Effects of breast cancer related lymphedema on hand muscle strength, hand functions and sensory loss of hand

Year 2016, Volume: 41 Issue: 2, 208 - 216, 30.06.2016

Gül Civelek

https://doi.org/10.17826/cutf.200040

Cited By: 2

Abstract

Purpose: In this study, we aimed to investigate clinical features of patients with breast cancer related lymphedema (BCRL) and effects of BCRL on hand muscle strength and function.
Materials and Methods: Patients applying to oncologic rehabilitation polyclinic with right hand dominancy were included in the study. Clinical and demographic data of all patients were noted, physical examinations were performed. The presence of shoulder pain was questioned. To determine the hand grip strength Jamar hand dynamometer and to evaluate the tip pinch strength pinchmeter were used. Sensory loss was assessed with Semmes-Weinstein monofilament test, hand volume measurement was made with hand volumeter.
Results: Thirty two female patients with mean age 54.5 ± 11.4 (mean ± SD) were included in the study. Axillary dissection was performed in all patients. 62.5% of patients received radiotherapy in post-operative period, 96.9% received chemotherapy. 78.1% of patients reported that they had shoulder pain on the affected side. In the right side affected group and the left side affected group, there were no significant differences in grip strengths, hand functions, sensory loss and volumes between right and left hands. The tip pinch strength of the right hand was higher than the left side in the left side affected group.
Conclusion: In patients with BCRL, having axillary dissection, receiving chemotherapy and radiotherapy in post-operative period, obesity and shoulder pain are common. Evaluation of patients with BCRL should be made in details, should be versatile and should include questioning shoulder pain and hand evaluation.

Keywords

-

Meme kanseri ile ilişkili lenfödemin el kas gücü, el fonksiyonları ve elde duyu kaybına etkisi

Abstract

Amaç: Bu çalışmada meme kanseri ile ilişkili lenfödem’i (MKİL) olan hastaların klinik özelliklerini tanımlamak, MKİL’in el kas gücü ve fonksiyonlarına etkisini araştırmak amaçlanmıştır.Gereç ve Yöntem: Çalışmaya onkolojik rehabilitasyon polikliniğine başvuran MKİL’i olan sağ eli dominant kadınlar dahil edildi. Çalışma prospektif olarak yürütüldü. Tüm hastaların klinik ve demografik bilgileri not edildi, fizik muayeneleri yapıldı. Omuz ağrısı varlığı sorgulandı. Elin kavrama gücünü belirlemek amacıyla Jamar el dinamometresi, parmak ucu kavramalarını değerlendirmek icin pinçmetre kullanıldı. Semmes-Weinstein monofilaman testi ile duyusal kayıplar, el volümetresi ile el volümleri değerlendirildi. Bulgular: Çalışmaya yaş ortalaması 54.5±11.4 (ortalama±SS) olan 32 kadın hasta dahil edildi. Hastaların tamamına aksiller diseksiyon yapılmıştı. Hastaların %62,5’i post- operatif dönemde radyoterapi, %96,9’u kemoterapi almıştı. Hastaların %78,1’i etkilenen tarafta omuz ağrısı olduğunu bildirdi. Sağ tarafı etkilenmiş grupta ve sol tarafı etkilenmiş grupta, sağ el ve sol elin kaba kavrama güçleri, el becerileri, duyu kaybı ve volümleri arasında anlamlı fark saptanmadı. Sol tarafı etkilenmiş grupta sağ elin parmak ucu kavrama gücü ise soldan daha fazlaydı.Sonuç: MKİL’i olan hastalarda aksiler diseksiyon yapılmış olması, post-operatif dönemde kemoterapi ve radyoterapi almış olmak, obezite ve omuz ağrısı sıktır. MKİL’li hastaların değerlendirilmesi ayrıntılı ve çok yönlü olarak yapılmalı ve omuz ağrısının sorgulanması ve el değerlendirmesini de içermelidir.

