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Exploring the causes of kinesiophobia in patients with breast cancer-related lymphedema: a comprehensive study

Year 2024, Volume: 7 Issue: 6, 626 - 631, 27.10.2024

Abstract

Aims: Breast cancer is the most common cancer in women worldwide. Breast cancer survivors often experience arm and shoulder pain, limited shoulder range of motion, and lymphedema as the most common post-treatment morbidities. All these morbidities can be considered as the main causes of the fear of movement, called kinesiophobia. This is the first study aims to evaluate the biological and psychological causes of kinesiophobia in breast cancer-related lymphedema (BCRL), the relationship between kinesiophobia and BCRL, and the impact of kinesiophobia on patients’ upper extremity function and quality of life. The biological and psychological causes of kinesiophobia in women with breast cancer-related lymphoedema were investigated for the first time in the literature.
Methods: Patients with BCRL were included in the study. Demographic and clinical information including age, educational status, body-mass index (BMI), and dominant upper extremity were recorded. BCRL stage (International Society of Lymphology (ISL) Scale), Quality of Life Scale [European Organisation for Research and Treatment of Cancer Quality of Life (EORTC QLO-C30)], upper extremity functional status [Quick-Disabilities of the Arm, Shoulder and Hand Score (Quick-DASH)], Tampa Kinesiophobia Scale (TKS), Kinesiophobia Causes Scale (KCS) were assessed.
Results: The mean age of the 114 patients included in the study was 58.25±9.41 years. A total of 100 patients exhibited a TKS score above 37, indicative of kinesiophobia. There was a statistically significant positive correlation between age and BMI and total TKS score (p<0.05). The TKS score (46.18±6.61) was significantly higher in 66 patients with a dominant limb affected by BCRL (p<0.05). No significant correlation was found between the lymphedema stage (ISL) and quick-DASH (p>0.05). However, the relationship between the Quick-DASH score and the TKS score was significant (p<0.05). A strong significant positive correlation was observed between the TKS score and the KCS score (p=0.0001).
Conclusion: In our study, the severity of kinesiophobia was higher in patients with more limited upper limb function. Psychological (self-acceptance, self-assessment of motor predispositions, body care) and biological causes (morphological, individual need for stimulation, energetic substrates, power of biological drivers) increased the severity of kinesiophobia. Biological causes were found to cause more kinesiophobia and affect upper limb function in MKBL. In particular, impairment in the strength of biological impulses was found to be one of the main causes of kinesiophobia. Understanding the causes of kinesiophobia in MDL may improve rehabilitation programs and lead to the development of new strategies to help patients support treatment to reduce fear of movement.

