Shoulder Pain, Kinesiophobia, Emotional State and Muscle Strength in Breast Cancer Surgery Patients: A Cross-Sectional Study

Yıl 2024, Cilt: 3 Sayı: 4, 165 - 170, 20.12.2024

Filiz Meryem Sertpoyraz , Murat Akyol Elif Umay Altaş , Eyüp Kebabçı Ecem Beytorun Fatma Demet Arslan

https://doi.org/10.57221/izmirtip.1562839

Öz

Breast cancer is the most common type of cancer in women. The life expectancy of patients is increasing with advances in treatment. However, lymphovascular, musculoskeletal, and psychogenic complications are reported to be expected in the follow-up period after breast cancer surgery.
Kinesiophobia is the behavior of avoiding movement for fear of increased pain. Research on the frequency and interrelationships of kinesiophobia and other complications in the follow-up period is limited.
Aim:
We aim to evaluate shoulder pain, kinesiophobia, emotional state and muscle strength in female patients who have undergone breast cancer surgery and are in the follow-up period and to examine the relationship between these factors.
Materials and Methods:
A total of 50 female patients who underwent unilateral breast cancer surgery and were using aromatase inhibitors were included in this cross-sectional descriptive study. Demographic data, details of the surgical procedure and medical treatment information were recorded from the patient files. Hand grip muscle strength was measured by hand dynamometer, the Beck Depression Scale assessed emotional state, and the Tampa Kinesiophobia Scale assessed fear of movement. A Beck Depression Scale score of 10 and above and a Tampa Kinesiophobia Scale of 37 and above were considered significant.
Results:
The mean age of 50 female patients was 59.31 ± 11.19 years. Sixty percent of the patients had undergone surgery on the right breast and 40% on the left breast. Shoulder pain (n:31) was present in 62%. There were statistically significant correlations between pain and the Tampa kinesiophobia scale and the Beck depression scale (p:0.042, p:0.038).
Kinesiophobia was present in 74% of the patients, and 64% had moderate to severe depression.
The mean of the Tampa Kinesiophobia scale was 42.86±8.81, and the mean of the Beck depression scale was 15.19±10.98. When the relationship between kinesiophobia and depression was evaluated, a statistically positive significant relationship was found between them (p=0.005, r=0.410).
The hand grip strength was 22.16±5.00 kg on the right and 18.22±5.10 kg on the left in patients who underwent left-sided breast cancer surgery. A significant difference was found in the left- and right-hand grip strength of those who underwent left-sided surgery for breast cancer (p<0.001).
Conclusion:
In this study, it was found that the incidence of shoulder pain, kinesiophobia and depression was high in the follow-up period after breast cancer surgery. As the level of depression increases, the severity of kinesiophobia also increases, emphasising the importance of psychosocial factors in this patient group. Multidisciplinary treatment approaches may contribute to the management of shoulder pain, kinesiophobia and depression in the follow-up process. Our study shows that addressing depression and kinesiophobia may improve quality of life in patients who have undergone breast cancer surgery.

Anahtar Kelimeler

Breast Cancer, Muscle Strength, Emotional State, Kinesiophobia

Meme Kanser Cerrahisi Geçirmiş Hastalarda Omuz Ağrısı, Kinezyofobi, Emosyonel Durum ve Kas Gücü: Kesitsel Bir Çalışma