Keywords

Meme kanseri, lenfödem, el kası gücü

References

• Ozmen V. Breast cancer in the world and Turkey. J Breast Health. 2008;4:6–12.
• Fidaner C, Eser SY, Parkin DM. Incidence in Izmir in 1993–1994: first results from Izmir cancer registry. Eur J Cancer. 2001;37:83–92.
• DeSantis C, Siegel R, Bandi P, Jemal A. Breast cancer statistics, CA Cancer J Clin. 2011;61:409–18.
• Lawenda BD, Mondry TE, Johnstone PA. Lymphedema: a primer on the identification and management of a chronic condition in oncologic treatment. CA Cancer J Clin. 2009;59:8–24.
• Bosompra K, Ashikaga T, O’Brien PJ, Nelson L, Skelly J. Swelling, numbness, pain and their relationship to arm function among breast cancer survivors: a disablement process model perspective. Breast J. 2002;8:338-48.
• Gül A, Aslan F. Meme kanseri ameliyatlarından sonra lenfödemin önlenmesinde basit lenf drenajı masajı ile aromatik yağlarla yapılan basit lenf drenajı masajının etkisinin karşılaştırılması. J Breast Health. 2007;3:75-81.
• Zhu YQ, Xie YH, Liu FH, Guo Q, Shen PP, Tian Y. Systemic analysis on risk factors for breast cancer related lymphedema. Asian Pac J Cancer Prev. 2014;15:6535-41.
• Passik SD, McDonald MV. Psychosocial aspects of upper extremity lymphedema in women treated for breast carcinoma. Cancer. 1998;83:2817-20.
• Sakorafas GH, Peros G, Cataliotti L, Vlastos G. Lymphedema following axillary lymph node dissection for breast cancer. Surg Oncol. 2006;15:153-65.
• Voogd AC,Ververs JM, Vingerhoets A, Roumen H , Coebergh JW, Crommelin MA. Lymphoedema and reduced shoulder function as indicators of quality of life after axillary lymph node dissection for invasive breast cancer. Br J Surg. 2003;90:76-81.
• Smoot B, Wong J, Cooper B, Wanek L, Topp K, Byl N et al. Upper extremity impairments in women with or without lymphedema following breast cancer treatment J Cancer Surviv. 2010;4:167–178.
• Park JE, Jang HJ, Seo KS. Quality of life, upper extremity function and the effect of lymphedema treatment in breast cancer related lymphedema patients. Ann Rehabil Med. 2012;36:240-7.
• Yıldız A, Karayurt Ö. Meme kanserli kadınların lenfödem nedeniyle yaşadıkları güçlükler. J Breast Health. 2011;7:154-162.
• Szuba A, Achalu R, Rockson SG. Decongestive lymphatic therapy for patients with breast carcinoma-associated lymphedema. A randomized, prospective study of a role for adjunctive intermittent pneumatic compression. Cancer. 2002;95:2260-7.
• Gerber LH. A review of measures of lymphedema. Cancer. 1998;83:2803-4.
• Harris SR, Hugi MR, Olivotto IA, Levine M. Clinical practice guidelines for the care and treatment of breast cancer: 11. Lymphedema. CMAJ. 2001;164:191-9.
• Mathiowetz V, Weber K, Volland G, Kashman N. Reliability and validity of grip and pinch strenght evaluations. J Hand Surg. 1984;9:222-6.
• Mathiowetz V, Weber K, Kashman N, Volland G. Adult norms for nine hole peg test of finger dexterity. Occup Ther J Res. 1985;5:24-38.
• Bell-Krotoski JA. Rehabilitation of the Hand Surgery and Therapy. St Louis, C.V. Mosby Co, 1990.
• Pagel KJ, Kaul MP, Dryden JD. Lack of utility of Semmes-Weinstein monofilament testing in suspected carpal tunnel syndome. Am J Phys Med. Rehabil. 2002;81:597-600.
• Ardıç F, Kahraman Y, Soyupek F, Yorgancıoğlu R. Meme kanseri tanılı hastaların rehabilitasyonu: II. bölüm: lenfödem. Fiziksel Tıp ve Rehabilitasyon Bilimleri Dergisi. 2001;4:163-7.
• Goffman TE, Laronga C, Wilson L, Elkins D. Lymphedema of the arm and breast in irradiated breast cancer patients: risks in an era of dramatically changing axillary surgery. Breast J. 2004;10:405-11.
• Paskett ED, Naughton MJ, McCoy TP, Case LD, Abbott JM. The epidemiology of arm and hand swelling in premenopausal breast cancer survivors. Cancer Epidemiol Biomarkers Prev. 2007;16:775-82.
• Ridner SH, Dietrich MS, Stewart BR, Armer JM. Body mass index and breast cancer treatment-related lymphedema. Support Care Cancer. 2011;19:853-7.
• Mak SS, Yeo W, Lee YM, Mo KF, Tse KY, Tse SM et al. Predictors of lymphedema in patients with breast cancer undergoing axillary lymph node dissection in Hong Kong. Nurs Res. 2008;57:416-25.