References

  • Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249. doi:10.3322/caac.21660
  • Nesvold IL, Reinertsen KV, Fosså SD, Dahl AA. The relation between arm/shoulder problems and quality of life in breast cancer survivors: a cross-sectional and longitudinal study. J Cancer Surviv. 2011;5(1):62-72.
  • Mortimer PS. The pathophysiology of lymphedema. Cancer. 1998;83(12):2798-2802.
  • Shen A, Lu Q, Fu X, et al. Risk factors of unilateral breast cancer-related lymphedema: an updated systematic review and meta-analysis of 84 cohort studies. Support Care Cancer. 2022;31(1):18.
  • Burwinkle T, Robinson JP, Turk DC. Fear of movement: factor structure of the Tampa Scale of kinesiophobia in patients with fibromyalgia syndrome. J Pain. 2005;6(6):384-391.
  • Courneya KS, Mackey JR, Jones LW. Coping with cancer: can exercise help?. Physic Sportsmed. 2000;28(5):49-73.
  • Hair BY, Hayes S, Tse CK, Bell MB, Olshan AF. Racial differences in physical activity among breast cancer survivors: implications for breast cancer care. Cancer. 2014;120(14):2174-2182.
  • Kwan ML, Sternfeld B, Ergas IJ, et al. Change in physical activity during active treatment in a prospective study of breast cancer survivors. Breast Cancer Res Treat. 2012;131(2):679-690.
  • Erdoğanoğlu Y, Çalık M, Vural M. Functional evaluation of patients with mastectomy lymphedema. Turk J Phys Med Rehabil. 2021;67(1):56-61.
  • Miller RP, Kori SH, Todd DD. The Tampa Scale: a measure of kinisophobia. Clin J Pain. 1991;7(1): p.51.
  • Norton PJ, Klenck SC, Barrera TL. Sudden gains during cognitive-behavioral group therapy for anxiety disorders. J Anxiety Disord. 2010;24(8):p.887-892.
  • Çayır M, Durutürk NA, Tekindal MA. Validity and reliability of the Turkish adaptation of the Kinesiophobia Causes Scale. J Exercise Therapy Rehabil. 2020;7(1):p.64-73.
  • Saulicz M, Saulicz E, Knapik A, et al. Impact of physical activity and fitness on the level of kinesiophobia in women of perimenopausal age. Menopause Rev Przegląd Menopauzalny. 2016;15(2):104-111.
  • Gencay Can A, Can SS, Ekşioğlu E, Çakcı FA. Is kinesiophobia associated with lymphedema, upper extremity function, and psychological morbidity in breast cancer survivors?. Turk J Phys Med Rehabil. 2019;65(2):139-146.
  • Witte MH, Bernas MJ. Evolution of the 2020 international society of lymphology consensus document parallels advances in lymphology: an historical perspective. Lymphology. 2020;53(1):1-2.
  • Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Nat Canc Instit. 1993;85(5):365-376.
  • Düger T, Yakut E, Öksüz Ç, et al. Kol, omuz ve el sorunları anketi Türkçe uyarlamasının güvenirliği ve geçerliği. Fizyoter Rehabil. 2006;17(3):99-107.
  • Vlaeyen JW, Kole-Snijders AM, Boeren RG, Van Eek H. Fear of movement/(re) injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62(3):363-372.
  • Velthuis MJ, Van den Bussche E, May AM, Gijsen BC, Nijs S, Vlaeyen JW. Fear of movement in cancer survivors: validation of the Modified Tampa Scale of Kinesiophobia-Fatigue. Psycho Oncol. 2012;21(7):762-770.
  • Kocjan J, Knapik A. Barriers of physical activity (kinesiophobia) in patients subjected to cardiac rehabilitation. Baltic J Health Phys Activity. 2014;6(4):7.
  • Malchrowicz-Mośko E, Nowaczyk P, Wasiewicz J, et al. The level of kinesiophobia in breast cancer women undergoing surgical treatment. Front Oncol. 2023;13:1010315.
  • Karadibak D, Yavuzsen T, Saydam S. Prospective trial of intensive decongestive physiotherapy for upper extremity lymphedema. J Surg Oncol. 2008;97(7):572-577.
  • Silvera SA, Jain M, Howe GR, Miller AB, Rohan TE. Energy balance and breast cancer risk: a prospective cohort study. Breast Cancer Res Treat. 2006;97(1):97-106.
  • Schünemann, H. and N. Willich, Lymphedema after breast carcinoma. A study of 5868 cases. Dtsch Med Wochenschr. 1997;122(17):536-541.
  • Park, J.E., H.J. Jang, and K.S. Seo, Quality of life, upper extremity function and the effect of lymphedema treatment in breast cancer related lymphedema patients. Ann Rehabil Med. 2012;36(2):240-247.
  • Smoot B, Wong J, Cooper B, et al. Upper extremity impairments in women with or without lymphedema following breast cancer treatment. J Cancer Surviv. 2010;4(2): 167-178.
  • Johansson K, Ingvar C, Albertsson M, Ekdahl C. Arm lymphoedema, shoulder mobility and muscle strength after breast cancer treatment? A prospective 2-year study. Adv Physiother. 2001;3(2):55-66.
  • Dawes D, Meterissian S, Goldberg M, Mayo N. Impact of lymphoedema on arm function and health-related quality of life in women following breast cancer surgery. J Rehabil Med. 2008; 40(8):651-658.
  • Altuğ F, Ünal A, Kilavuz G, Kavlak E, Çitişli V, Cavlak U. Investigation of the relationship between kinesiophobia, physical activity level and quality of life in patients with chronic low back pain 1. J Back Musculoskelet Rehabil. 2016;29(3):527-531.

Meme kanserine bağlı lenfödemi olan hastalarda kinesiofobinin nedenlerinin araştırılması: kapsamlı bir çalışma

