Author: Pavla Suchanová Title: Lymphedema in patients after the breast cancer treatment from the view of physiotherapy: literature review Objective: The aim of the literature review was to find out which are the most used and in practice the most effective physiotherapeutic approaches which affect secondary lymphedema of the arm related to breast cancer. The purpose was also to gather the current available knowledge of this issue. Methods: The presented literature review is of the analytical-descriptive nature. It was divided into two parts. The first part is called the theoretical background and deals with the anatomy, pathophysiology, and physiotherapy of arm lymphedema after breast cancer. The second part is focused on the data collection according to the given criteria, analysis, and interpretation of the results of the research. The sources were searched for in the electronic databases of Cochrane trials, Pub Med and PEDro in the period from 2010 to 2021. Of the total number of 7379 studies, 11 randomized controlled trials, meeting the evaluation criteria, were further analyzed. Searches were performed using various keywords and synonyms connected with the research questions: breast cancer lymphedema, postmastectomy lymphedema, breast cancer lymphedema and exercise. Results: Of the searched...

Made available in DSpace on 2016-01-26T12:51:23Z (GMT). No. of bitstreams: 1 flaviamariana valente_dissert.pdf: 880429 bytes, checksum: 6243894c71b939f3cad53d3b5cf35c8c (MD5) Previous issue date: 2009-08-10 / Thermotherapy has been indicated by some researchers as a technique in the treatment of lymphedema. Objective: The aim of the current study was to evaluate whether the association of heat with mechanical lymph drainage favors the reduction in volume of lymphedematous and healthy lower extremities. Method: Fifteen patients with lymphedema of the lower extremities with ages ranging from 18 to 79 years old (mean of 44.4 years) were enrolled in this study. Volume changes were evaluated for mechanical lymph drainage both in isolation and associated with heat. Mechanical lymph drainage was performed using the RA3000/Godoy ® apparatus and the Thermolipo (Advice®) apparatus was utilized for the simultaneous application of heat. The volume of lower extremities, before and after treatment, was evaluated by volumetry. The Wilcoxon s test was utilized for statistical analysis with the significance level set at 5% (p-value < 0.05). Results: Significant differences were observed comparing lymph drainage in isolation and when associated with heat of lymphedematous (p-value = 0.0008) and healthy (p-value = 0.028) limbs. There were significant reductions in volume with treatment using mechanical lymph drainage in isolation both for lymphedematous (p-value = 0.0001) and healthy (p-value = 0.006) limbs. However, no significant difference was seen with the simultaneous application of heat (p-value = 0.56 and 0.51 for lymphedematous and healthy limbs, respectively). Conclusion: The association of surface heat with mechanical lymph drainage does not favor a reduction in volume of lymphedematous or healthy lower extremities. / A termoterapia tem sido sugerida por alguns pesquisadores como forma de tratamento do linfedema. Objetivo: O objetivo deste estudo foi avaliar se a associação do calor à drenagem linfática mecânica favorece a redução do volume de membros inferiores linfedematosos e sadios. Método: Participaram do estudo 15 portadores de linfedema de membros inferiores, com idades entre 18 e 79 anos (média de 44,4 anos). Os mesmos voluntários foram avaliados quanto ao efeito da drenagem linfática mecânica isolada, e de sua associação ao calor, totalizando 88 avaliações. A drenagem linfática mecânica foi realizada com o dispositivo RA3000/Godoy®, e para a aplicação simultânea do calor foi utilizado o aparelho Thermolipo (Advice®). A avaliação dos membros inferiores, imediatamente antes e após o protocolo de tratamento, foi realizada pela volumetria. Na análise estatística utilizou-se o teste de Wilcoxon, com nível de significância fixado em 5% (p &#8804; 0,05). Resultados: Houve diferença significativa na comparação entre os efeitos da drenagem isolada e sua associação ao calor nos membros com linfedema (p = 0,0008) e sadios (p = 0,028). Os valores pré e pós tratamento com a drenagem mecânica isolada apresentaram diferença significativa tanto nos membros com linfedema (p = 0,0001) quanto sadios (p = 0,006), mas não houve diferença significativa com a aplicação simultânea do calor em ambos os membros (p = 0,56 e p = 0,51, respectivamente). Conclusão: A associação do calor superficial à drenagem linfática mecânica não favoreceu a redução volumétrica de membros inferiores linfedematosos ou sadios.

