More than half of women who underwent treatment for breast cancer experienced physical/functional complications involving an upper limb, according to results of a cross-sectional study published in Supportive Care in Cancer.1

Although a high incidence of posttreatment upper limb dysfunction has been previously reported in survivors of breast cancer, the aim of this study was to take a closer look at the underlying causes of this condition in women with a history of breast cancer.

“Knowing what actually influences the development of upper limb dysfunction after breast cancer treatment can help healthcare professionals minimize the incidence of this complication, thus reducing the physical and functional impact of the disease and providing a better quality of life of survivors,” the study authors commented.

This study involved adult women who had received breast cancer treatment between 2009 and 2016 at 1 of 2 institutions in Brazil.


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Data related to sociodemographic characteristics and treatment history were collected during a patient interview and/or review of the patient medical record. The Disabilities of Arm, Shoulder and Hand (DASH) questionnaire was used to assess the impact of breast cancer treatment on the upper limb.2

Regarding the selection of the DASH questionnaire, the study authors explained that “most of the instruments used to assess complications include physical examination with measurement of range of motion, muscle strength, and sensory capacity, and because they are limited to physical issues, many are unable to identify the level of independence and functionality for performing daily life activities related to the upper limbs.”

They further clarified that the incorporation of patient-reported outcome measures into the DASH questionnaire also allowed for assessment of patient quality of life.

Other patient assessments included evaluations for the presence of lymphedema in the upper limb, breast skin sensitivity, paresthesia, pain, and scar adherence.

Of the 233 women included in this study, the mean patient age was 56.3 years. All patients underwent surgery for breast cancer with an average of approximately 5 years between surgical treatment and assessment. Lymphadenectomy was performed in 60.2% of patients, with the remaining patients having undergone either sentinel lymph node dissection or no surgical assessment of the lymph nodes. Approximately three-quarters of patients had received chemotherapy, radiation therapy, and were overweight/obese based on body mass index (BMI).

Key study findings included some level of upper limb dysfunction and evidence for sensory intercostobrachial nerve damage in 55.4% and 47.2% of patients, respectively.

Of note, analyses based on models adjusted for age and BMI showed that only paresthesia due to intercostobrachial nerve damage was significantly associated with upper limb dysfunction in these patients (odds ratio [OR], 1.96; 95% CI, 1.06-3.60; P =.03).

In summarizing the findings from this study, the study authors stated that “upper limb dysfunction is a frequent complication after breast cancer treatment and may be associated with neuropathies due to changes in the intercostobrachial nerve pathway.”

Reference

1. Siqueria TC, Fragoas SP, Pelegrini A, de Oliveira AR, Medeiros da Luz C. Factors associated with upper limb dysfunction in breast cancer survivors. Support Care Cancer. Published online August 17, 2020.  doi:10.1007/s00520-020-05668-7

2. Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C. Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity. J Hand Ther. 2001;14(2):128-146.