Year 2024, Volume: 7 Issue: 6, 626 - 631, 27.10.2024

Abstract

Amaç: Meme kanseri dünya genelinde kadınlarda en sık görülen kanserdir. Meme kanseri tedavisi sonrası en sık görülen morbiditeler olarak kol ve omuz ağrısı, omuz hareket açıklığında kısıtlanma ve lenfödem gibi komplikasyonlar gelişebilir.Tüm bu morbiditeler, kinezyofobi olarak adlandırılan hareket korkusuna yol açabilir. Bu çalışma, meme kanserine bağlı lenfödemde (MKBL) kinezyofobinin biyolojik ve psikolojik nedenlerini ve kinezyofobinin üst ekstremite fonksiyonu ve yaşam kalitesi üzerindeki etkisini değerlendirmeyi amaçlamaktadır.Meme kanserine bağlı lenfödemi olan kadınlarda kinezyofobinin biyolojik ve psikolojik nedenleri literatürde ilk kez araştırılmıştır.
Yöntemler: Çalışmaya MKBL'li hastalar dahil edildi. Yaş, eğitim durumu, vücut kitle indeksi (VKİ) ve dominant üst ekstremite gibi demografik ve klinik bilgiler kaydedildi. MKBL evresi (International Society of Lymphology (ISL) ölçeği), yaşam kalitesi ölçeği (European Organisation for Research and Treatment of Cancer Quality of Life (EORTC QLO-C30)), üst ekstremite fonksiyonel durumu (Quick-Disabilities of the Arm, Shoulder and Hand Score (QUICK-DASH)), Tampa Kinesiophobia Scale (TKS), Kinesiophobia Causes Scale (KCS) değerlendirildi.
Bulgular: Çalışmaya dahil edilen 114 hastanın yaş ortalaması 58.25±9.41 yıl idi. Toplam 100 hastada kinezyofobinin göstergesi olan TKS skoru 37'nin üzerindeydi. Yaş ve VKİ ile toplam TKS puanı arasında istatistiksel olarak anlamlı pozitif bir korelasyon vardı (p<0.05). TKS skoru (46.18±6.61), dominant ekstremitesi lenfödemden etkilenen 66 hastada anlamlı derecede yüksekti (p<0.05). Lenfödem evresi (ISL) ile QUICK-DASH arasında anlamlı bir korelasyon bulunmamıştır (p>0.05). Ancak, QUICK-DASH skoru ile TKS skoru arasındaki ilişki anlamlıydı (p<0.05). TKS skoru ile KCS skoru arasında güçlü ve anlamlı bir pozitif korelasyon gözlenmiştir (p=0.0001).
Sonuç: Çalışmamızda, üst ekstremite fonksiyonu daha kısıtlı olan hastalarda kinezyofobi şiddeti daha yüksekti. Kinezyofobiye eşlik eden psikolojik (kendini kabul etme, motor yatkınlığın öz değerlendilmesi, vücut bakımı) ve biyolojik nedenler (morfolojik, harekete geçmek için bireysel ihtiyaç, enerji kaynakları, biyolojik dürtülerin gücü) kinezyofobinin şiddetini artırmıştır. MKBL'de biyolojik nedenlerin daha fazla kinezyofobiye neden olduğu ve üst ekstremite fonksiyonunu etkilediği bulunmuştur. Özellikle, biyolojik dürtülerin gücündeki bozulmanın kinezyofobinin ana nedenlerinden biri olduğu bulunmuştur. MKBL'de kinezyofobinin nedenlerinin anlaşılması rehabilitasyon programlarını iyileştirebilir ve hastaların hareket korkusunu azaltmak için tedaviyi desteklemelerine yardımcı olacak yeni stratejilerin geliştirilmesine yol açabilir.

