Measuring upper limb function and patient reported outcomes after major breast cancer surgery : a pilot study in an Asian cohort
Background: Breast cancer is the most common cancer in women worldwide. Major breast cancer surgery especially with axillary lymph node dissection (ALND), is associated with upper limb functional decline. Majority of studies are conducted in Western population and may not be applicable to Asians. Th...
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Science::Medicine Breast Surgery Rehabilitation Chan, Kai Siang Zeng, Ding Leung, Joelle Hoi Ting Ooi, Belinda Si Yin Kong, Kit Teng Yeo, Yi Heng Goo, Jerry Tiong Thye Chia, Clement Luck Khng Measuring upper limb function and patient reported outcomes after major breast cancer surgery : a pilot study in an Asian cohort |
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Background: Breast cancer is the most common cancer in women worldwide. Major breast cancer surgery especially with axillary lymph node dissection (ALND), is associated with upper limb functional decline. Majority of studies are conducted in Western population and may not be applicable to Asians. This pilot study aims to evaluate whether major breast surgery results in upper limb functional impairment in a cohort of Asian women with breast cancer. Methods: This is a prospective cohort study of 41 patients who underwent 44 major breast surgeries from April 2018 to August 2019. Main inclusion criteria were patients over 21 years of age undergoing major breast surgery for breast cancer. Major breast surgery was defined as wide local excision (WLE) or mastectomy. Main exclusion criteria were patients with pre-existing neurological or rheumatological co-morbidities affecting upper limb function or previous trauma with resulting deformities to the upper limbs. Patients underwent early rehabilitation from post-operative day 1. Shoulder flexion and abduction active range of motion (AROM) and QuickDASH disability score were assessed 1 week before surgery, post-operative week 2 and week 6. Baseline demographics and peri-operative data were also collected. Results: Median age was 62.5 years. There were 16 (36.4%) wide local excisions and 28 (63.6%) simple mastectomies. Two (4.5%) cases had neoadjuvant chemotherapy. Fifteen (34.1%) cases had ALND. At post-operative week 6, shoulder flexion was comparable to baseline (p = 0.775), while abduction improved from baseline (p = 0.016). However, QuickDASH disability score was significantly worse at post-operative week 6 compared to baseline (median score 2.5 vs 0, p = 0.027). Subgroup analysis of patients with ALND demonstrated significantly worse QuickDASH disability score at post-operative week 6 (p = 0.010) but not for patients with only sentinel lymph node biopsy (p = 0.396). Conclusion: This pilot study in an Asian cohort found that patients were able to regain AROM of shoulder after major breast surgery at post-operative week 6 but had a worse QuickDASH disability score, especially in the subgroup with ALND. Aggressive and early rehabilitation should be encouraged. However, a longer follow-up is required to evaluate long term functional outcomes. |
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Lee Kong Chian School of Medicine (LKCMedicine) |
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Lee Kong Chian School of Medicine (LKCMedicine) Chan, Kai Siang Zeng, Ding Leung, Joelle Hoi Ting Ooi, Belinda Si Yin Kong, Kit Teng Yeo, Yi Heng Goo, Jerry Tiong Thye Chia, Clement Luck Khng |
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Article |
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Chan, Kai Siang Zeng, Ding Leung, Joelle Hoi Ting Ooi, Belinda Si Yin Kong, Kit Teng Yeo, Yi Heng Goo, Jerry Tiong Thye Chia, Clement Luck Khng |
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Chan, Kai Siang |
title |
Measuring upper limb function and patient reported outcomes after major breast cancer surgery : a pilot study in an Asian cohort |
title_short |
Measuring upper limb function and patient reported outcomes after major breast cancer surgery : a pilot study in an Asian cohort |
title_full |
Measuring upper limb function and patient reported outcomes after major breast cancer surgery : a pilot study in an Asian cohort |
title_fullStr |
Measuring upper limb function and patient reported outcomes after major breast cancer surgery : a pilot study in an Asian cohort |
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Measuring upper limb function and patient reported outcomes after major breast cancer surgery : a pilot study in an Asian cohort |
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measuring upper limb function and patient reported outcomes after major breast cancer surgery : a pilot study in an asian cohort |
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2021 |
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https://hdl.handle.net/10356/146277 |
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sg-ntu-dr.10356-1462772023-03-05T16:47:31Z Measuring upper limb function and patient reported outcomes after major breast cancer surgery : a pilot study in an Asian cohort Chan, Kai Siang Zeng, Ding Leung, Joelle Hoi Ting Ooi, Belinda Si Yin Kong, Kit Teng Yeo, Yi Heng Goo, Jerry Tiong Thye Chia, Clement Luck Khng Lee Kong Chian School of Medicine (LKCMedicine) Science::Medicine Breast Surgery Rehabilitation Background: Breast cancer is the most common cancer in women worldwide. Major breast cancer surgery especially with axillary lymph node dissection (ALND), is associated with upper limb functional decline. Majority of studies are conducted in Western population and may not be applicable to Asians. This pilot study aims to evaluate whether major breast surgery results in upper limb functional impairment in a cohort of Asian women with breast cancer. Methods: This is a prospective cohort study of 41 patients who underwent 44 major breast surgeries from April 2018 to August 2019. Main inclusion criteria were patients over 21 years of age undergoing major breast surgery for breast cancer. Major breast surgery was defined as wide local excision (WLE) or mastectomy. Main exclusion criteria were patients with pre-existing neurological or rheumatological co-morbidities affecting upper limb function or previous trauma with resulting deformities to the upper limbs. Patients underwent early rehabilitation from post-operative day 1. Shoulder flexion and abduction active range of motion (AROM) and QuickDASH disability score were assessed 1 week before surgery, post-operative week 2 and week 6. Baseline demographics and peri-operative data were also collected. Results: Median age was 62.5 years. There were 16 (36.4%) wide local excisions and 28 (63.6%) simple mastectomies. Two (4.5%) cases had neoadjuvant chemotherapy. Fifteen (34.1%) cases had ALND. At post-operative week 6, shoulder flexion was comparable to baseline (p = 0.775), while abduction improved from baseline (p = 0.016). However, QuickDASH disability score was significantly worse at post-operative week 6 compared to baseline (median score 2.5 vs 0, p = 0.027). Subgroup analysis of patients with ALND demonstrated significantly worse QuickDASH disability score at post-operative week 6 (p = 0.010) but not for patients with only sentinel lymph node biopsy (p = 0.396). Conclusion: This pilot study in an Asian cohort found that patients were able to regain AROM of shoulder after major breast surgery at post-operative week 6 but had a worse QuickDASH disability score, especially in the subgroup with ALND. Aggressive and early rehabilitation should be encouraged. However, a longer follow-up is required to evaluate long term functional outcomes. Published version 2021-02-04T09:02:02Z 2021-02-04T09:02:02Z 2020 Journal Article Chan, K. S., Zeng, D., Leung, J. H. T., Ooi, B. S. Y., Kong, K. T., Yeo, Y. H., . . . Chia, C. L. K. (2020). Measuring upper limb function and patient reported outcomes after major breast cancer surgery : a pilot study in an Asian cohort. BMC Surgery, 20(1), 108-. doi:10.1186/s12893-020-00773-0 1471-2482 https://hdl.handle.net/10356/146277 10.1186/s12893-020-00773-0 32430021 2-s2.0-85084962214 1 20 en BMC Surgery © 2020 The Author(s). This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. application/pdf |