS showed a significantly distinct distribution in T-MLN compared with N-LN and Inf-LN. Signals were mainly distributed at the centre of T-MLN but at the periphery of N-LN and Inf-LN. The ratio of PA intensity (R) at the centre of the LNs compared with that at the periphery was 5.93 ± 0.75 for T-MLNs of the 5K-HA-HPPS group, which was much higher than that for the Inf-LNs (R = 0.2 ± 0.07) and N-LNs (R = 0.45 ± 0.09). These results suggest that 5K-HA-HPPS injection combined with PAM provides a powerful tool for distinguishing metastatic SLNs from pLNs and inflamed LNs, thus guiding the removal of SLNs during breast cancer surgery.

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The Findings of SPECT/CT Concerning Bypass Lymph Circulation in Lymphedema Following Breast Cancer Surgery

Healthcare ◽

10.3390/healthcare9040471 ◽

2021 ◽

Vol 9 (4) ◽

pp. 471

Author(s):

Min Young Lee ◽

Eunjung Kong ◽

Dong Gyu Lee

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Lymphatic Drainage ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Node Dissection ◽

Positive Group

This study aimed to determine whether bypass circulation was present in lymphedema and its effect. This was a retrospective, cross-sectional study. Patients who underwent unilateral breast cancer surgery with axillary lymph node dissection were recruited and underwent single-photon emission tomography/computed tomography (SPECT/CT). SPECT/CT was performed to detect the three-dimensional locations of radio-activated lymph nodes. Patients with radioactivity in anatomical locations other than axillary lymph nodes were classified into a positive group. All patients received complete decongestive therapy (CDT). Exclusion criteria were as follows: History of bilateral breast cancer surgery, cervical lymph node dissection history, and upper extremity amputation. The difference in the upper extremity circumference (cm) was measured at four points: Mid-point of the upper arm, elbow, and 10 and 15 cm below the elbow. Twenty-nine patients were included in this study. Fifteen patients (51.7%) had bypass lymphatic systems on the affected side, six (20.7%) had a bypass lymphatic system with axillary lymph nodes on the unaffected side, and 11 (37.9%) showed new lymphatic drainage. The positive group showed significantly less swelling than the negative group at the mid-arm, elbow, and 15 cm below the elbow. Bypass lymphatic circulation had two patterns: Infraclavicular lymph nodes and supraclavicular and/or cervical lymph nodes. Changes in lymph drainage caused by surgery triggered the activation of the superficial lymphatic drainage system to relieve lymphedema. Superficial lymphatic drainage has a connection through the deltopectoral groove.

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Effect of physical activity levels on oncological breast surgery recovery: a prospective cohort study

Scientific Reports ◽

10.1038/s41598-021-89908-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ifat Klein ◽

Leonid Kalichman ◽

Noy Chen ◽

Sergio Susmallian

Keyword(s):

Breast Cancer ◽

Physical Activity ◽

Chronic Pain ◽

Self Efficacy ◽

Breast Cancer Surgery ◽

Activity Levels ◽

Axillary Web Syndrome ◽

Function Range ◽

A Prospective Study ◽

The Impact

AbstractAfter breast cancer (BC) surgery, women may experience a physical decline. The effect of physical activity (PA) on the course of recovery after BC surgery has not yet been thoroughly examined. To analyze the impact of physical activity performed by women undergoing breast cancer surgery on measures of function, range of motion, and self-efficacy. A prospective study was carried out in 157 patients who underwent surgery for BC between October 2018 and April 2019, divided into four groups according to the intensity of PA with 6 months follow-up. 50 sedentary patients and 107 active patients were enrolled; the mean age was 52.6. Women who performed physical activity, moderate to vigorous, demonstrated lower function disabilities (QuickDASH 2.22) compared with inactivity or light physical activity (QuickDASH 7.0, p < 0.001), with better shoulder flexion (159.0° vs. 150.7°, p = 0.007) and abduction (159.5° vs. 152.2°, p = 0.008). Higher PA levels, displayed in higher self-efficacy reports (9.5 vs. 8.8, p = 0.002), and return to prior job status (0.005). The PA level does not influence pain at one, three and 6 months postoperatively (p = 0.278, p = 0.304 and p = 0.304 respectively). High PA levels increase the risk of axillary web syndrome (p = 0.041), although, it reduces the incidence of chronic pain (p = 0.007). Women who practice physical activity recover better from BC surgery than sedentary women. The higher the intensity and frequency of training, the better the results. Vigorous activity cause axillary web syndrome, despite, it has a beneficial effect on lowering the rate of chronic pain.

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