Authors (including presenting author) :
Shum PL(1)(3), Wong HY(1)(3), Wong PM(1)(3), Chan WP(1)(3), Weng WN(1)(3), Yeung SF(1)(3), Yip ML(2)(3), Chan YW(2)(3), Lee SY(2)(3), Wan SY(1)(3)
Affiliation :
(1) Department of Physiotherapy (2) Department of Surgery (3) Pamela Youde Nethersole Eastern Hospital
Introduction :
Shoulder stiffness, scar adhesion and lymphedema are common in breast cancer patients who underwent surgery with axillary lymph node dissection. These complications delay subsequent treatments, in particular radiotherapy. The decreased shoulder range and lymphedema are closely related. The prevalence of lymphedema is 20% when followed up until 18 months (Hayes et al, 2010). Lymphedema hinders shoulder movement and becomes worse itself at the same time (Chan et al. 2010). Exercises after breast surgery is effective to improve shoulder range and decrease scar tightness. However, unsupervised or too early shoulder mobilization after breast surgery may introduce seroma formation. A supervised exercise training program was introduced to patients of breast cancer.
Objectives :
(1) To provide a well supervised training throughout the rehabilitation journey; (2) Early screening and to decrease prevalence of lymphedema by early intervention;
Methodology :
Patients with breast cancer were referred from Department of Surgery, PYNEH. Patients were seen before operation, post-op day 1, 2 weeks, 6 weeks and 9 months. Shoulder range was measured and upper limbs lymphedema was monitored by bioimpedence analysis. Education and exercise including shoulder mobilization exercises, scar management and lymphedema massage was delivered. Lymphedema was screened in each session except post-op day 1. Individualized intervention will be given if shoulder stiffness or lymphedema was detected. Patients were then followed up to post-op 9 months. Evaluation questionnaires on patient satisfaction were collected.
Result & Outcome :
From September 2017 to December 2017, 30 female patients were recruited. Shoulder abduction range was significantly decreased at 2 weeks after surgery (173 to 137 degree, P=0.000). However, significant improvement in shoulder abduction was shown at post-op 6 weeks after exercise was introduced (137 to 161 degree, P=0.000) and maintained to post-op 9 months. At post-op 9 months, 97% patients’ water percentage was under 0.39 which indicated no lymphedema. Satisfactory rate was 8.5 out of 10. The low incidence of lymphedema (3%) in this study showing that early supervised training with continuous monitoring is effective in controlling lymphedema and preventing shoulder stiffness post-operatively. Most important of all, all patients have a better understanding in their rehabilitation journey after breast cancer surgery.
Co-location with:
