Article

OBJECTIVE: To examine upper limb physical function and adverse effects after
axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB) in
patients with breast cancer to identify impairments that can inform
rehabilitation strategies. DESIGN: Prospective longitudinal cohort. Upper limb
measurements were studied preoperatively and 2.5 years after breast cancer
treatment. SETTING: Hospital setting. PARTICIPANTS:
Two groups of patients with
early-stage primary breast cancer (N=391): the ALND surgery group (mean age,
55+/-10y) and the SLNB group (mean age, 57+/-10y). INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Arm lymphedema (>/=10% increased arm volume relative to
control arm volume), grip strength (in kilograms), shoulder mobility, pain
intensity during isometric shoulder abduction (on a 100-mm visual analog scale),
and body mass index (kg/m(2)). Parametric/nonparametric tests were used for
hypothesized changes and differences, and regression analysis was used for
confounding factors. RESULTS: We observed more adverse effects in women treated
with ALND than with SLNB after 2.5 years (P<.05): arm lymphedema (17% vs 3%),
grip strength reduction (12% vs 2%), and shoulder abduction-provoked pain
(increase of 6% vs decrease of 50%). The adverse effects were similar for
affected and control upper limbs for all outcomes except arm lymphedema, which
occurred only on the affected side. CONCLUSIONS: Adverse effects in both affected
and control/unaffected upper limb were observed after 2.5-year follow-up in both
ALND and SLNB groups, but a higher prevalence was observed in the ALND group.
Thus, women going through ALND surgery may benefit from further postoperative
physical therapy, including resistance and strength exercise, focusing on pain
management.
CI - Copyright (c) 2014 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS