Effects of Baduanjin on postoperative rehabilitation of patients with breast cancer: A protocol for systematic review and meta-analysis.

BACKGROUND: Baduanjin, as an ancient Chinese exercise, is beneficial to both physical and mental health. Moreover, researchers discovered that Baduanjin has effects on the recovery of postoperative breast cancer patients. Yet, nobody focused on the systematic review, which can provide convincing evidence to verify the effect of Baduanjin in breast cancer patients. Therefore, our study will conduct a systematic review to fill in the blank, besides we will offer new evidence for clinical workers. METHODS: PubMed, Embase.com, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and SinoMed will be used for literature search, retrieve time is up to June 1, 2021. We will include randomized controlled trials that evaluate the effects of Baduanjin on postoperative rehabilitation for breast cancer patients. Two independent researchers will perform study selection and data extraction. The risk of bias will be assessed by the Cochrane bias assessment tool. We will use funnel plot and Egger test to evaluate publication bias. Stata 13.0, as a necessary software, will be used to perform statistical analysis. Also, we will utilize subgroup analyses and sensitivity analyses to explore the sources of heterogeneity. RESULTS: The results of this study will be published in a peer-reviewed journal. CONCLUSION: Evidence that adequately assesses the effect of Baduanjin in the recovery of breast cancer patients will be confirmed through this systematic review. Our study will offer a guideline for clinical workers, besides we will supply a new way for the rehabilitation of breast cancer patients.

Application of a mind-body tool in a rural population to improve post-operative outcomes in women with breast cancer: A pilot study.

BACKGROUND: Breast cancer is the most commonly diagnosed cancer in women in the United States. While improvements in treatment have improved mortality, they can negatively impact quality of life (QOL). Mindfulness-based programs are low-cost interventions shown to improve QOL. The study aim was to evaluate a well-validated mind-body program - determining its feasibility, acceptability, and improvement in symptomatology in post-operative breast cancer patients in a rural setting. METHODS: We recruited patients during post-operative appointments following mastectomy or lumpectomy for breast cancer. Each participant completed 3 surveys before and after the intervention: (8 PROMIS-29, PROMIS -Global QOL, and MAAS (Mindfulness Attention Awareness Scale). The intervention was an 8-week course: "The Stress Management and Resiliency Training (SMART) - Relaxation Response and Resiliency Program (3RP)", which has been well-validated for the treatment of various clinical problems. Feasibility, acceptability, quantitative survey data, and demographics were analyzed. RESULTS: SMART-3RP was highly acceptable with greater than >80% completion rate. 23% of the invited participants enrolled, although over 70% of patients approached (34/48) expressed interest. The principal recruitment deterrent was scheduling. Sleep and anxiety/depression were improved in participants although not significantly due to small sample size. We also demonstrated improving trends in other QOL measures. CONCLUSIONS: This small pilot study proved feasibility, showed excellent acceptability, and demonstrated a benefit in post-operative breast cancer patients. Even with our small sample size, we found trends in improvement in certain QOL measures which emphasizes SMART-3RP's potential effectiveness. A large-scale randomized controlled trial is warranted.

Interrater Reliability of Dynamic Muscle Testing After Breast Cancer Surgery in Women at High Risk of Lymphedema: To Improve Quality in Clinical Practice.

Background: The purpose of this study is to determine the interrater reliability of dynamic muscle tests in the early rehabilitation phase in women after breast cancer surgery with axillary lymph node dissection (ALND) based on the "preventive intervention against lymphedema after breast cancer" (LYCA) randomised controlled trial. Methods: Fifteen women treated with breast cancer surgery including ALND were recruited from participants in the LYCA trial. In this interrater reliability study, women were tested in 4 dynamic muscle tests by 2 physiotherapists at a Capital Hospital in Denmark. Intraclass correlation coefficients (ICCs) with 95% confidence intervals (CIs) was used to assess the relative reliability between raters. A Bland-Altman plot and limits of agreement were calculated to describe the absolute reliability. Results: All 6 subtests displayed high interrater reliability. ICC values were: leg press 0.96 (95% CI = 0.87-0.99), elbow flexion (contralateral) 0.94 (0.83-0.98), elbow flexion (affected arm) 0.93 (0.80-0.98), elbow extension 0.80 (0.41-0.93), shoulder abduction (contralateral) 0.89 (0.68-0.96), and shoulder abduction (affected arm) 0.91 (0.74-0.97). Cumulated interrater reliability for the test battery was very high (ICC = 0.99, 95% CI = 0.990-1.0). The absolute reliability of this study was considered high, and the absence of large shifts between mean and the line of 0 difference suggest no systematic bias that could influence clinical interpretation. Conclusions: The dynamic muscle tests evaluated in this study had high interrater reliability and can be used reliably in women in the postoperative phase after breast cancer surgery with ALND.

Effect of topical microporous polysaccharide hemospheres on the duration and amount of fluid drainage following mastectomy: a prospective randomized clinical trial.

BACKGROUND: Seroma formation is the most common complication after mastectomy and places patients at risk of associated morbidities. Microporous polysaccharide hemospheres (MPH) consists of hydrophilic, plant based, polysaccharide particles and is currently used as an absorbable hemostatic agent. An animal model evaluating MPH and seroma formation after mastectomy with axillary lymph node dissection showed a significant decrease in seroma volume. Study aim was to evaluate topical MPH on the risk of post-mastectomy seroma formation as measured by total drain output and total drain days. METHODS: Prospective randomized single-blinded clinical trial of patients undergoing mastectomy for the treatment of breast cancer. MPH was applied to the surgical site in the study group and no application in the control group. RESULTS: Fifty patients were enrolled; eight were excluded due to missing data. Forty-two patients were evaluated, control (n = 21) vs. MPH (n = 21). No difference was identified between the two groups regarding demographics, tumor stage, total drain days, total drain output, number of clinic visits, or complication rates. On a subset analysis, body mass index (BMI) greater than 30 was identified as an independent risk factor for high drain output. Post hoc analyses of MPH controlling for BMI also revealed no statistical difference. CONCLUSIONS: Unlike the data presented in an animal model, no difference was demonstrated in the duration and quantity of serosanguinous drainage related to the use of MPH in patients undergoing mastectomy for the treatment of breast cancer. BMI greater than 30 was identified as an independent risk factor for high drain output and this risk was not affected by MPH use. NCT03647930, retrospectively registered 08/2018.

Complex Therapy Physical alone or Associated with Strengthening Exercises in Patients with Lymphedema after Breast Cancer Treatment: a Controlled Clinical Trial

Objective: To compare a complex physical therapy (CPT) protocol alone or combined with complex physical therapy muscle more strength training (CPT+ST) in patients with lymphedema after breast cancer treatment regarding strength and limb muscle volume. Methods: In this controlled clinical trial, consecutive patients treated from breast cancer from April 2014 to December 2015 were allocated in two groups, the CPT group 1 and the CPT+ST group 2, that performed CPT associated with muscle strengthening. Patients in the CPT group 1 received the routine protocol of care, consisting of manual lymphatic drainage (MLD), multilayer bandage compression therapy, skin care and regular exercises. Patients CPT+ST performed, 2 sets of 10 repetitions exercises at 40% of maximal voluntary contraction the first week, increasing to 3 sets with 10 repetitions during the second and third weeks, 3 sets with 15 repetitions, for 8 weeks, 50 minutes per session, twice per week. Strength and muscle volume were analyzed. Result: In the study period, 42 patients were enrolled, 22 in the CPT group 1 and 20 in the CPT+ST group 2. Only 36 completed treatment. Both groups showed similar increases in the range of movement in: shoulder flexion, extension, adduction, abduction and external rotation. Internal rotation showed less improvement in CPT+ST group 2 (p = 0,034). Strength improvement was similar between groups. The CPT+ST group 2 seemed to have a greater volume in the upper limb when compared to CPT group 1, but it was not possible to prove any significant difference (p = 0.555). Conclusion: There was no difference of muscular limb volume between the two interventions. This means that strengthening exercises can be performed by patients with lymphedema safely, without the risk of increasing upper limb volume with edema.

Long term effects of manual lymphatic drainage and active exercises on physical morbidities, lymphoscintigraphy parameters and lymphedema formation in patients operated due to breast cancer: A clinical trial.

PURPOSE: evaluate whether manual lymphatic drainage (MLD) or active exercise (AE) is associated with shoulder range of motion (ROM), wound complication and changes in the lymphatic parameters after breast cancer (BC) surgery and whether these parameters have an association with lymphedema formation in the long run. METHODS: Clinical trial with 106 women undergoing radical BC surgery, in the Women's Integrated Healthcare Center-University of Campinas. Women were matched for staging, age and body mass index and were allocated to performed AE or MLD, 2 weekly sessions during one month after surgery. The wound was evaluated 2 months after surgery. ROM, upper limb circumference measurement and upper limb lymphoscintigraphy were performed before surgery, and 2 and 30 months after surgery. RESULTS: The incidence of seroma, dehiscence and infection did not differ between groups. Both groups showed ROM deficit of flexion and abduction in the second month postoperative and partial recovery after 30 months. Cumulative incidence of lymphedema was 23.8% and did not differ between groups (p = 0.29). Concerning the lymphoscintigraphy parameters, there was a significant convergent trend between baseline degree uptake (p = 0.003) and velocity visualization of axillary lymph nodes (p = 0.001) with lymphedema formation. A reduced marker uptake before or after surgery predicted lymphedema formation in the long run (>2 years). None of the lymphoscintigraphy parameters were shown to be associated with the study group. Age ≤39 years was the factor with the greatest association with lymphedema (p = 0.009). In women with age ≤39 years, BMI >24Kg/m2 was significantly associated with lymphedema (p = 0.017). In women over 39 years old, women treated with MLD were at a significantly higher risk of developing lymphedema (p = 0.011). CONCLUSION: Lymphatic abnormalities precede lymphedema formation in BC patients. In younger women, obesity seems to be the major player in lymphedema development and, in older women, improving muscle strength through AE can prevent lymphedema. In essence, MLD is as safe and effective as AE in rehabilitation after breast cancer surgery.

[Correction of the functional state of the autonomous nervous system in the women presenting with the postmastectomy syndrome at the stationary stage of the rehabilitative treatment]. / Korrektsiya funktsional'nogo sostoyaniya vegetativnoi nervnoi sistemy u zhenshchin s postmastektomicheskim sindromom na statsionarnom etape lecheniya.

UNLABELLED: A frequent consequence of the treatment of breast cancer is the postmastectomy syndrome that combines psycho-emotional and functional disorders in various body systems. AIM: The objective of the present study was to evaluate the influence of the program of differential physical rehabilitation on the functional state of the autonomic nervous system in the women with the postmastectomy syndrome at the stationary stage of the rehabilitative treatment. MATERIAL AND METHODS: The study included 50 presenting with the postmastectomy syndrome following radical mastectomy as described by J.L. Madden. The patients were randomly divided into two groups comprised of 25 patients each. The main group consisted of the women at the mean age of 55,44±1,06 years, the group of comparison (2) was composed of the women at the mean age of 55,60±1,14 years. The program of the rehabilitative treatment of the patients in group 1 envisaged the use of the physical therapeutic modalities chosen on an individual basis in agreement with the basic principles of medical gymnastics including the differential selection of static and dynamic respiratory maneuvers with due regard for the type of vegetative regulation in a given patient, post-isometric relaxation, Vodder's manual lymphatic drainage and autotraining as described by J.H. Suhultz. The patients comprising the group of comparison performed therapeutic physical exercises as described by T.I. Grushina. The analysis of the literature and empirical data was combined with that of the heart rate variability was measured twice: within days 2-3 after the surgical intervention and on days 19-20 of the hospital stay. The methods of mathematical statistics were employed to treat the data obtained. RESULTS: The study has demonstrated reduced reserves of vegetative support, the overall decrease of the heart rate variability, and enhanced tension of the adaptive mechanisms in this group of women. Moreover, it showed the positive outcome of the physical rehabilitation program designed to correct most of the time-related and spectral parameters of the heart rate variability and gave evidence of the significant improvement of the total activity of the regulatory systems due to the enhancement of the high-frequency, low-frequency and very low-frequency components of the spectrum. The values of the stress index and the mode amplitude were reduced whereas the adaptive capabilities of the autonomic nervous system in women of the main group were extended. CONCLUSION: The proposed program of differential physical rehabilitation can be employed in the practical work of the specialized healthcare facilities for the correction of the functional state of the autonomic nervous system in the women with the postmastectomy syndrome.

Application of Tensegrity Massage to Relive Complications After Mastectomy--Case Report.

PURPOSE: The case study was to determine the effectiveness of tensegrity massage in a patient after mastectomy. DESIGN: Tensegrity massage was performed in a 50-year-old woman after mastectomy. The purpose of the massage was to normalize the tension of musculo-ligamento-fascial system in the chest, shoulder girdle, and back. METHODS: The patient was subjected to a series of six massage sessions, 45 minutes each, twice a week. FINDINGS: The applied massage therapy contributed to the reduction of the postoperative scar tenderness and painfulness, to the relaxation of the muscular tone within the shoulder girdle, and to the improvement of the patient's general feeling. CONCLUSIONS: Tensegrity massage is an effective therapy in the elimination of pain and abnormal tissue tension induced by extensive scarring after mastectomy. CLINICAL RELEVANCE: The presented massage procedure had a positive effect immediately after the therapy and after 1-month follow-up.