References

  • Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249. doi:10.3322/caac.21660
  • Nesvold IL, Reinertsen KV, Fosså SD, Dahl AA. The relation between arm/shoulder problems and quality of life in breast cancer survivors: a cross-sectional and longitudinal study. J Cancer Surviv. 2011;5(1):62-72.
  • Mortimer PS. The pathophysiology of lymphedema. Cancer. 1998;83(12):2798-2802.
  • Shen A, Lu Q, Fu X, et al. Risk factors of unilateral breast cancer-related lymphedema: an updated systematic review and meta-analysis of 84 cohort studies. Support Care Cancer. 2022;31(1):18.
  • Burwinkle T, Robinson JP, Turk DC. Fear of movement: factor structure of the Tampa Scale of kinesiophobia in patients with fibromyalgia syndrome. J Pain. 2005;6(6):384-391.
  • Courneya KS, Mackey JR, Jones LW. Coping with cancer: can exercise help?. Physic Sportsmed. 2000;28(5):49-73.
  • Hair BY, Hayes S, Tse CK, Bell MB, Olshan AF. Racial differences in physical activity among breast cancer survivors: implications for breast cancer care. Cancer. 2014;120(14):2174-2182.
  • Kwan ML, Sternfeld B, Ergas IJ, et al. Change in physical activity during active treatment in a prospective study of breast cancer survivors. Breast Cancer Res Treat. 2012;131(2):679-690.
  • Erdoğanoğlu Y, Çalık M, Vural M. Functional evaluation of patients with mastectomy lymphedema. Turk J Phys Med Rehabil. 2021;67(1):56-61.
  • Miller RP, Kori SH, Todd DD. The Tampa Scale: a measure of kinisophobia. Clin J Pain. 1991;7(1): p.51.
  • Norton PJ, Klenck SC, Barrera TL. Sudden gains during cognitive-behavioral group therapy for anxiety disorders. J Anxiety Disord. 2010;24(8):p.887-892.
  • Çayır M, Durutürk NA, Tekindal MA. Validity and reliability of the Turkish adaptation of the Kinesiophobia Causes Scale. J Exercise Therapy Rehabil. 2020;7(1):p.64-73.
  • Saulicz M, Saulicz E, Knapik A, et al. Impact of physical activity and fitness on the level of kinesiophobia in women of perimenopausal age. Menopause Rev Przegląd Menopauzalny. 2016;15(2):104-111.
  • Gencay Can A, Can SS, Ekşioğlu E, Çakcı FA. Is kinesiophobia associated with lymphedema, upper extremity function, and psychological morbidity in breast cancer survivors?. Turk J Phys Med Rehabil. 2019;65(2):139-146.
  • Witte MH, Bernas MJ. Evolution of the 2020 international society of lymphology consensus document parallels advances in lymphology: an historical perspective. Lymphology. 2020;53(1):1-2.
  • Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Nat Canc Instit. 1993;85(5):365-376.
  • Düger T, Yakut E, Öksüz Ç, et al. Kol, omuz ve el sorunları anketi Türkçe uyarlamasının güvenirliği ve geçerliği. Fizyoter Rehabil. 2006;17(3):99-107.
  • Vlaeyen JW, Kole-Snijders AM, Boeren RG, Van Eek H. Fear of movement/(re) injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62(3):363-372.
  • Velthuis MJ, Van den Bussche E, May AM, Gijsen BC, Nijs S, Vlaeyen JW. Fear of movement in cancer survivors: validation of the Modified Tampa Scale of Kinesiophobia-Fatigue. Psycho Oncol. 2012;21(7):762-770.
  • Kocjan J, Knapik A. Barriers of physical activity (kinesiophobia) in patients subjected to cardiac rehabilitation. Baltic J Health Phys Activity. 2014;6(4):7.
  • Malchrowicz-Mośko E, Nowaczyk P, Wasiewicz J, et al. The level of kinesiophobia in breast cancer women undergoing surgical treatment. Front Oncol. 2023;13:1010315.
  • Karadibak D, Yavuzsen T, Saydam S. Prospective trial of intensive decongestive physiotherapy for upper extremity lymphedema. J Surg Oncol. 2008;97(7):572-577.
  • Silvera SA, Jain M, Howe GR, Miller AB, Rohan TE. Energy balance and breast cancer risk: a prospective cohort study. Breast Cancer Res Treat. 2006;97(1):97-106.
  • Schünemann, H. and N. Willich, Lymphedema after breast carcinoma. A study of 5868 cases. Dtsch Med Wochenschr. 1997;122(17):536-541.
  • Park, J.E., H.J. Jang, and K.S. Seo, Quality of life, upper extremity function and the effect of lymphedema treatment in breast cancer related lymphedema patients. Ann Rehabil Med. 2012;36(2):240-247.
  • Smoot B, Wong J, Cooper B, et al. Upper extremity impairments in women with or without lymphedema following breast cancer treatment. J Cancer Surviv. 2010;4(2): 167-178.
  • Johansson K, Ingvar C, Albertsson M, Ekdahl C. Arm lymphoedema, shoulder mobility and muscle strength after breast cancer treatment? A prospective 2-year study. Adv Physiother. 2001;3(2):55-66.
  • Dawes D, Meterissian S, Goldberg M, Mayo N. Impact of lymphoedema on arm function and health-related quality of life in women following breast cancer surgery. J Rehabil Med. 2008; 40(8):651-658.
  • Altuğ F, Ünal A, Kilavuz G, Kavlak E, Çitişli V, Cavlak U. Investigation of the relationship between kinesiophobia, physical activity level and quality of life in patients with chronic low back pain 1. J Back Musculoskelet Rehabil. 2016;29(3):527-531.
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Details

Primary Language English
Subjects Clinical Sciences (Other)
Journal Section Original Article
Authors

Songül Keskin Kavak 0000-0003-4409-4996

Lale Aktekin 0000-0001-9853-4753

Publication Date October 27, 2024
Submission Date August 31, 2024
Acceptance Date October 8, 2024
Published in Issue Year 2024 Volume: 7 Issue: 6

Cite

AMA Keskin Kavak S, Aktekin L. Exploring the causes of kinesiophobia in patients with breast cancer-related lymphedema: a comprehensive study. J Health Sci Med / JHSM. October 2024;7(6):626-631.

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