Bakgrund: Lymfödem är en besvärande komplikation efter bröstcancerkirurgi. Det kan leda till svullnad, smärta och rörelseinskränkningar i den drabbade armen. Det är ett kroniskt och svårbehandlat tillstånd. Syfte: Att sammanställa vetenskaplig litteratur som beskriver omvårdnadsåtgärder utförda av sjuksköterskan och metoder för egenvård utförda av patienter för prevention och behandling av lymfödem efter bröstcancerkirurgi. Metod: PubMed användes som databas för insamling av artiklar under februari 2016. Fyra kombinationer av sökorden “blood draws”, “lymphedema”, “self-management”, “nurse”, “breast cancer” samt “knowledge” användes. Artiklarna sammanställdes och kvalitetsgranskades. Resultat: Tio relevanta vetenskapliga originalartiklar identifierades; sju med kvantitativ metod och tre med kvalitativ metod. Blodprovstagningar, infusioner, blodtrycksmätningar, trauma och flygresor innebar inte en ökad risk för lymfödem trots rådande rekommendationer om att detta bör undvikas. Patientundervisning från sjuksköterskan och egenvård var viktigt för att förebygga och behandla lymfödem. Patientundervisningen upplevdes emellertid som bristfällig av flertalet patienter och sjuksköterskor måste utveckla sin kompetens inom detta område. Majoriteten av patienterna var medvetna om egenvårdens betydelse, men trots detta utfördes den inte av alla. Bristande kunskap och stöd var två svårigheter som identifierades. Regelbunden träning minskade risken för lymfödem. Slutsats: Vissa rekommendationer om omvårdnadsåtgärder relaterade till lymfödem bör ses över. Patientundervisning tycks vara en förutsättning för egenvård och bör få större utrymme. Egenvård har visat sig effektivt, och strategier för att hantera olika hinder behövs. Sjuksköterskan kan ses som en resurs i omvårdnaden av denna patientgrupp och har en viktig funktion som ansvarig för såväl medicinsktekniska procedurer som patientundervisning och stöd vid egenvård. / Background: Lymphedema is a feared complication after breast cancer surgery, causing swelling, pain and restriction of mobility in the affected arm. This condition is chronic and difficult to treat. Aim: To compile scientific literatur describing nursing activities and methods for self care performed by patients for prevention and treatment of lymphedema after breast cancer surgery. Methods: The PubMed database was used for data collection during february 2016. Four combinations of the search terms “blood draws”, “lymphedema”, “self-management”, “nurse”, “breast cancer” and “knowledge” were used. A quality review and an analysis of the results were conducted. Results: Ten relevant scientific original articles were identified; seven using a quantitative design and three using a qualitative design. Blood sampling, infusions, blood pressure measurements, trauma and air travel did not increase the risk of lymphedema despite current recommendations that this should be avoided. Patienteducation by nurses and self care were important to prevent and treat lymphedema. However, the education was perceived as inadequate by several patients, suggesting that nurses must expand their knowledge in this area. Although most patients were aware of the importance of self care, it was not performed by everyone. Lack of knowledge and support were two difficulties identified. Regular exercise decreased the risk of lymphedema. Conclusions: Some recommendations concerning nursing care related to lymphedema should be reconsidered. Patienteducation seems to be a condition for self care and should be given greater emphasis. Self care has been proven effective, and strategies for dealing with difficulties are needed. The nurse may be considered as a resource in nursing care for this group of patients and has an important function as responsible for blood sampling, injections and blood pressure readings as well as patienteducation and self care support.

A dor e o linfedema são as principais sequelas que acometem as pacientes com câncer de mama após o tratamento dessa doença, e essas sequelas acarretam alterações físicas e psicológicas que podem modificar a qualidade de vida relacionada à saúde (QVRS) dessas pacientes. Este estudo teve como objetivo verificar a presença da dor, do linfedema e da QVRS nas pacientes com câncer de mama. Foram realizadas avaliações da presença da dor com a EVA, da presença do linfedema com a perimetria e da QVRS com o EORTC QLQ C30. A amostra constituiu-se de 181 pacientes com câncer de mama que faziam acompanhamento médico da doença no Ambulatório de Mastologia do HCFMRP-USP e no Ambulatório de Fisioterapia da Fundação Pio XII - Hospital do Câncer de Barretos. A média da idade das pacientes variou de 52,81 (±11,68) a 54,09 (±11,39); a maioria das pacientes era casada, com baixo nível de escolaridade e desempenhavam atividade doméstica. A mama esquerda foi a mais acometida, o carcinoma ductal infiltrante foi o predominante e a mastectomia foi a técnica cirúrgica mais utilizada nas pacientes deste estudo. Constatou-se que 78 pacientes referiram sentir dor no membro superior homolateral à intervenção cirúrgica, em 52 pacientes constatou a presença do linfedema. A QVRS foi considerada como boa pelas pacientes. / The pain and lymphedema are the major consequences that affect patients with breast cancer after treatment of this disease, and these consequences cause physical and psychological changes that may alter the quality of life related to health of these patients (HRQOL). This study aimed to verify the presence of pain, lymphedema and HRQOL in patients with breast cancer. The presence of pain evaluated using visual anologue scale (VAS), perimetry was used to evaluate presence of lymphedema and HRQOL was measure with EORTC QLQ C30. The sample consisted of 181 patients with breast cancer who were monitoring the disease at the Mastology Outpatient of the Hospital das Clínicas of the University of São Paulo at Ribeirão Preto Medical School (HCRPFMRP/USP) and the Physiotherapy Outpatient of the Pius XII Foundation - Cancer Hospital of Barretos. The mean age of the patients ranged from 52,81 (±11,68) to 54,09 (±11,39). Most patients were married, with a low educational level and housewifes. The left breast was the most affected, the infiltrating ductal carcinoma was the most prevalent and mastectomy surgical technique was used in most patients in this study. 78 patients reported pain in the homolateral upper limb subsequent to surgery, in 52 patients had lymphedema. HRQOL was considered good for patients.

Objetivo: Avaliar o efeito da compressão elástica e enfaixamento compressivo funcional associados à cinesioterapia sobre o fluxo sanguíneo do membro superior com linfedema secundário ao tratamento do câncer de mama. Métodos: Trata-se de ensaio clínico randomizado cego crossover, com período washout de sete dias entre os tratamentos. Foram avaliadas 20 mulheres com idade média de 66.85 anos (DP = 11.76), submetidas a três tipos de procedimentos terapêuticos aplicados aleatoriamente mediante sorteio: cinesioterapia (C), cinesioterapia + enfaixamento compressivo funcional (ECF), cinesioterapia + compressão elástica (CE). O fluxo sanguíneo, incluindo velocidade média e máxima, foi avaliado por meio de ultrassom Doppler antes e após procedimento terapêutico, nos tempos 0, 15, 30 minutos. Foi utilizado análise de variância (ANOVA) de medidas repetidas seguido do teste de Bonferroni, considerado um nível de significância de 5%. Resultados: Os grupos CE e ECF apresentaram incremento significativo da velocidade média do fluxo sanguíneo das artérias e veias axilar e braquial, quando comparados ao grupo que recebeu apenas cinesioterapia (C). Quando realizadas as comparações entre os grupos CE e ECF, não foi observada diferença significativa (p>0.05). Foi observada interação grupo-versus-tempo para a artéria (F=7.033, p<0.001) e veia axilar (F=5.524, p<0.001), e para artéria (F= 11.195, p<0.001) e veia braquial (F=10.521, p<0.001), sendo os grupos CE e ECF com incremento circulatório mais significativo (p<0.05). Com relação à velocidade máxima, foi observada significativa interação grupo-versus-tempo para a artéria braquial (F=2.492, p=0.029). Conclusão: A CE e o ECF associados à C produzem incremento do fluxo sanguíneo do membro superior com linfedema. / Objective: To evaluate the effect of elastic compression, functional compressive bandaging and kinesiotherapy on blood flow of the upper limb with lymphedema secondary to the treatment of breast cancer. Methods: This was a randomized blind crossover clinical trial with washout period of seven days between treatments. We evaluated 20 women with a mean age of 66.85 years (standard deviation = 11.76), submitted to three types of therapeutic procedures randomly applied by lot: kinesiotherapy, kinesiotherapy + functional compressive bandaging (FCB), kinesiotherapy + elastic compression (EC). Blood flow, including mean and maximum velocity, was assessed by Doppler ultrasound before and after therapeutic procedure (immediately after, 15 and 30 minutes). We used 2-way analysis of variance for repeated measures followed by Bonferroni\'s test, considering a significance level of 5%. Results: The EC and FCB groups showed significant increase in the mean velocity of blood flow of the axillary and brachial arteries and veins when compared to the group that received only kinesiotherapy (p<0.05). When made comparisons between the EC and FCB groups, there was no significant difference (p>0.05). Regarding to the maximum velocity the EC and FCB groups showed greater increase of the maximum velocity of blood flow in the brachial artery (p<0.05) when compared to the group that received only kinesiotherapy, but no difference between them (p>0.05). Conclusion: The elastic compression and functional compressive bandaging associated to kinesiotherapy produce increased blood flow of upper limb lymphedema

Submitted by Fabíola Silva (fabiola.silva@famerp.br) on 2017-05-26T12:52:18Z No. of bitstreams: 1 edivandrabuzato_dissert.pdf: 917604 bytes, checksum: b9e88e30b29c674ac928aaff474acc7e (MD5) / Made available in DSpace on 2017-05-26T12:52:18Z (GMT). No. of bitstreams: 1 edivandrabuzato_dissert.pdf: 917604 bytes, checksum: b9e88e30b29c674ac928aaff474acc7e (MD5) Previous issue date: 2014-11-13 / Introduction: Breast cancer is currently the most common cancer of women worldwide. Historically, one of the most feared complications after the treatment of breast cancer is lymphedema. However, one problem often observed in patients is obesity with abdominal fat being a cardiovascular risk factor. Objective: The aim of this study was to evaluate the distribution of abdominal fat in patients with clinical diagnosis of breast cancer treatment-related lymphedema. Patients and Method: Forty-five female patients with clinical diagnosis of lymphedema after breast cancer treatment were evaluated in a randomized controlled case study in the Clinica Godoy in 2012. A control group of 38womenwithout breast cancer, who attended the clinic for other reasons, were matched for age and body mass index (BMI). Both groups were evaluated by bioimpedance using the InBody®S10 device; age, abdominal fat and BMI were the main variables considered. The unpaired t-test, and Mann-Whitney and Fisher's exact tests were used for statistical analysis with an alpha error of 5% being considered acceptable. Results: There was no significant difference in the BMI between groups (unpaired t-test: p-value=0.23; 95% CI=-2.68-0.66: Standard deviation of study and control groups were 4.03 and 3.53, respectively). However there was a significant difference between the two groups in respect to abdominal fat (unpaired t-test: p-value<0.0001; 95% CI=86.71-116.77 and Mann-Whitney test: mean =100.75; 95% CI =83.7-112.5). Conclusions: Using bioimpedance, this study found that women with arm lymphedema after breast cancer treatment have higher levels of abdominal fat compared to women who had not suffered from breast cancer. Bioimpedance is efficient to evaluate abdominal fat as a low cost option in these patients and not invisibility. / Introdução: O câncer de mama atualmente é o mais comum dos cânceres em mulheres no mundo. Uma das complicações mais temida no pós-tratamento do câncer de mama relatado historicamente é o linfedema. Entretanto, um dos problemas observados nestas mulheres é a obesidade, sendo que a gordura abdominal constitui risco cardiovascular. Objetivo: O objetivo do presente estudo foi avaliar o aumenta na distribuição da gordura abdominal em mulheres pós-tratamento de câncer de mama com linfedema de membros superiores. Casuística e Método: Foram avaliadas, em estudo caso controle randomizado, 45 pacientes do sexo feminino com linfedema, diagnóstico clínico pós-tratamento de câncer de mama, acompanhadas na Clínica Godoy, em 2012; e comparadas com 38 mulheres sem câncer de mama, do grupo controle, que frequentam a clínica por outras causas, as quais foram pareadas por idade e Índice de Massa Corpórea (IMC). Ambos os grupos foram submetidos à avaliação pela bioimpedância, aparelho InBody® S 10, sendo enfatizada a idade, gordura abdominal e Índice de Massa Corpórea (IMC). Para a análise estatística foram utilizados Teste t não pareado, Teste de Mann-Whitney e Teste exato de Fisher, considerando erro alfa de 5%. Resultados: Relação do IMC do grupo controle com o grupo de estudo apresentado no Teste t não pareado: P = 0,23; IC 95% = -2,68 - 0,66. Desvio padrão do grupo de estudo (4,03) e desvio padrão do grupo controle (3,53). Em relação à gordura abdominal do grupo controle com o grupo de estudo apresentado no teste t não pareado: P < 0,0001; IC 95% = 86,71- 116,77. Teste Mann-whitney para análise da gordura abdominal entre o grupo de estudo e o grupo controle: média= 100,75; IC = 83,7 - 112,5. Conclusões: 1- O presente estudo concluiu que mulheres no pós-tratamento de câncer de mama com linfedema de membros superiores, apresentaram aumento no valor da gordura abdominal em relação a mulheres que não tiveram câncer de mama, avaliadas pela Bioimpedância. 2- A bioimpedância pode ser indicada para rastreamento da gordura abdominal nessas pacientes como uma opção de exame de baixo custo e viável.

Submitted by Fabíola Silva (fabiola.silva@famerp.br) on 2018-01-17T11:04:30Z No. of bitstreams: 1 kleberrobertosantanna_dissert.pdf: 2567533 bytes, checksum: eae324ad76ed0dfd667eaf47bad5c5ea (MD5) / Made available in DSpace on 2018-01-17T11:04:30Z (GMT). No. of bitstreams: 1 kleberrobertosantanna_dissert.pdf: 2567533 bytes, checksum: eae324ad76ed0dfd667eaf47bad5c5ea (MD5) Previous issue date: 2017-03-08 / Introduction: Lymphedema is a clinical condition in which there is an accumulation of macromolecules in the interstitial space. As a result, it promotes water retention, consequently a failure in the formation or lymph drainage. Objectives: To access the images obtained from Computed Scintigraphy Chamber through a specific protocol of Lymphoscintigraphy and associate them to epidemiological data such as gender, age, educational level, socioeconomic status and prevalence of Lymphedema. Method: Epidemiological data were evaluated in a quantitative cross-sectional study comparing the diagnostic results for Lymphedema of the lower limbs using the Lymphoscintigraphy. They were correlated with gender, age, education level, family income and prevalence among the lower limbs at Hospital de Base in the last 10 years, 2006 to 2016. All patients clinically suspected of Lymphedema of the lower limbs were included and lymphoscintigraphic examinations of the upper limbs were excluded. Descriptive data were considered, and Fisher's exact test was used to correlate these variables considering alpha error of 5%. Results: A total of 430 patients were analyzed, 320(74.42%) were female and 110 (25.58%) male patients. Their age ranged from 10 to 90 years (mean = 48 years). A total 199 (46.27%) were positive findings and 231 (53.73%) negative. Among the images analyzed as positive; female patients were the majority, 183 (91.95%); Fisher's exact test p-value <0.001. When comparing patients with the first grade of high school with patients with complete college education, it was clear that Lymphedema was more prevalent in the first grade of high school, according to Fisher's exact test, p<0.0001. Comparing the second grade of high school with the ones with college education, it was observed that Lymphedema was more prevalent in those with high school; Fisher's exact test, p<0.0001. When comparing the wage gain from one to three minimum wages per month with three to five gains, five to seven and over seven salaries, a higher prevalence of Lymphedema was observed in the group