La rehabilitación física de mujeres mastectomizadas desde la perspectiva de ciencia, tecnología y sociedad / The physical rehabilitation of mastectomized women from the perspective of science, technology and society

Introducción: El cáncer de mama en Cuba constituye una de las primeras causas de muerte en las féminas, por lo que se trabaja incansablemente para encontrar una respuesta a esta problemática de salud, con este fin se elaboran instrumentos que sirvan de orientación en la aplicación de intervenciones de prevención, detección precoz y tratamiento. Se realizó un estudio con el objetivo de reflexionar desde la perspectiva de ciencia, tecnología y sociedad acerca de la rehabilitación física de mujeres con cáncer de mama mastectomizadas. Desarrollo: Existe un conocimiento ético política del trabajo científico que incluye la clara concepción de que el mismo se realiza para satisfacer las necesidades del desarrollo social y la satisfacción de los ciudadanos al tener en cuenta que no existen paradigmas que frenen el desarrollo científico tecnológico para el bien y la supervivencia humana. Ese conocimiento es compartido por los actores involucrados en los procesos científicos tecnológicos y de innovación; los que tienen sus raíces en las transformaciones sociales que el país ha vivido y la ideología revolucionaria que lo ha conducido. Conclusiones: La incorporación de la Medicina Bioenergética y Naturista con su método inocuo y sin efectos colaterales de digitopresión para la rehabilitación física del miembro comprometido, permite brindar a las pacientes un mejor estado de salud, al incidir en la sobrevida, al mismo tiempo se aprecia el cáncer como una enfermedad crónica no transmisible y no como enfermedad terminal. Con el presente estudio se puede evaluar un gran impacto económico, social y científico (AU)

Introduction: The breast cancer in Cuba is one of the leading causes of death in females, so it is working tirelessly searching for an answer to this problem of health, to this end are elaborated instruments that serve as guidance in the implementation of interventions for prevention, early detection and treatment. A study with the aim of reflecting the perspective of science, technology and society about the physical rehabilitation of women with breast cancer mastectomy was carried out. Development: An ethical and political knowledge exists of scientific work that includes clear conception that it is done to meet the needs of social development and the satisfaction of citizens to keep in mind that there are no paradigms that restrain the technological scientific development for the good and human survival. That knowledge is shared by those people involved in the scientific technological and innovation process; those who have their roots in the social transformations that the country has experienced and the revolutionary ideology that has led it. Conclusions: The incorporation of the Bioenergetic Medicine and naturist with its innocuous method and without side effects of digitopressure for the physical rehabilitation of the committed member, it allows to give patients a better state of health, influencing the survival, at the same time it can see cancer as a chronic non-transmissible and not terminal disease. A great economic, social and scientific impact can be evaluated with this study (AU)

Fisioterapia en mastectomizadas con alteraciones físicas y funcionales en el hombro ipsolateral / Physiotherapy in mastectomized women with physical and functional disorders in the ipsilateral shoulder

Se efectuó un estudio descriptivo, longitudinal y prospectivo de 28 mujeres con mastectomía radical modificada, a fin de evaluar las principales alteraciones del hombro ipsolateral y su respuesta ante la atención fisioterapéutica brindada en el Servicio de Rehabilitación Integral del Policlínico Universitario Julián Grimau García de Santiago de Cuba, desde junio hasta noviembre del 2011. En la casuística, 3 pacientes abandonaron el tratamiento. La complicación más frecuente fue la omalgia (67,8 por ciento), acompañada en muchos casos de limitación articular y disminución de la fuerza del miembro superior afectado. Entre los procederes terapéuticos empleados figuraron: tratamiento postural, cinesiterapia y masoterapia. La respuesta al tratamiento fue satisfactoria en 96,2 por ciento de las afectadas, puesto que las técnicas y procederes fisioterápicos utilizados eran sencillos y con escasos recursos materiales(AU)

A descriptive, longitudinal and prospective study was conducted in 28 women with modified radical mastectomy in order to assess the main ipsilateral shoulder disorders and their response to physiotherapy provided in Comprehensive Rehabilitation Service of Julián Grimau García University Polyclinic of Santiago de Cuba from June to November 2011. In the case series 3 patients discontinued treatment. The most frequent complication was the shoulder pain (67.8 percent), accompanied in many cases by joint limitation and decreased strength of the affected upper limb. Among the therapeutic procedures were postural treatment, kinesitherapy and massage therapy. The response to treatment was successful in 96.2 percent of patients, since the used techniques and therapeutic procedures were simple and with limited material resources(AU)

Linfedema pós-mastectomia: um protocolo de tratamento / Post-mastectomy lymphedema: a treatment protocol / Linfedema post-mastectomía: un protocolo de tratamiento

O linfedema ainda é uma das principais sequelas decorrentes do tratamento cirúrgico do câncer de mama. O objetivo do estudo foi avaliar a eficácia de um protocolo que inclui a utilização da estimulação elétrica de alta voltagem (EEAV) associada a ­exercícios ­terapêuticos, automassagem e autocuidados no ­tratamento do linfedema de membros superiores em mulheres submetidas a cirurgia para tratamento do câncer de mama. Participaram do estudo 17 voluntárias (60,9_+11,72 anos) submetidas à mastectomia unilateral, ­portadoras de linfedema de membro superior, homolateral à cirurgia. O tratamento constituiu-se de 14 aplicações da EEAV, duas vezes por semana, complementadas por orientações quanto ao autocuidado, automassagem e exercícios físicos. A evolução do tratamento foi avaliada por perimetria, cálculo da diferença de volume (DV) entre os membros, e percentual de aumento do volume (PAV) do membro afetado em relação ao contralateral. Os dados foram analisados por meio do método estatístico T ­pareado para variáveis dependentes e revelaram redução significativa de 14,13% (p=0,0067) do PAV e de 13,8% (p=0,0089) da DV, bem como da perimetria em três pontos: sete centímetros acima do cotovelo (p=0,0138), sete centímetros abaixo do cotovelo (p=0,0282) e no punho (p=0,0476). Pôde-se concluir que a utilização da estimulação elétrica de alta voltagem associada a exercícios e orientações foi eficaz na redução do linfedema do grupo avaliado...

Lymphedema is still considered as one of the main sequela resulting from surgical treatment of breast cancer. The aim of this study was to evaluate the efficacy of a protocol that included use of a high-voltage electrical stimulation (HVES) associated with therapeutic exercises, self-massage, and self-care for the treatment of lymphedema of the upper limbs in women who underwent surgery for breast cancer treatment. This study included 17 volunteers (60.9_+11.72 years of age) submitted to unilateral mastectomy, with lymphedema of the upper limb, ipsilateral to surgery. The treatment consisted of application of 14 HVES, to the patients, twice a week, supplemented by guidance on self-care, self-massage, and physical exercises. The evolution of this treatment was assessed by perimetry, calculation of the volume difference (VD) between the limbs, and calculation of the volume increase percentage (VIP) of the affected limb compared to the contralateral limb. Data were analyzed using the statistical method for paired T and dependent variables, which showed a significant reduction of 14.13% (p=0.0067) in VIP and 13.8% (p=0.0089) in VD, as well as perimetry at the following three points: 7 cm above the elbow (p=0.0138), 7 cm below the elbow (p=0.0282), and at the wrist (p=0.0476). It was concluded that the use of HVES associated with the exercises and guidance on ­self-care and self-massage was effective to reduce the lymphedema in the evaluated group...

El linfedema todavía es una de las principales secuelas derivadas del tratamiento quirúrgico del cáncer de mama. El objetivo del estudio fue evaluar la eficacia de un protocolo que incluye la utilización de estimulación eléctrica de alto voltaje (EEAV) asociada a ejercicios terapéuticos, automasajes y autocuidados en el tratamiento del linfedema de miembros superiores en mujeres sometidas a cirugía para el tratamiento de cáncer de mama. Participaron del estudio 17 voluntarias (60,9±11,72 años) sometidas a mastectomía unilateral, portadoras de linfedema de miembro superior, ipsilateral a la cirugía. El tratamiento consiste en 14 aplicaciones de EEAV, dos veces por semana, complementadas por orientaciones en el autocuidado, automasaje y ejercicios físicos. La evolución del tratamiento fue evaluada por perímetros, cálculo de la diferencia de volumen (DV) entre los miembros y porcentaje de aumento del volumen (PAV) del miembro afectado en relación al contralateral. Los datos fueron analizados por medio del método estadístico T pareado para variables dependientes y revelaron reducción significativa de 14,13% (p=0,0067) del PAV y de 13,8% (p=0,0089) del DV, también en los perímetros en tres puntos: siete centímetros encima del codo (p=0,0138), siete centímetros abajo del codo (p=0,0282) y en la muñeca (p=0,0476). Se puede concluir que la utilización de la estimulación eléctrica de alto-voltaje asociada a ejercicios y orientaciones fue eficaz en la reducción del linfedema del grupo evaluado...

Infiltración con toxina botulínica para el control del dolor en cáncer de mama / Botulinum toxin infiltration for breast cancer pain control

Introducción. El dolor es frecuente entre las pacientes con cáncer de mama, siendo la causa principal de la baja calidad de vida. La toxina botulínica (TB) podría ser una opción de tratamiento en estas pacientes durante la reconstrucción mamaria o en el síndrome de dolor postmastectomía. Muy pocos autores han estudiado su efectividad en el tratamiento del dolor. Hipótesis. La infiltración con TB en el músculo pectoral provoca una inhibición del espasmo muscular mejorando el dolor. Objetivos. Valoración de la efectividad de la TB en el control del dolor, en la reconstrucción con expansor tisular, implantes mamarios y en el dolor crónico. Material y métodos. Tipo de estudio: cuasiexperimental. La muestra incluyó 89 pacientes seleccionados de forma no aleatorizada entre junio de 2009 y febrero de 2011. Todas presentaban cáncer de mama con enfermedad controlada y contractura dolorosa de pectoral mayor. Valoración: exploración clínica y la puntuación en la escala EVA previo y posterior a la infiltración. Resultados. El 21% fueron infiltradas durante la reconstrucción, el 16% portaban prótesis mamaria y el 63% tenían dolor crónico. El dolor nociceptivo fue más frecuente en el grupo de expansor (73,6%) y el mixto en dolor crónico (89,2%). La puntuación en la escala EVA inicial fue más alta para el grupo de expansor que obtuvo mayores descensos posteriores a la infiltración. Conclusiones. La infiltración del músculo pectoral mayor con TB tipo A mejora el dolor en el cáncer de mama, tanto durante la fase de reconstrucción mamaria con expansor como en las pacientes con implantes y en las que presentan síndrome de dolor postmastectomía (AU)

