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1

Problems associated with physiotherapeutic management of patients after breast cancer surgery

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Kołodziejski L., Niedbała E.

Medical Rehabilitation

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2008

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vol. 12(2)

24-30

EN

Breast cancer (BC) is the most frequent malignant neoplasm in women in Poland and its treatment majorly depends on the degree of disease progression. Surgery is the main radical therapy of BC. In most cases, this therapy involves mastectomy with excision of the lymphatic system of the axilla. Breast-saving treatment is used in patients at early stages of breast cancer. This treatment involves excision of the primary tumour within the broders of the unchanged tissue and of the axillary lymphatic system followed by breast irradiation. The majority of early and late complications of surgery are due to the axillary lymphadenopathy, the sequel of surgical therapy. Early inpatient rehabilitation is initiated on the day of the surgery and aims at prevention of the following states: hypo-ventilation and inflammatory pulmonary complications, thrombo-embolioc complications, early post-operation oedema, restrictions in movements in the shoulder joint and acute psychotic syndromes. It also prepares the patient for every-day activities, anti-oedema preventive care and teaches performance of physical exercises. Late rehabilitation conducted at home, as outpatient care or during balneological treatment is a continuation of the early rehabilitation. It involves improvement of shoulder functioning, prevention of incorrect posture, anti-oedema care and providing psychological support. Regular motor exercises improve functioning of the extremity ipsilateral to the side of breast surgery, prevent incorrect posture and the associated ailments. The majority of problems are associated with the therapy of late lymphoedema of the upper limb. Physiotherapeutic management results in measurable effects: amelioration of spontaneous lymph outflow, reduction of oedema size, improvement in limb agility reduction of ailments; it is, however, not always sufficient. Effectiveness of various management approaches is still a subject of discussion.

2

Comparison of distant effects of early, stationary rehabilitation with domestic rehabilitation after instructing women subjected to radical breast amputation as a result of cancer

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Niedbała E., Kołodziejski L.

Medical Rehabilitation

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2013

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vol. 17(2)

4-10

PL

Wstęp: Radykalna amputacja piersi prowadzi często do ograniczenia ruchomości w stawie ramiennym i osłabienia siły mięśniowej kończyny górnej po stronie operowanej, co opóźnia powrót do codziennej aktywności i pracy zawodowej. Cel: Porównanie odległych wyników wczesnej rehabilitacji stacjonarnej i ambulatoryjnej z indywidualnym usprawnianiem domowym po instruktażu u kobiet poddanych radykalnej amputacji piersi z powodu raka. Materiał i metody: Badaniami objęto grupę 146 „Amazonek” w wieku 32-83 lat, u których w latach 2002-2009 wykonano jednostronną radykalną amputację piersi sposobem Maddena. 71 kobiet operowano w Centrum Onkologii w Krakowie (grupa małopolska - M) i 75 w Świętokrzyskim Centrum Onkologii w Kielcach (grupa świętokrzyska - Ż). W grupie M wczesną rehabilitację pooperacyjną prowadziły przeszkolone pielęgniarki i wolontariuszki Klubu „Amazonka”, a chore kontynuowały samodzielnie ćwiczenia w domu. W grupie Ż kompleksową rehabilitację w warunkach stacjonarnych wykonywali zawodowi fizjoterapeuci. Od wszystkich kobiet uzyskano dane dotyczące wieku, przebytego leczenia i rehabilitacji, źródła utrzymania, rodzaju wykonywanych prac domowych oraz pracy zawodowej. Dokonano obustronnych pomiarów zakresu ruchów w stawie ramiennym i siły ścisku globalnego ręki. Obie grupy porównano pod względem cech antropometrycznych, przebytego leczenia oraz zdolności do wykonywania prac domowych i pracy zawodowej. Wyniki: Kobiety obu grup (M i Ż) cechowały się podobnymi zakresami ruchomości w stawach ramiennych i siłą ścisku globalnego ręki. Podobny odsetek kobiet z obu grup powrócił do wykonywania codziennych zajęć domowych i kontynuacji pracy zawodowej. Wnioski: 1. Mimo różnic w podejściu do wczesnej rehabilitacji w obu ośrodkach referencyjnych pacjentki z obu województw (M i Ż) nie różniły się istotnie zakresem ruchomości stawu ramiennego i siłą ścisku globalnego ręki. 2. Niezależnie od rodzaju wczesnej rehabilitacji podobny odsetek kobiet powrócił do codziennych czynności domowych i pracy zawodowej. 3. Uzyskane wyniki sugerują, że sposób prowadzenia rehabilitacji nie jest czynnikiem decydującym o wynikach usprawniania kobiet poddanych radykalnej amputacji piersi z powodu raka.

