The Sequelae of Mastectomy and Quadrantectomy Respect to the Reaching Movement in Breast Cancer Survivors
Condition: Breast Cancer; Pain, Chronic; Pain, Postoperative; Mastectomy; Lymphedema
MeSH terms: Breast Neoplasms; Lymphedema; Pain, Postoperative; Chronic Pain
Study type: Interventional

Summary: 
      The hypothesis behind our study was that patients after BC surgery, who underwent
      quadrantectomy or mastectomy, may present a different disability respect to the upper limb on
      the operated side. Accordingly they could have a different functional recovery patterns after
      rehabilitation.

      The aim of our study was to compare the recovery of the fluidity of the reaching movement
      (Jerk) as the primary outcome, the reduction of shoulder pain and improvement of disability
      for the upper limb respect the operated side as secondary outcomes, before and after a
      specific rehabilitation protocol treatment.
    

Detailed description: 
      Surgery is usually the first line of attack against breast cancer (BC). The decisions about
      surgery depend on many factors based on the stage, the type of cancer and patient
      acceptability, in terms of her long term peace of mind and survival prospects. Typically,
      breast reconstruction takes place during or soon after mastectomy, to avoid psychological
      distress for the patient, and in some cases, also after lumpectomy or quadrantectomy;
      furthermore breast reconstruction can be done many months or even years after surgery too.

      Today, breast cancer rehabilitation can help survivors to obtain and maintain the highest
      possible physical, social, psychological and vocational functioning, within the limits
      created by cancer and its treatments. After BC surgery, is common to detect disorders as
      shoulder dysfunction, postmastectomy syndrome, chemotherapy-induced peripheral neuropathy,
      axillary cording, lymphedema and a host of others as postural imbalance.

      Also, alterations in muscle activation and restricted shoulder mobility, which are common in
      BC patients, have been found to affect upper limb function and alterations in muscle activity
      patterns differed by breast surgery and reconstruction type: rehabilitation and in particular
      mobilization stretches and shoulder and scapula exercises after breast surgery are an
      effective resource to improve upper limb range of motion and decrease chest tightness and
      pain.

      This study was prompted by the lack of literature about the quadrantectomy versus mastectomy
      intervention, considering the disability of the upper limb from the operated side, especially
      if in relation to the rehabilitation pathway, currently recommended in BC care.
    

Intervention name(s): Rehabilitation protocol
Intervention type(s): Other
Intervention description(s): The rehabilitation treatment was performer in single session, lasted 60 minutes for session, 2 times a week, carried-out a 6-week exercises program for a total of 12 sessions, by a physiotherapist trained in oncologic rehabilitation, who started with a first phase of at least 15-20 min of low-impact aerobics warm-up. The second phase consisted in diaphragmatic breathing and postural exercises for the midline alignment in a supine position. Finally the patient continued in front of the mirror with exercises for the recovery of shoulder joint, isometric reinforcement exercises for the recovery of strength of shoulder stabilizer muscles. In the presence of lymphedema an additional weekly lymph drainage session was performed for a total of 10 sessions.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Breast Cancer; Pain, Chronic and Postoperative; Posture; Target - Reaching movement; Mastectomy; Quadrantectomy; Lymphedema; Rehabilitation; Scapula tilting; Shoulder; Biomechanics; Upper limb