Introduction: Breast cancer is the most frequently diagnosed cancer and leading cause of cancer death among women and represents a considerable public health burden in South Africa and other low-middle income countries. Breast cancer management comprises single or combination treatment including surgery, radiotherapy and chemotherapy. Short and long-term complications of these treatments include shoulder morbidities such as pain, decreased range of motion, tightness, weakness, pain, numbness and lymphoedema, and may be present for up to 6 years post-surgery. An understanding of baseline demographic and clinical risk factors can guide rehabilitation and management strategies for high risk patients. Materials and Methods: This study was a cross-sectional analysis of the prevalence of shoulder pain and dysfunction in women attending their post-treatment annual follow up visit for unilateral breast carcinoma. The aim of this study was to quantify the burden of shoulder pain and disability in a tertiary academic hospital in Cape Town, South Africa, and identify potential risk factors for the development of shoulder morbidity. The primary objective of this study was to determine the prevalence of shoulder morbidity and the secondary objective was to evaluate associations between shoulder morbidity and risk factors such as treatment protocol or baseline demographics. Results: The majority of patients were of mixed ancestry, had their left side affected, received ALND and had undergone Modified Radical Mastectomy. The mean age was 60 years with a mean follow-up since surgery of 6 years. Three-quarters of patients reported a presence of pain or disability; 9% experienced severe pain and disability. Multivariable ordinal logistic regression analysis identified race, side, axillary surgery, chemotherapy and age as significant predictors of pain, and chemotherapy a significant predictor of disability. Discussion: The substantial burden of shoulder morbidity in this population represents a significant public health burden. The use of identified clinical and demographic characteristics may guide in the development of survivorship programmes incorporating surveillance and management of these high risk patients.

Made available in DSpace on 2014-07-29T15:29:19Z (GMT). No. of bitstreams: 1 RENATA.pdf: 841954 bytes, checksum: 22a19d48bb00070603bf3c14a16b8ab8 (MD5) Previous issue date: 2009-11-25 / OBJECTIVES: To compare the prevalence of shoulder-arm morbidity, quality of life (QOL) and satisfaction with surgical treatment in women submitted to quadrantectomy with those submitted to modified radical mastectomy (MRM) with immediate breast reconstruction (IBR). METHODS: A cross-sectional study was performed on women with breast cancer who had been submitted to quadrantectomy or to MRM+IBR with a transverse rectus abdominis myocutaneous (TRAM) flap, who had completed treatment at least six months previously. A total of 44 women submitted to quadrantectomy and 26 submitted to MRM+IBR were included in the study. RESULTS: Prevalence of lymphedema was 12% in the MRM+IBR group and 18% in the quadrantectomy group (OR: 0.51; 95%CI: 0.02-10.1; p=0.66). There was a greater prevalence of restricted inner shoulder rotation in the women submitted to quadrantectomy (OR: 7.23; 95%CI: 1.28-17.1; p=0.03). There was no difference in QOL scores or satisfaction with surgery. When the participants were questioned whether they would have opted for a different surgical technique, 25% of women in the MRM+IBR group and 12% in the quadrantectomy group reported that they would have made a different choice (adjusted analysis, OR: 7.4; 95%CI: 0.7- 73.3; p=0.09). CONCLUSIONS: The present findings suggest that the type of surgery does not affect the occurrence of lymphedema. Quadrantectomy increased the likelihood of restricted shoulder movement. In addition, the two surgical techniques evaluated were found to exert a similar effect on QOL and on the woman s satisfaction with surgery. / OBJETIVOS: Comparar a prevalência da morbidade no complexo ombro-braço, satisfação com o tratamento cirúrgico e a qualidade de vida (QV) de mulheres submetidas à quadrantectomia às daquelas submetidas à mastectomia radical modificada (MRM) com reconstrução imediata (RI) da mama. MÉTODOS: Conduziu-se um estudo de corte transversal incluindo mulheres com câncer de mama, que haviam se submetido à quadrantectomia ou à MRM+RI com retalho miocutâneo transverso do músculo reto abdominal, que apresentavam pelo menos seis meses de término do tratamento. Foram incluídas 44 mulheres submetidas à quadrantectomia e 26 à MRM+RI. RESULTADOS: A prevalência de linfedema foi de 12% no grupo de MRM+RI e 18% na quadrantectomia (OR: 0,51; IC 95%: 0,02-10,1; p=0,66). As mulheres submetidas à quadrantectomia apresentaram maior prevalência de restrição do movimento de rotação interna do ombro (OR: 7,23; IC 95%; 1,28-17,1; p=0,03). Não houve diferença nos escores de QV e da satisfação com a cirurgia. Quando as participantes foram questionadas se optariam por outra técnica cirúrgica, 25% no grupo de MRM+RI e 12% no grupo de quadrantectomia referiram que fariam uma escolha diferente (análise ajustada, OR: 7,4; IC 95%: 0,7-73,3; p=0,09). CONCLUSÕES: Nossos dados sugerem que o tipo de cirurgia não influenciou a ocorrência de linfedema. A quadrantectomia aumentou a chance de restrição do movimento do ombro. Observou-se ainda que a técnica cirúrgica apresentou impacto semelhante na QV e na satisfação da mulher com a cirurgia.