Breast Cancer Patients - Musculoskeletal Problems Experienced

Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton, Chloe Waller and Kim Jackson  

Introduction[edit | edit source]

Breast cancer and its' treatment, usually localised surgery with chemotherapy, radiotherapy and endocrine therapy, increase the risk of musculoskeletal problems, especially in the upper limb[1]. Research suggests 67% of women may have shoulder or arm problems up to 3 years after treatment[2].

Musculoskeletal Conditions[edit | edit source]

Post-Mastectomy Pain Syndrome (PMPS)[edit | edit source]

Post-mastectomy pain syndrome (PMPS) is a neuropathic condition defined as pain located in the anterior surface of the chest, arm pit, shoulder or upper half of the arm that persists for longer than 3 months after surgery. The nature of PMPS is inflammatory and/or neuropathic pain, possibly due to sensitization of peripheral nociceptors, neuroma formation and fibrotic entrapment. [11]

Treatments include physiotherapy, mindfulness-based cognitive therapy, oral medications, surgical intervention (fat grafting, neuroma or lymphedema surgery as required), anesthesia, nerve blocks and neurolysis, laser, neuromodulators and topical capsaicin. [12]

Physiotherapy Management[edit | edit source]

Physiotherapy intervention will be patient-specific, but can include:

Evidence[edit | edit source]

Overall, evidence supports exercise for breast cancer patients to improve physical and mental health.

One controlled trial of 209 patients comparing a three-month rehabilitation program of physical training and psycho-educational sessions to usual care found improvements in Sit and Reach Test, maximal incremental exercise test, Six-Minute Walk Test, BMI and body fat percentage and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30.[18]

A self-completed questionnaire completed by 94 women who had had breast cancer found increased physical activity habits and physiotherapy treatments contributed for the perception of lower number of musculoskeletal disorders.[19]

The UK PROSPER trial assessed 392 women undergoing breast cancer surgery at 17 UK NHS cancer centres, and found an exercise program to be clinically and cost effective. Patients were randomised to either usual care (information leaflets) or usual care plus a physiotherapy programme (with stretching, strengthening, physical activity, and behaviour change techniques for exercise adherence). Upper limb function improved after exercise compared with usual care (mean Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire 16.3 (SD 17.6) for exercise (n=132); 23.7 (22.9) usual care (n=138); adjusted mean difference 7.81, 95% confidence interval 3.17 to 12.44; P=0.001). Moreover at 12 months there was lower adjusted mean difference on numerical rating scale (P=0.02) and less arm disability symptoms (P=0.001). There was no increase in complications or adverse events in the exercise group.[13]

Multidisciplinary Team Management[edit | edit source]

  • Primary care and gynaecology services, including doctors, nurses and midwives are able to provide assessment, treatment, education and referrals for physical and psychosocial changes post breast cancer.[20]
  • Occupational therapy has been found to improve global quality of life, role functions, physical, emotional, cognitive, and social functions, fatigue, insomnia, financial impact, systemic therapy side effects, breast symptoms scales and engagement in meaningful activities.[21]
  • Psychosocial interventions such as cognitive behavioural therapy had positive effects on mental health and quality of life.[15]
  • Dietitians can provide diet and nutritional support and education, which has been linked with positive changes in psychological, physiological and behavioural outcomes.[22]

References[edit | edit source]