of one to three salaries in relation to the others by Fisher's exact test, p<0.0001 in all evaluations. Comparing the salary range of three to five salaries with the salary range of five to seven and over seven monthly minimum wages, greater prevalence was observed in the range of three to five minimum wages; Fisher's exact test, p<0, 0.001 in both comparisons. The right lower limb presented 65 patients (32.66%), and 87(43.71%) unilateral left limb and 7 patients (23.63%), bilaterally were found. The left side was more prevalent than the right side; Fisher's exact test, p<0.01. Conclusions: Lymphedema is a public health issue that affects mostly women from lower cultural-educational socioeconomic status. One-sided onset can occur in the limb, but bilateral occurrence is frequent and Lymphoscintigraphy is useful in defining the diagnosis in cases of doubt. / Introdução: O Linfedema é uma condição clínica na qual ocorre um acúmulo de macromoléculas no espaço intersticial. Como consequência, promove retenção hídrica tendo como causa uma falha na formação ou na drenagem da linfa. Objetivos: Avaliar as imagens obtidas em Câmara de Cintilação Computadorizada por meio do protocolo de Linfocintilografia específico e relacioná-las com dados epidemiológicos como sexo, idade, grau de escolaridade, nível socioeconômico e prevalência de Linfedema. Método: Foram avaliados em estudo transversal quantitativo, dados epidemiológicos comparando-se os resultados diagnósticos para Linfedema de membros inferiores, utilizando a Linfocintilografia. Foram correlacionados com o sexo, idade, grau de escolaridade, renda familiar e predominância entre os membros inferiores no Hospital de Base nos últimos 10 anos, 2006 a 2016. Foram inclusos todos os pacientes com suspeita clínica de Linfedema de membros inferiores e excluídos os exames Linfocintilográficos de membros superiores. Foram considerados dados descritivos e utilizado o teste exato de Fisher para correlacionar essas variáveis, considerando-se erro alfa de 5%. Resultados: Foram analisados 430 pacientes sendo que 320(74,42%) eram pacientes do sexo feminino e 110(25,58%) pacientes do sexo masculino. A idade dos pacientes variava de 10 a 90 anos (média=48 anos). Os achados positivos somavam 199(46,27%) e negativos 231(53,73%); dentre as imagens analisadas como positivas, predominavam pacientes do sexo feminino; 183(91,95%); no teste exato de Fisher valor p<0,001. Quando se comparou o primeiro grau de escolaridade do ensino médio com o segundo grau do ensino médio, ficou evidenciado que o Linfedema é mais prevalente no primeiro grau do ensino médio, de acordo com o teste exato de Fisher, valor p<0,0001. Comparando-se o primeiro grau do ensino médio com os pacientes que possuíam grau do ensino superior, detectou-se que a prevalência do Linfedema é maior no primeiro ano do ensino médio de escolaridade; teste exato de Fisher, valor p<0,0001. Comparando-se segundo grau do ensino médio de escolaridade com os do ensino superior, detectou-se que o Linfedema é mais prevalente no segundo grau do ensino médio; teste exato de Fisher, valor p<0,0001.Quando se comparou o ganho salarial de um a três salários mínimos por mês com ganhos de três a cinco, cinco a sete e acima de sete salários detectou-se uma maior prevalência do Linfedema no grupo de um a três salários em relação aos demais com teste exato de Fisher, valor p<0,0001 em todas as avaliações. Comparando-se a faixa salarial de três a cinco salários com a faixa salarial de cinco a sete e maior que sete salários mínimos mensais detectou-se maior prevalência na faixa de três a cinco salários mínimos, teste exato de Fisher, valor p<0,0001 nas duas comparações. O membro inferior direito apresentou 65 pacientes (32,66%), e 87(43,71%) achados unilaterais de membro inferior esquerdo e bilateralmente em 47 pacientes (23,63%). O lado esquerdo é mais prevalente que o lado direito; teste exato de Fisher, valor p<0,01. Conclusões: O Linfedema é um problema de saúde pública que acomete na sua maioria, as mulheres de classe socioeconômica cultural e educacional mais baixa. Ocorre uma unilateralização no acometimento do membro, porém a ocorrência bilateral é frequente e a Linfocintilografia é útil na definição do diagnóstico nos casos de dúvida.