Öz

Meme kanseri, kadınlarda en sık görülen kanser türüdür. Tedavideki gelişmelerle hastaların beklenen yaşam süresi artmaktadır. Bununla birlikte, meme kanseri cerrahisi sonrası takip döneminde lenfovasküler, kas-iskelet sistemi ve psikojenik komplikasyonların sık yaşandığı bildirilmektedir.
Kinezyofobi, ağrının artacağı korkusuyla hareketten kaçınma davranışıdır. Kinezyofobinin ve takip dönemindeki diğer komplikasyonların sıklığı ve birbirleriyle ilişkileri konusundaki araştırmalar kısıtlıdır.
Amaç:
Meme kanseri cerrahisi geçirmiş ve takip sürecinde olan kadın hastalarımızda omuz ağrısı, kinezyofobi, emosyonel durum ve kas gücünü değerlendirmeyi ve bu faktörlerin birbirleriyle ilişkisini incelemeyi amaçlıyoruz.
Gereç Yöntem:
Kesitsel tanımlayıcı çalışmaya, tek taraflı meme kanseri cerrahisi geçirmiş ve aromataz inhibitörü kullanan toplam 50 kadın hasta dahil edildi. Hastaların demografik verileri, cerrahi süreç ayrıntıları ve tıbbi tedavi bilgileri hasta dosyalarından kaydedildi. El kavrama kas kuvveti el dinamometresi ile ölçüldü; emosyonel durum Beck Depresyon Ölçeği, hareket korkusu ise Tampa Kinezyofobi Ölçeği ile değerlendirildi. Beck Depresyon Ölçeği skoru 10 ve üzeri, Tampa Kinezyofobi Ölçeği skoru ise 37 ve üzeri anlamlı kabul edildi.
Bulgular:
Çalışmaya 50 kadın hastanın yaş ortalamaları 59,31 ± 11,19 yıldı. Hastaların %60 sağ, %40 sol memeden cerrahi geçirmişti. Omuz ağrısı (n:31) %62’sinde vardı. Ağrı ile Tampa kinezyofobi ölçeği ve Beck depresyon ölçeği, arasındaki istatisitksel olarak anlamlı ilişkili saptandı(p:0.042, p:0.038).
Hastaların %74’ünde kinezyofobi ve %64’ünde orta ve şiddetli düzeyde depresyon vardı.
Tampa Kinezyofobi ölçek ortalaması 42,86±8,81ve Beck depresyon ölçeği ortalaması 15,19±10,98 idi. Kinezyofobiyle depresyon ilişkisi değerlendirildiğinde, aralarında istatistiksel olarak pozitif anlamlı ilişki saptandı (p=0.005, r=0.410).
Meme kanser cerrahisini sol taraftan geçirenlerde el kavrama gücü sağda 22,16±5,00 kg, solda 18,22±5,10 kg'dı. Meme kanseri nedeniyle sol taraftan cerrahi geçirenlerin sol ve sağ el kavrama gücünde anlamlı farklılık bulundu (p<0.001)
Sonuç:
Bu çalışmada, meme kanseri cerrahisi sonrası takip sürecinde omuz ağrısı, kinezyofobi ve depresyon görülme sıklığının yüksek olduğu saptanmıştır. Depresyon düzeyi arttıkça kinezyofobi şiddetinin de artması, psikososyal faktörlerin bu hasta grubunda önemini vurgulamaktadır. Multidisipliner tedavi yaklaşımları, takip sürecinde omuz ağrısı, kinezyofobi ve depresyonun yönetimine katkı sağlayabilir. Çalışmamız, depresyon ve kinezyofobinin ele alınmasının, meme kanseri cerrahisi geçirmiş hastalarda yaşam kalitesini artırabileceğini göstermektedir.

Anahtar Kelimeler

Meme Kanseri, Kas Gücü, Duygusal Durum, Kinezyofobi

Etik Beyan

This cross-sectional descriptive study was conducted in 2023-2024 with the approval of izmir Bakircay Universty local ethics committee (ethics committee no: 503)

