To identify long-term predictive factors for upper-limb morbidity in patients who completed an early rehabilitation program after breast cancer surgery.
Material and Methods:
Prospective cohort study. The study population comprised 659 female patients who were consecutively enrolled in a rehabilitation program shortly after breast cancer surgery between April 1999 and June 2010. The rehabilitation program comprised clinical evaluation, written information on hygiene measures, aerobic exercise, and physical therapy. Variables assessed for affected and contralateral limb included circumferential measurement for lymphedema, passive range of motion in the shoulder, pain intensity using a visual analog scale, and sensory loss by the pin-prick method and tactile sensitivity. Predictive variables covered age, body mass index, regular physical activity, previous shoulder pathology, type of breast surgery, side of surgery, postsurgical complications, sentinel lymph node biopsy/axillary lymph node dissection, tumor size and histology, chemotherapy, radiotherapy, and hormonal treatment. A multivariate logistic regression analysis was performed to control for confounding factors.
The mean follow-up period was 72 months. A total of 306 patients (64.4%) showed upper-limb symptoms at some point during the follow-up period. Sensory loss and pain were the most relevant impairments. Predictive factors for shoulder and arm morbidity were obesity (odds ratio [OR] = 2.45; 95% confidence interval [CI], 1.18-5.08), previous shoulder pathology (OR = 6.05; 95% CI, 2.89-12.63), postsurgical complications (OR = 2.16; 95% CI, 1.05-4.43), and regional lymph node radiotherapy (OR = 3.42; 95% CI, 2.07-5.63).
Previous shoulder pathology, postsurgical events, obesity, and site of radiotherapy were significant risk factors for developing shoulder and arm morbidity.