O tratamento cirúrgico e adjuvante de câncer de mama pode desencadear sequelas físicas como diminuição da amplitude de movimento do ombro, linfedema, alteração da sensibilidade tátil e dor. O objetivo do presente estudo foi comparar sequelas físicas do tratamento de câncer de mama em dois grupos de mulheres: não inseridas e inseridas em um centro de reabilitação física. O estudo foi realizado no Centro de Oncologia do Hospital Santa Casa de Araçatuba (grupo I - controle) e no Núcleo de Ensino, Pesquisa e Assistência na Reabilitação de Mastectomizadas (grupo II - experimental). Os instrumentos usados para avaliação da amplitude de movimento de flexão e abdução do ombro foi o flexímetro, o linfedema foi avaliado por perimetria para posterior cálculo de volume, a sensibilidade pelo estesiômetro de Semmes-Weinstein e a dor pela Escala de Estimativa Numérica. Primeiramente, houve um treinamento de medidas realizado por duas fisioterapeutas, em 26 mulheres para investigação do coeficiente de correlação intraclasse. Em seguida, o estudo piloto foi realizado com 10 mulheres em cada grupo. Após o piloto, o cálculo amostral foi realizado. Observou-se nos resultados do treinamento de medidas uma concordância muito boa (>0,81) para a flexão de ombro homolateral e contra-lateral, abdução do ombro homolateral, volume homolateral e contra-lateral, sensibilidade homolateral. A abdução de ombro contra-lateral obteve boa concordância (0,61 - 0,80) e a sensibilidade contralateral obteve moderada concordância (0,41 - 0,60). O cálculo amostral determinou n = 22 mulheres para cada grupo. O grupo I apresentou maior idade, menor índice de massa corporal e maior quantidade de mulheres submetidas a mastectomia. O grupo II apresentou menor idade, maior nível educacional e renda média familiar, mais cirurgias conservadoras (p = 0,041) e radioterapia (p = 0,012). O valor médio da flexão homolateral foi maior no grupo II (p = 0,036) e tomando o lado contralateral como parâmetro de normalidade, o grupo I obteve a amplitude de flexão de ombro homolateral comprometida (p = 0,014). Não houve diferença estatística entre os grupos na amplitude de movimento de abdução e na diferença de volume entre os membros superiores, mas percentualmente observou-se melhores resultados no grupo II. A intensidade da dor foi a mesma entre os grupos. A análise descritiva apresentou maior frequencia de mulheres com valores considerados de normalidade para a sensibilidade tátil no grupo II. Os resultados apontam que a intervenção realizada foi satisfatória, principalmente para a amplitude de movimento de flexão de ombro. / The surgical and adjuvant treatment of breast cancer can trigger physical sequels such as diminished shoulder range of motion, tactile sensibility changes and pain. The goal of this study is to compare physical sequels of the breast cancer treatment in two groups of women: those not inserted and in a physical rehabilitation center, and those inserted. The study was conducted in the Oncology Center of the Santa Casa de Araçatuba Hospital (Centro de Oncologia do Hospital Santa Casa de Araçatuba) (group I - control) and in the Núcleo de Ensino, Pesquisa e Assistência na Reabilitação de Mastectomizadas (group II - experimental). The instruments used to evaluate the extent of shoulder flexion and abduction movement was the goniometer. The volume of the lymphedema was calculated after an evaluation by upper circumferences. Sensibility was measured by Semmes-Weinstein monofilament testing, while pain was measured by Numeric Rating Scale (NRS). First, there was a measurement training conducted by two physiotherapists in 26 women. The goal was to investigate the intraclass correlation coefficient. Next, the pilot study was conducted with 10 women of each group. After the pilot, we performed the sample calculation. In the results of measurement training, we observed a very good agreement (>0,81) for ipsilateral and contralateral shoulder flexion, abduction of ipsilateral shoulder, ipsilateral and contralateral volume, and ipsilateral sensibility. The abduction of contralateral shoulder obtained good agreement (0,61 - 0,80) and the contralateral sensibility obtained moderate agreement (0,41 - 0,60). The sample calculation determined n = 22 women for each group. Group I has higher age, smaller BMI and higher number of women submitted to mastectomy. Group II has smaller age, higher educational level and higher average family income, more conservative surgeries (p=0,041) and radiotherapy (p = 0,012). The average value of ipsilateral flexion was higher in group II (p = 0,036). Taking the contralateral side as the normality parameter, group I obtained higher compromised shoulder flexion range (p=0,014). There was no significant statistical difference among the groups in the range of the abduction movement, and in the difference of the volume of the upper arms. However, group II presented better percentage results. Pain intensity was the same in both groups. Descriptive analysis presented higher frequency in women with normal values for tactile sensibility in group II. Results point that the intervention was satisfactory, especially to the range of shoulder flexion movement.