Introduction. Pain is common among patients with breast cancer, it being the leading cause of poor quality of life. Botulinum toxin (BT)may be a treatment option in these patients during breast reconstruction or in post-mastectomy pain syndrome. Very few authors have studied its effectiveness in treating pain. Hypothesis. Infiltration with BTin the breast muscle causes an inhibition of the muscle spasm, thus improving the pain. Objectives. To assess the effectiveness of BT in pain control in reconstruction with tissue expanders, breast implants and in chronic pain. Material and methods. The study had a quasi-experimental design. The sample included 89 randomly selected patients between June 2009 and February 2011. All had breast cancer with controlled disease and painful contracture of the pectoralis major. The evaluation was performed by clinical examination and score on the visual analogue scale (VAS) before and after the infiltration. Results. A total of 21% had undergone infiltration during reconstruction; 16% had a breast prosthesis and 63% had chronic pain. Nociceptive pain was more frequent in the expander (73.6%) and mixed chronic pain (89.2%) group. Initial VAS score was higher for the expander group that obtained greater declines after the injection. Conclusions. Infiltration of the pectoral muscle with BT type A improves pain in breast cancer subjects, both during breast reconstruction with expander and in patients with implants and in those with post-mastectomy pain syndrome (AU)

Upper-body morbidity after breast cancer: incidence and evidence for evaluation, prevention, and management within a prospective surveillance model of care.

The purpose of this paper is to review the incidence of upper-body morbidity (arm and breast symptoms, impairments, and lymphedema), methods for diagnosis, and prevention and treatment strategies. It was also the purpose to highlight the evidence base for integration of prospective surveillance for upper-body morbidity within standard clinical care of women with breast cancer. Between 10% and 64% of women report upper-body symptoms between 6 months and 3 years after breast cancer, and approximately 20% develop lymphedema. Symptoms remain common into longer-term survivorship, and although lymphedema may be transient for some, those who present with mild lymphedema are at increased risk of developing moderate to severe lymphedema. The etiology of morbidity seems to be multifactorial, with the most consistent risk factors being those associated with extent of treatment. However, known risk factors cannot reliably distinguish between those who will and will not develop upper-body morbidity. Upper-body morbidity may be treatable with physical therapy. There is also evidence in support of integrating regular surveillance for upper-body morbidity into the routine care provided to women with breast cancer, with early diagnosis potentially contributing to more effective management and prevention of progression of these conditions.

Impact of relaxation training according to Yoga In Daily Life® system on self-esteem after breast cancer surgery.

OBJECTIVES: The purpose of this pilot study was to gather information on the immediate and short-term effects of relaxation training according to the Yoga In Daily Life(®) system on the self-esteem of patients with breast cancer. DESIGN: This is a parallel-groups design. SETTINGS/LOCATION: Baseline interventions took place at the Institute for Oncology of Ljubljana (Slovenia). At discharge, the experimental group was issued with audiocassette recordings containing the instructions for relaxation training to be practiced individually at home for an additional 3 weeks. SUBJECTS: The convenience sample of 32 patients with breast cancer was recruited from an accessible population of hospitalized women. Patients were randomized to the experimental (n=16) and to the control group (n=16). INTERVENTIONS: Both groups received the same standard physiotherapy for 1 week, while the experimental group additionally received a group relaxation training sessions according to the Yoga in Daily Life(®) system. At discharge, the experimental group was issued with audiocassette recordings containing similar instructions for relaxation training to be practiced individually at home for an additional 3 weeks. OUTCOME MEASURES: Outcome measures were obtained by blinded investigators (physiotherapists) using standardized questionnaires (Rosenberg Self-Esteem Scale) at baseline (after the surgery); at 1 week (1 week postattendance; at discharge); and at 4 weeks (4 weeks postattendance); prior the commencement of radiation. RESULTS: Analysis of variance showed that there were statistically significant differences between the experimental and control group in all measuring self-esteem scores over the study period (p<0.0005). At the same time, the control group's scores remained unchanged over the study period (p>0.05). CONCLUSIONS: The results indicate that relaxation training according to the Yoga in Daily Life system could be a useful clinical physiotherapy intervention for patients who have breast cancer and who are experiencing low self-esteem. Although this kind of relaxation training can be applied to clinical oncology in Slovenia, more studies need to be done.