EN

Introduction: Radical breast amputation often results in decreased shoulder mobility on the operated side and a reduction in the muscular strength of the upper limb, which delays a return to daily activities and professional work.The objective of the research: A comparison of the distant effects of early, stationary rehabilitation with domestic rehabilitation after instructing women subjected to radical breast amputation as a result of cancer. Materials and methods: 146 women of the ‘Amazon’ Club aged 32-83 were tested following a one-sided breast amputation using Madden’s method (carried out between 2002-2009). 71 were operated on at the Oncological Centre in Krakow (the Małopolska group) and 75 at the Świętokrzyskie Oncological Centre in Kielce (the Świętokrzyska group). In the Małopolska group early postoperative rehabilitation was conducted by trained nurses and volunteers of the ‘Amazon’ Club, and the patients continued their exercises on their own at home. In the Świętokrzyska group a complex form of rehabilitation in stationary conditions was conducted by professional physiotherapists. Data from all the women was obtained including the patient’s age, past treatment and rehabilitation as well as their livelihood, the type of housework they do and their professional employment. Measurements of movements in the shoulder joint and palm muscle flexor strength were carried out. Both groups were compared in terms of anthropometric features, past treatment and the ability to perform housework and professional work.Results: The women in both groups obtained similar results of mobility in their upper extremity and hand flexor strength. The percentage of women who returned to housework and professional employment was similar. Conclusions: 1. In spite of the difference in the methods of early postoperative rehabilitation in both oncological centres, the patients in both provinces (M and Ś) did not differ significantly as far as mobility in their shoulder joints and hand flexor strength was concerned. 2. Regardless of the sort of early rehabilitation a similar percentage of women returned to their everyday tasks and professional forms of employment . 3. The results obtained suggest that the way in which rehabilitation is conductedis not a decisive factor determining the rehabilitation outcome for women treated surgically for breast cancer.

3

Lymphedema of upper limb after radical treatment of breast cancer patients: current management principles

81%

Kołodziejski L. S., Łobaziewicz W., Ochałek K., Niedbała E.

Medical Rehabilitation

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2009

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vol. 13(2)

23-31

EN

Upper limb lymphedema (ULL) is the most severe late complication following radical treatment of breast cancer (BC). It can be caused by both cancer recurrence and previous therapy (lymphadenectomy, axillary radiotherapy). In BC survivors, ULL- inducing factors include: previous irradiation treatment, infections within the upper limb or the scar, high BMI. Diagnosis of ULL makes use of measurements of the circumference and volume of the limb, imaging, measuring electrical impedance of tissues and lymphoscintigraphy which determines the type and severity of lymph flow disturbances. ULL has a chronic and progressive nature leading to physical, psychic and social disability and, on rare occasions, to secondary neoplasms of the lymphatic system. Therapeutic management involves: patients’ education, complex physical therapy (manual lymphatic drainage, compression therapy), reduction and drainage surgery (microsurgery) as well as liposuction. The most effective conservative procedures include complex physical therapy and particularly manual lymphatic drainage with compression therapy. Failure of conservative therapy indicates the need for surgery. Liposuction is a currently preferred surgical procedure because of its simplicity and a low percentage of complications. Surgery should be complemented by constant compression therapy. Due to low efficiency of all the methods applied, ULL prevention is of paramount importance. It should consist in rationalising indications for oncological treatment (lymphadenectomy, radiation therapy).

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Problems associated with physiotherapeutic management of patients after breast cancer surgery

Comparison of distant effects of early, stationary rehabilitation with domestic rehabilitation after instructing women subjected to radical breast amputation as a result of cancer

Lymphedema of upper limb after radical treatment of breast cancer patients: current management principles