Lymphedema of the arm is a complication that occurs in about 10-20% of women treated for breast cancer. Breast cancer treatment can damage or disrupt normal lymphatic pathways, causing fluid to accumulate in the arm. This condition is called lymphedema. Swelling of the arm can be painful and disfiguring, negatively impacting the quality of life of afflicted individuals. Lymphedema is a progressive disorder that requires prompt diagnosis and treatment to prevent the occurrence of more serious complications, such as infection or severe disability of the arm. Past research have attempted to identify risk factors that influenced the development of lymphedema, however conflicting results were observed between studies. Therefore, a comprehensive literature review was conducted to identify studies that examined the effect of prognostic and/or personal factors on lymphedema. In the meta-analyses, results from each independent study were abstracted and pooled with other studies using the random-effects model. In an effort to examine additional factors that were not widely studied, a retrospective cohort study was conducted on women diagnosed with breast cancer in Iowa during 2004. A questionnaire was developed to collect information on arm activities, co-morbidity, and lymphedema-related symptoms. Eligible women were identified from the State Health Registry of Iowa and data were collected through computer-assisted telephone interviews. At the end of the interview, each woman was asked to measure the circumference of her right and left arm one hand width above and below the elbow crease. The meta-analysis found that mastectomy (as opposed to a lumpectomy), axillary dissection (as opposed to sentinel node biopsy), radiation therapy, presence of positive nodes, obesity (body mass index >30), low education (less than high school), presence of any co-morbidity, injury and infection increased the risk of developing lymphedema. The cohort study found that the presence of axillary dissection and radiation, cancer stage, positive nodes, large tumor size, high body mass index, and younger women increased the risk of lymphedema.

There is no evidenced-based research on prevention of upper extremity lymphedema following breast cancer treatment. General guidelines have been identified from a basic understanding of the lymphatic system and are considered to be prudent advice for prevention. Cause of lymphedema is hypothesized to be multifactorial and time of onset is widely varied. Exogenous risk factors leading to lymphedema are the removal and destruction of lymph nodes; however, not all women develop lymphedema following axillary lymph node dissection. Co-morbid conditions such as obesity, diabetes, and hypertension are cited as possible endogenous risk factors. Several studies identify hypertension as a significance endogenous risk factor resulting in increased capillary filtration causing an increase in the fluid load on an already compromised lymph drainage system. This retrospective chart review was designed to compare systolic blood pressure in two matched groups to determine if there is a difference between groups. The study population included 147 stage II and III breast cancer patients. after receiving IRB approval, charts of patients with a diagnosis code of lymphedema (n=19) were identified from the 147 possible charts. A matching sample of 18 women without lymphedema was assembled. Vital sign records were then reviewed and 3 measures of systolic blood pressure were used from a time period of two to 15 moths after lymph node dissection. Results revealed mean age and number of lymph nodes removed in the two groups were equivalent. No significant difference in systolic blood pressure was found between the two groups. However, the study was limited by the lack of chart data on the variables of lymphedema and systolic blood pressure. This pilot study pointed out adjustments needed to capture a more diverse sample. Other limitations such as missing demographic data on race, number of participants treated with radiation to the axilla and records of ambulatory blood pressure should be included in future studies.