Manual lymphatic drainage therapy in patients with breast cancer related lymphoedema.

BACKGROUND: Lymphoedema is a common and troublesome condition that develops following breast cancer treatment. The aim of this study is to analyze the effectiveness of Manual Lymphatic Drainage in the treatment of postmastectomy lymphoedema in order to reduce the volume of lymphoedema and evaluate the improvement of the concomitant symptomatology. METHODS: A randomized, controlled clinical trial in 58 women with post-mastectomy lymphoedema. The control group includes 29 patients with standard treatment (skin care, exercise and compression measures, bandages for one month and, subsequently, compression garments). The experimental group includes 29 patients with standard treatment plus Manual Lymphatic Drainage. The therapy will be administered daily for four weeks and the patient's condition will be assessed one, three and six months after treatment.The primary outcome parameter is volume reduction of the affected arm after treatment, expressed as a percentage. Secondary outcome parameters include: duration of lymphoedema reduction and improvement of the concomitant symptomatology (degree of pain, sensation of swelling and functional limitation in the affected extremity, subjective feeling of being physically less attractive and less feminine, difficulty looking at oneself naked and dissatisfaction with the corporal image). DISCUSSION: The results of this study will provide information on the effectiveness of Manual Lymphatic Drainage and its impact on the quality of life and physical limitations of these patients. TRIAL REGISTRATION: ClinicalTrials (NCT): NCT01152099.

External qigong therapy for women with breast cancer prior to surgery.

UNLABELLED: The majority of patients with cancer use some form of complementary or alternative medicine. External qigong treatment (EQT), classified as a bioenergy therapy, is one such approach that patients combine with conventional medicine or, in some cases, use in place of conventional medicine. This study aimed to determine whether EQT could shrink breast cancer tumors and improve quality of life (QOL) in women with pathologically confirmed breast cancer awaiting surgery. A total of 9 women with pathologically confirmed breast cancer were recruited from large cancer centers in the United States (n = 5) and China (n = 4). A single-arm pre/post design was used. Each patient underwent 5 consecutive days of EQT, with each treatment lasting from 2 to 5 minutes. All treatments were performed by the same qigong master. Tumor measurements were made before and after the EQT sessions. Tumor assessments were conducted prior to study initiation and following the last EQT. Patients underwent both an ultrasound and mammogram (United States) or an ultrasound and magnetic resonance imaging (China). All patients also underwent physical breast examinations (PBEs) and completed QOL questionnaires before and after the last EQT. No clinical changes in tumor measurements from pre- to post-EQT were noted. There was also no suggestion of change in tumor size by PBE or change in QOL. Using the current STUDY DESIGN: EQT also does not appear to have any effect on patient QOL. Because of the small sample size and working with only one qigong practitioner, to definitively determine the efficacy or lack of efficacy of EQT, a larger study with multiple qigong practitioners would need to be conducted.

Efeito da hidroterapia na qualidade de vida de mulheres mastectomizadas / The Effects of Hydrotherapy in the Quality of Life of Women Undergoing Mastectomy

Introdução: O diagnóstico de câncer e todo o processo da doença são vividos pelo paciente e sua famíliacomo um momento de intensa angústia, sofrimento e ansiedade. No câncer de mama, além disso, encontram-se outras angústias ligadas à feminilidade, maternidade e sexualidade, já que o seio é um órgão de simbolismopara a mulher. A mastectomia é um procedimento cirúrgico muito utilizado no tratamento do câncer de mama,a qual, no entanto, pode causar complicações físicas e emocionais para a paciente, no qual a fisioterapia podeatuar. Assim, o objetivo do estudo foi verificar o efeito da hidroterapia, que é um recurso fisioterapêutico, naqualidade de vida de mulheres mastectomizadas. Metodologia: Participaram do estudo 3 mulheres submetidasà mastectomia, as quais responderam o questionário de qualidade de vida SF-36 antes e após realizarem 10sessões de hidroterapia. Resultados: Houve melhora da capacidade funcional, aspecto físico, vitalidade easpecto emocional. Já os componentes dor, aspectos sociais e saúde mental mantiveram-se iguais; e ocomponente estado geral de saúde apresentou piora. Conclusão: A hidroterapia é eficaz na reabilitação depacientes mastectomizadas, pois proporciona benefícios físicos e funcionais, auxilia na melhora do estadoemocional das pacientes, e consequentemente, na qualidade de vida destas.

