title: Upper limb physical function and adverse effects after breast cancer surgery: a prospective 2.5-year follow-up study and preoperative measures.
abstract: 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.
  
  
  METHODS
  Prospective longitudinal cohort. Upper limb measurements were studied preoperatively and 2.5 years after breast cancer treatment.
  
  
  METHODS
  Hospital setting.
  
  
  METHODS
  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).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  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.
authors.affiliation: Department of Cancer Treatment, The Norwegian Research Center for Active Rehabilitation, Oslo University Hospital, Oslo, Norway. Electronic address: aase.sagen@uus.no.
authors.forename: Aase
authors.initials: A
authors.lastname: Sagen
authors.affiliation: Department of Breast and Endocrine Surgery, The Norwegian Research Center for Active Rehabilitation, Oslo University Hospital, Oslo, Norway.
authors.forename: Rolf
authors.initials: R
authors.lastname: Kaaresen
authors.affiliation: Center of Epidemiology and Biostatistics, The Norwegian Research Center for Active Rehabilitation, Oslo University Hospital, Oslo, Norway.
authors.forename: Leiv
authors.initials: L
authors.lastname: Sandvik
authors.affiliation: Department of Cancer Treatment, The Norwegian Research Center for Active Rehabilitation, Oslo University Hospital, Oslo, Norway; Faculty of Health Sciences, Department of Community Medicine, University of Tromsø, Tromsø, Norway.
authors.forename: Inger
authors.initials: I
authors.lastname: Thune
authors.affiliation: Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
authors.forename: May Arna
authors.initials: MA
authors.lastname: Risberg
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength / Q000502:physiology*; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008207:Lymphatic Metastasis; D008209:Lymphedema / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D009367:Neoplasm Staging; D026741:Physical Therapy Modalities; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation; D057234:Preoperative Period; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D013997:Time Factors; D034941:Upper Extremity / Q000503:physiopathology*
keywords: Adverse effects; Breast cancer; Hand strength, grip; Lymphedema; Physical therapy modalities; Rehabilitation