The study reviewed here found that most women who had breast cancer surgery had some type of arm problem (ranging from mild to severe) even 1 1/2 years after surgery. The research was presented at the 2008 American Society of Clinical Oncology (ASCO) Breast Cancer Symposium.
After breast cancer surgery, some women experience numbness, swelling, weakness, or tingling in the arm and shoulder area on the same side of the body on which surgery was done. These problems are more likely to happen after mastectomy surgery and less likely to happen after lumpectomy. The possibility for arm and shoulder problems depends quite a bit on whether any lymph nodes were removed during surgery and if so, how many were removed.Lymphedema (pronounced LIMF-eh-DEE-ma) is a condition that can happen after breast cancer surgery. Research has shown that between 5% and 25% of women develop some lymphedema after breast cancer surgery. Lymphedema is a build-up of lymph fluid in arm tissue, which causes swelling. Edema is the medical term for swelling. Lymph fluid normally drains from body tissue through the lymph nodes and lymph channels. If some lymph nodes and channels are removed or damaged during surgery, lymph fluid doesn't drain properly and collects in the tissue near the surgery site. Lymphedema can cause other symptoms such as tingling, numbness, stiffness, and weakness. Still, those problems can happen after breast cancer surgery even without lymphedema.
The researchers studied more 250 women for 18 months after breast cancer surgery. Every 3 months, the women reported any arm problems and had a physical exam to check for any movement or function problems. The researchers tested upper body strength and endurance, hand grip, flexibility, and range of motion.
The results:
Many of the women who had arm problems after surgery gradually improved during the 18 months of the study. Still, some surgery-related problems, including lymphedema, can become chronic (come back frequently over a long time period).
Breast cancer surgery side effects can greatly affect your quality of life. In most cases, the side effects are unavoidable and your surgeon will do everything possible to minimize them. But just because the side effects are unavoidable doesn't mean they can't be treated or eased.
If you've had breast cancer surgery and now have arm and shoulder problems, talk to your doctor. While not all problems will go away completely, there are steps you can take to manage them. Depending on your situation, you may want to ask your doctor whether referral to a physical rehabilitation or occupational therapy specialist with experience treating breast cancer surgery side effects makes sense. These specialists have experience with specific treatments and exercises that may improve your situation.
For more information on managing and avoiding lymphedema, visit the Breastcancer.org Lymphedema side effect page.
WASHINGTON, Sept. 9 (MedPage Today) -- Function-limiting upper-body morbidity after breast cancer surgery is more common and more debilitating than is commonly appreciated, Australian investigators reported here.
Half of breast cancer survivors have function-limiting upper body morbidity that persists for up to 18 months and cannot be completely explained by lymphedema, Sandra Hayes, Ph.D., of Queensland University of Technology in Brisbane, said at the ASCO Breast Cancer Symposium.
In most cases, patients have two or more symptoms, which remain moderate or severe at 18 months in almost 40% of cases, Upper body morbidity correlated inversely with upper body function at six and 18 months.
"Upper body morbidity affects a substantial proportion of breast cancer survivors," Dr. Hayes said in an interview. "I think healthcare providers are aware of the problems, but may not appreciate the magnitude or severity of the problems."
Treatment advances for breast cancer have improved survival but also created the impression that symptoms among survivors are infrequent and minor. To examine that perception, Dr. Hayes and colleagues reviewed data on upper body symptoms reported by 258 breast cancer patients.
Symptoms and their impact on upper body function were assessed at three-month intervals, beginning six months after diagnosis and continuing until 18 months. Functional assessments include upper body strength and endurance, hand grip, flexibility and range of motion, and score on the Disability of the Arm, Shoulder and Hand questionnaire.
At every assessment, numbness and swelling were the most commonly reported symptoms (24% to 31% and 19% to 24%, respectively). However, 10% or more of patients reported pain, tingling, weakness, stiffness, and poor range of motion between six and 18 months.
The proportion of patients reporting moderate or severe symptoms ranged from 51.5% at six months to 37.6% at 18 months. At every assessment, patients were more likely to report two or more symptoms than an isolated symptom.
"When we included mild symptoms in our analysis, 85% of women reported symptoms at six months and 75% at 18 months," said Dr. Hayes.
Upper-body symptoms were more common among patients with lymphedema (66% versus 44% of those without lymphedema at six months). Even so, lymphedema could not account for the range, severity, and persistence of patients' upper-body symptoms, Dr. Hayes said.
Upper-body function scores improved gradually from six to 18 months, but persistence of moderate-to-severe upper body morbidity correlated with lower function scores at each assessment.
The study was supported by the National Breast Cancer Foundation. Dr. Hayes reported no conflicts of interest.
Primary source: 2008 Breast Cancer Symposium Source reference: Hayes S et al. "Upper-body morbidity following breast cancer treatment and its relationship with quality of life" Breast Cancer Symposium 2008; Abstract 142.
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