Introduction: Cancer diagnosis and the disease process are experienced by the patient and his/her family asa moment of the intense anguish, suffering and anxiety. Moreover, in breast cancer there are other anguishesassociated to womanliness, maternity, and sexuality, once the breast is an organ with a certain symbolism forwomen. The excision of the breast is a very common surgical proceeding performed in the treatment of breastcancer. Nevertheless, it can cause physical and emotional complications for the patient, opening space forphysical therapists to act upon. Thus, the objective of this study was to verify the effect of the hydrotherapy,which is a physiotherapeutic tool, in the quality of life of women who have their breast removed. Methodology:Three women underwent mastectomy. They have answered the SF-36 life’s quality questionnaire before andafter 10-hydrotherapy sessions. Results: There was improvement of the functional capacity, physical andemotional aspects, and vitality. The components of pain, socials aspects, and mental health remained thesame; the general health condition component became aggravated. Conclusion: The hydrotherapy is effectivein the rehabilitation of patients undergoing excision of the breast because it provides functional and physicalbenefits, helps in the recovery of the patients’ emotional condition, and consequently, in their quality of life.

Fisioterapia en el linfedema tras cáncer de mama y reconstrucción mamaria / Physiotherapy in the lymphedema alter breast cancer and breast reconstruction

La detección precoz y los nuevos tratamientos están reduciendo la mortalidad que conlleva el cáncer de mama; si bien persisten las secuelas, especialmente relacionadas con los efectos secundarios de la cirugía, la quimioterapia y la radioterapia. El linfedema de extremidad superior, secundario a la alteración estructural linfática de la zona tumoral, en general, cursa con un aumento de volumen que interfiere con la funcionalidad de la extremidad, amén de los efectos psicológicos negativos, entre otros, en la mujer si no se trata correctamente. Sin embargo, al no ser mortal, a menudo ha sido poco estudiado, diagnosticado y tratado correctamente. Búsqueda realizada en MEDLINE, Cancerlit, CINAHL, Cochrane Library y PEDro. Los términos utilizados principalmente fueron ®breast cancer», ®lymphedema», ®clinical trial», ®physiotherapy» y ®reconstruction». El tratamiento fisioterapéutico posibilita el control de esta modalidad de linfedema, y es fundamental conocer la situación de la investigación en este campo para poder establecer tratamientos eficaces que minimicen cualquier tipo de complicación(AU)

Early detection and new treatment are reducing the mortality associated with breast neoplasm, although the aftermath persist, especially related to the side effects of surgery, chemotherapy and radiotherapy. Upper limb lymphedema, secondary to lymph node structural alteration of the tumor zone general evolves with an increase in volume that interferes with limb functionality in addition to the negative psychological effects, among others, in the women if they are not adequately treated. However, given that it is not fatal, it is often not studied, or is not correctly diagnosed and treated. A search was conducted in MEDLINE, Cancerlit, CINAHL, and Cochrane Library PEDro. The terms used were mainly ®breast neoplasm», ®lymphedema», ®clinical trial», ®physical therapy» and ®reconstruction». Physical therapy make sit possible to control this form of lymphedema, it being essential to know the status of research in this field in order to establish effective therapies that minimize any complication(AU)

Tratamiento fisioterapéutico en el linfedema de miembro superior postmastectomía / Physiotherapeutic treatment in the upper limbs lymphoedema secondary to mastectomy

El linfedema de miembro superior secundario a mastectomía es una afección frecuente entre los pacientes, generalmente mujeres, que han sido sometidas a esta intervención. Será necesario inculcarles a estos pacientes con riesgo potencial de padecer un linfedema, unas normas de higiene de vida y educación sanitaria, para prevenir en lo posible su aparición. Una vez instaurado, un tratamiento de fisioterapia lo más precoz posible, mediante el uso combinado de técnicas de Drenaje Linfático Manual y vendaje compresivo, será de vital importancia para conseguir mantener unos resultados satisfactorios, mejorando considerablemente la calidad de visa de estos pacientes. El objetivo principal de este artículo es exponer un protocolo de tratamiento para estas afecciones, desde las fases más iniciales hasta la prevención y tratamiento de las futuras complicaciones, siguiendo las directrices del fisioterapeuta Jean Claude Ferrandez. Del mismo modo, será necesario para poder evaluar su eficacia, valorar el estado del paciente antes y después de someter a los pacientes a dicho tratamiento(AU)

Mastectomy-associated upper limb lymphedema is a common disorder among patients(mostly woman) who have undergone this type of surgery. Patients at risk of suffering fromthis complication must be trained in healthcare habits which may lead to a good hygiene;this may help them to prevent eventual development of lymphedema. Once settled, an early physiotherapy treatment using combined manual lymphatic drainage andcompression bandaging will be vital in order to achieve a good outcome, which may allowthe patients to improve their quality of life in a significant way. The main goal of thepresent paper is to propose a protocol for the management of these conditions from thevery early stages to the prevention and treatment of potential future complicationsfollowing the guidelines by Jean Claude Ferrandez. Likewise, in order to evaluate theefficacy of the proposed protocol, patients’ clinical condition must be assessed before andafter they receive the abovementioned treatment(AU)