Kaynakça

• 1. Mokhatri-Hesari P, Montazeri A. Health-related quality of life in breast cancer patients: a review of reviews from 2008 to 2018. Health and Quality of Life Outcomes. 2020;18:1-25.
• 2. Marco E, Trépanier G, Chang E, Mauti E, Jones JM, Zhong T. Postmastectomy functional disorders. Current Oncology Reports. 2023;25:1445-53.
• 3. Stubblefield MD, Keole N. Upper body pain and functional impairments in patients with breast cancer. PMR. 2014;6:170-83.
• 4. Liu W, Lui J, Ma L, Chen J. Effect of mindfulness yoga on anxiety and depression in early breast cancer patients received adjuvant chemotherapy: a randomised clinical trial. J Cancer Res Clin Oncol. 2022;148:2549-60.
• 5. Yuan R, Wei X, Ye Y, Wang M, Jiang J, Li K, et al. The effects of the mirror therapy on shoulder function in patients with breast cancer following surgery: a randomised controlled trial . J Cancer Surviv. 2024;18:1574-89.
• 6. Karadibak D, Yavuzsen T, Saydam S. Prospective trial of intensive decongestive physiotherapy for upper extremity lymphedema. J Surg Oncol. 2008;97:572-7.
• 7. Jansen RF, Van Geel AN, De Groot HG, Rottier AB, Olthuis GA, Van Putten WL. Immediate versus delayed shoulder exercises after axillary lymph node dissection. Am J Surg. 1990;160:481-4.
• 8. Wang YC, Bohannon RW, Li X, Sindhu B, Kapellusch J. Hand grip strength: normative reference values and equations for individuals aged 18 to 85 years residing in the United States. J Orthop Sports Phys Ther. 2018 Sep;48(9):685-93.
• 9. Yildirim S, Dane S. Cerebral lateralisation and hand preference. (https://www.eajm.org/content/files/sayilar/171/buyuk/pdf_EAJM_177.pdf
• 10. Incel NA, Ceceli E, Durukan PB, Oken O, Erdem R. Grip strength: effect of gender and hand dominance. Archives of Rheumatology. 2002;17:12-6.
• 11. Kılıc P, Pekcan G. Reference values of handgrip strength for healthy adults. Journal of Nutrition and Diet. 2012;40:32-42.
• 12. Sinaki M. Relationship of muscle strength of back and upper extremity level of physical activity in healthy women.Am J Phys Med Rehabil. 1989;68:134-8.
• 13. Neblett R, Hartzell MM, Mayer TG, Bradford EM, Gatchel RJ. Establishing clinically meaningful severity levels for the Tampa Scale for Kinesiophobia (TSK-13). Eur J Pain. 2016;20:701-10.
• 14. Beck AT, Mendelson W, Ward C, Erbaugh C. Beck depression inventory (BDI). Arch Gen Psychiatry. 1961:4:561-71.
• 15. Fevzioglu O, Dincer S, Akan A, Algun ZC. Is Xbox 360 kinect-based virtual reality training as effective as standard physiotherapy in patients undergoing breast cancer surgery? Support Care Cancer. 2020;28:4295-303.
• 16. Mosko EM. Kinesiophobia among breast cancer survivors one year after hospital treatment. Int J Environ Res Public Health. 2022;19:14565.
• 17. Khan FA, Castillo JA, Amaravadi KSS, Nalisetty P, Vadlamani N, Ibrahimli S, et al. prevalence of depression in patients and survivors of breast cancer: a systematic review. Cureus. 2024;16:e63816.
• 18. Mohammed A, Melak D, Demeke Bayou F, Yasin H, Zerga AA, Wagaye B, et al.Prevalence and associated factors of depression among breast cancer patients in Sub-Saharan Africa: a systematic review and meta-analysis. SAGE Open Medicine. 2024;12:20503121241226897.
• 19. Sunar I, Sunar V. Kinesiophobia in breast cancer survivors and its relationship with quality of life, comorbidity and other clinical parameters. Acta Oncologica Turcica. 2021;54:198-205.
• 20. Grusdat NP, Stäuber A, Tolkmitt M, Schnabel J, Schubotz B, Schulz H. Routine cancer treatment regimens and ıts ımpact on fine motor dexterity in breast cancer. Oncology Research and Treatment. 2022;45:37-44.
• 21. Valenti M, Porzio G, Aielli F, Cannita K, Manno R. Physical exercise and quality of life in breast cancer survivors. International Journal of Medical Sciences 2008;15:24-8.
• 22. Zahraa AH, Wilkerson A. Management of postoperative complications following operations for breast cancer. Surgical Clinics. 2021;101:845-63.
• 23. Saini KS, Taylor C, Ramirez AJ, Palmieri C, Gunnarssson U, Schmoll HJ et al. Role of the multidisciplinary team in breast cancer management: results from a large international survey involving 39 countries. Annals of Oncology. 2012;23:853-9.