The Perioperative Educational Program for Improving Upper Arm Dysfunction in Patients with Breast Cancer: A Controlled Trial

Abstract

Most patients who undergo breast cancer surgery suffer from impairment of upper extremity function. In this study, we investigated the effectiveness of a perioperative educational program for improving upper arm dysfunction in patients with breast cancer. This longitudinal controlled study was conducted between January 2010 and July 2012. Participants comprised 149 patients with primary breast cancer before operation, allocated to intervention and control groups. Intervention comprised a 3-month educational program on monitoring arm function and exercises for preventing shoulder dysfunction and lymphedema. The control group received routine care from on-site staffs. Of the 149 patients analyzed, 69 underwent axillary lymph node dissection (ALND), and 80 underwent sentinel lymph node biopsy (SLNB). The intervention group included 39 patients with ALND and 51 patients with SLNB, while the control group included 30 patients with ALND and 29 patients with SLNB. Arm girth, shoulder range of motion (ROM), and grip strength were measured before surgery and at 1 week, 1 month and 3 months postoperatively. Self-reported questionnaires, the Subjective Perception of Post-Operative Functional Impairment of the Arm (SPOFIA) and the Disabilities of the Arm, Shoulder and Hand (DASH), were administered at the same time points. Among the variables examined, only SPOFIA and grip strength were significantly improved in the intervention group with ALND. In contrast, the perioperative educational program caused no significant improvement for the patients who underwent the surgery with SLNB. Thus, the present program improves the postoperative upper arm function and discomfort in breast cancer patients who undergo surgery with ALND.