Quality of Life and Recovery of Arm Function Applying Physiotherapy After Breast Cancer Surgery

Abstract

Research background. Breast cancer is the most common female malignancy. Different types of surgery are performed after assessing stage of the disease, tumour morphology, and other dimensions. Dysfunction of hand after surgery may affect physical, emotional and sexual function and quality of life more than body shape changes (Guan et al., 2012). The aim of this study was to evaluate the quality of life, shoulder range of motion, arm pain, circumference of arm, and hand muscle strength after breastconserving surgery after mastectomy. Methods. The study included 30 women, 15 of them were after breast conserving surgery, and 15 – after mastectomy. All subjects participated in the same physiotherapy program ‒ stretching and muscle strengthening exercises, shoulder girdle, neck and hand massage, lymph drainage massage (sleeve), transcutaneous electrical nerve stimulation (TENS). Duration of rehabilitation was two weeks. Quality of life, shoulder range of motion, arm pain and circumference, hand muscle strength of the affected side were measured before and after rehabilitation. Results. Regardless of the type of surgical intervention, the range of motion of shoulder flexion, extension and abduction in both groups after physiotherapy increased signifcantly, but for the patients who had undergone breast conserving surgery the ranges of motion were signifcantly higher (flexion – 163.20 ± 11,7°; extension – 48.53 ± 5.5°; abduction – 145.27 ± 13.6°) than for those who undergone mastectomy (flexion – 141.20 ± 13.2°; extension – 33.13 ± 4.9°; abduction – 130.33 ± 14.9°). It was found that circumference of the arm reduced significantly  in both groups, but comparing one group to another no signifcant differences were found. Pain intensity after physiotherapy in patients with mastectomy and patients who had undergone breast conserving surgery signifcantly decreased, but pain reduction was signifcantly higher in patients after breast conserving surgery (6.00 ± 1.1 points) compared to mastectomy group (3.67 ± 1.5 points). Muscle strength of hand of the affected side after physiotherapy increased signifcantly in both groups, but signifcantly more (up to 15.03 ± 2.1 kg) in patients after the breast conserving surgery compared to patients who had undergone mastectomy (up to 12.77 ± 2.0 kg). In addition, most of the functions of quality of life in patients who had undergone breast conserving surgery were signifcantly better than those in patients who had undergone mastectomy. Conclusions: 1. Regardless of the surgery type, shoulder range of motion and hand muscle strength increased signifcantly, and arm circumference and the pain reduced signifcantly after physiotherapy. 2. Shoulder range of motion and hand strength of the affected side were signifcantly higher while pain was signifcantly lower in patients who had undergone breast-conserving surgery compared to patients who had undergone mastectomy. 3. three components of the quality of life ‒ role, emotional and social functions – were signifcantly higher, but symptom scale scores were better in patients who had undergone breast-conserving surgery compared to those who had undergone mastectomy.

Keywords: physiotherapy, breast cancer, mastectomy, breast-conserving surgery