  1. Richmond H et al, PROSPER Study Group. Development of an exercise intervention for the prevention of musculoskeletal shoulder problems after breast cancer treatment: the prevention of shoulder problems trial (UK PROSPER). BMC Health Serv Res. 2018 Jun 18;18(1):463
  2. 2.0 2.1 Bruce J, Williamson E, Lait C on behalf of the PROSPER Study Group, et al. Randomised controlled trial of exercise to prevent shoulder problems in women undergoing breast cancer treatment: study protocol for the prevention of shoulder problems trial (UK PROSPER). BMJ Open 2018;8:e019078
  3. 3.0 3.1 Ballinger TJ, Thompson WR, Guise TA. The bone-muscle connection in breast cancer: implications and therapeutic strategies to preserve musculoskeletal health. Breast Cancer Res. 2022 Nov 23;24(1):84.
  4. Suskin J, Shapiro CL. Osteoporosis and musculoskeletal complications related to therapy of breast cancer. Gland Surg. 2018 Aug;7(4):411-423.
  5. 5.0 5.1 Ebaugh, D., Spinelli, B. and Schmitz, K.H. Shoulder impairments and their association with symptomatic rotator cuff disease in breast cancer survivors. 2011. Medical Hypotheses. Vol. 77, p.481–487.
  6. 6.0 6.1 Pacurar R, Miclaus C, Miclaus M. Morbidity associated with breast cancer therapy and the place of physiotherapy in its management. Timisoara Physical Education & Rehabilitation Journal 2011 05;3(6):46-54.
  7. Stubblefield MD, Custodio CM. Upper-extremity pain disorders in breast cancer. Physical Medicine and Rehabiliation. 2006. 87; 3: 96-99
  8. Rafn BS, Christensen J, Larsen A, Bloomquist K. Prospective Surveillance for Breast Cancer-Related Arm Lymphedema: A Systematic Review and Meta-Analysis. J Clin Oncol. 2022 Mar 20;40(9):1009-1026.
  9. Plaza Meza MP, Marín Fermín T, Maffulli N. Diagnosis and epidemiology of winged scapula in breast cancer patients: A systematic review and meta-analysis. Br Med Bull. 2021 Dec 16;140(1):23-35
  10. Leclerc AF et al. Multidisciplinary rehabilitation program after breast cancer: benefits on physical function, anthropometry and quality of life. Eur J Phys Rehabil Med. 2017 Oct;53(5):633-642. doi: 10.23736/S1973-9087.17.04551-8. Epub 2017 Mar 20
  11. Yuksel SS, Chappell AG, Jackson BT, Wescott AB, Ellis MF. "Post Mastectomy Pain Syndrome: A Systematic Review of Prevention Modalities". JPRAS Open. 2021 Oct 30;31:32-49.
  12. Chappell AG, Yuksel S, Sasson DC, Wescott AB, Connor LM, Ellis MF. Post-Mastectomy Pain Syndrome: An Up-to-Date Review of Treatment Outcomes. JPRAS Open. 2021 Aug 11;30:97-109.
  13. 13.0 13.1 Bruce J et al; Prevention of Shoulder Problems Trial (PROSPER) Study Group. Exercise versus usual care after non-reconstructive breast cancer surgery (UK PROSPER): multicentre randomised controlled trial and economic evaluation. BMJ. 2021 Nov 10;375:e066542
  14. 14.0 14.1 Lahart IM, Metsios GS, Nevill AM, Carmichael AR. Physical activity for women with breast cancer after adjuvant therapy. Cochrane Database Syst Rev. 2018 Jan 29;1(1):CD011292
  15. 15.0 15.1 Olsson Möller U, Beck I, Rydén L, Malmström M. A comprehensive approach to rehabilitation interventions following breast cancer treatment - a systematic review of systematic reviews. BMC Cancer. 2019 May 20;19(1):472.
  16. Serra-Añó P, Inglés M, Bou-Catalá C, Iraola-Lliso A, Espí-López GV. Effectiveness of myofascial release after breast cancer surgery in women undergoing conservative surgery and radiotherapy: a randomized controlled trial. Support Care Cancer. 2019 Jul;27(7):2633-2641.
  17. Kasawara KT, Mapa JMR, Ferreira V, Added MAN, Shiwa SR, Carvas N Jr, Batista PA. Effects of Kinesio Taping on breast cancer-related lymphedema: A meta-analysis in clinical trials. Physiother Theory Pract. 2018 May;34(5):337-345.
  18. Leclerc AF et al. Multidisciplinary rehabilitation program after breast cancer: benefits on physical function, anthropometry and quality of life. Eur J Phys Rehabil Med. 2017 Oct;53(5):633-642.
  19. Rangel J, Tomás MT, Fernandes B. Physical activity and physiotherapy: perception of women breast cancer survivors. Breast Cancer. 2019 May;26(3):333-338.
  20. Lovelace DL, McDaniel LR, Golden D. Long-Term Effects of Breast Cancer Surgery, Treatment, and Survivor Care. J Midwifery Womens Health. 2019 Nov;64(6):713-724.
  21. Petruseviciene D, Surmaitiene D, Baltaduoniene D, Lendraitiene E. Effect of Community-Based Occupational Therapy on Health-Related Quality of Life and Engagement in Meaningful Activities of Women with Breast Cancer. Occup Ther Int. 2018 Apr 17;2018:6798697
  22. Carayol M, Ninot G, Senesse P, Bleuse JP, Gourgou S, Sancho-Garnier H, Sari C, Romieu I, Romieu G, Jacot W. Short- and long-term impact of adapted physical activity and diet counseling during adjuvant breast cancer therapy: the "APAD1" randomized controlled trial. BMC Cancer. 2019 Jul 25;19(1):737