• Vignes S, Arrault M, Dupuy A. Factors associated with increased breast cancer-related lymphedema volume. Acta Oncol. 2007;46:1138-42.
• Lee SH, Min YS, Park HY, Jung TD. Health-related quality of life in breast cancer patients with lymphedema who survived more than one year after surgery. J Breast Cancer. 2012;15:449-53.
• Tsai RJ, Dennis LK, Lynch CF, Snetselaar LG, Zamba GK, Scott-Conner C. The risk of developing arm lymphedema among breast cancer survivors: a meta-analysis of treatment factors. Ann Surg Oncol. 2009;16:1959-72.
• Ahmed RL, Thomas W, Yee D, Schmitz KH. Randomized controlled trial of weight training and lymphedema in breast cancer survivors. J Clin Oncol. 2006;24:2765–72.
• Harris SR, Niesen-Vertommen SL. Challenging the myth of exercise-induced lymphedema following breast cancer: a series of case reports. J Surg Oncol. 2000;74:95–8.
• Schmitz KH, Ahmed RL, Troxel A, Cheville A, Smith R, Lewis-Grant L et al. Weight lifting in women with breast-cancer-related lymphedema. N Engl J Med. 2009;361:664-73.
• Balancing paid work, unpaid work and leisure – OECD.http:// www.oecd.org/gender/ data/ balancingpaidworkunpaidworkandleisure.htm. (Accessed July 21, 2015).
• Devoogdt N, Pans S, De Groef A, Geraerts I, Christiaens MR, Neven P et al. Postoperative evolution of thickness and echogenicity of cutis and subcutis of patients with and without breast cancer-related lymphedema. Lymphat Res Biol. 2014;12:23-31.
• Hacard F, Machet L, Caille A, Tauveron V, Georgescou G, Rapeneau I et al. Measurement of skin thickness and skin elasticity to evaluate the effectiveness of intensive decongestive treatment in patients with lymphoedema: a prospective study. Skin Res Technol. 2014;20:274-81.
• Strzalkowski ND, Triano JJ, Lam CK, Templeton CA, Bent LR. Thresholds of skin sensitivity are partially influenced by mechanical properties of the skin on the foot sole. Physiol Rep. 2015;3:pii:e12425.
• Lee TS, Kilbreath SL, Refshauge KM, Herbert RD, Beith JM. Prognosis of the upper limb following surgery and radiation for breast cancer. Breast Cancer Res Treat. 2008;110:19–37.
• Yang EJ, Park WB, Seo KS, Kim SW, Heo CY, Lim JY. Longitudinal change of treatment-related upper limb dysfunction and its impact on late dysfunction in breast cancer survivors: a prospective cohort study. J Surg Oncol. 2010;101:84-91.
• Avrahami R, Gabbay E, Bsharah B, Haddad M, Koren A, Dahn J et al. Severe lymphedema of the arm as a potential cause of shoulder trauma. Lymphology. 2004;37:202-5.
• Jeong HJ, Sim YJ, Hwang KH, Kim GC. Causes of Shoulder Pain in Women with Breast Cancer-Related Lymphedema: A Pilot Study Yonsei Med J. 2011;52:661-7.
• Hidding JT, Beurskens CH, van der Wees PJ, van Laarhoven HW, Nijhuis-van der Sanden MW. Treatment related impairments in arm and shoulder in patients with breast cancer: a systematic review. PLoS One. 2014;9:e96748.
• Ewertz M, Jensen AB. Late effects of breast cancer treatment and potentials for rehabilitation. Acta Oncol. 2011;50:187–93.
• McNeely ML, Campbell K, Ospina M, Rowe BH, Dabbs K, Klassen TP. Exercise interventions for upper-limb dysfunction due to breast cancer treatment. Cochrane Database Syst Rev. 2010;16:CD005211.
• Stuiver MM, ten Tusscher MR, Agasi-Idenburg CS, Lucas C, Aaronson NK, Bossuyt PM. Conservative interventions for preventing clinically detectable upper-limb lymphoedema in patients who are at risk of developing lymphoedema after breast cancer therapy. Cochrane Database Syst Rev. 2015;2:CD009765.
• Fialka-Moser V, Korpan M, Varela E, Ward A, Gutenbrunner C, Casillas JM et al. The role of physical and rehabilitation medicine specialist in lymphoedema. Ann Phys Rehabil Med. 2013;56:396–410.
• Civelek GM, Adam M. Knowledge of patients about physical medicine and rehabilitation attending a tertiary physical medicine and rehabilitation clinic. J Rheumatol Med Rehabil. 2012;22:56–9.
• Mete Civelek G, Aypak C, Turedi O. Knowledge of primary care physicians about breast-cancer-related lymphedema: Turkish perspective. J Cancer Educ. 2015;doi:10.1007/s13187-015-0880-6.