En tverrsnittstudie av langtidseffekter i arm og skulder etter behandling for brystkreft

Hensikt Hensikten med studien var å studere forekomst av langtidseffekter i arm/skulder hos brystkreft pasienter stadium II-IIIA som har fjernet hele brystet (Modifisert Radikal Mastectomi: RM) eller gjort brystbevarende kirurgi (Breast-Conserving Therapy:BCT). I tillegg har alle fjernet lymfeknuter i axillen. Alle pasientene fikk postoperativt lokoregional stråleterapi med eller uten kjemoterapi og hormonbehandling som tilleggsbehandling. Materiale og metode Etter median observasjonstid på 47 måneder (range 32-87) etter det kirurgiske inngrepet, ble 266 kvinner (RM: n=189, BCT: n=77) undersøkt på poliklinikken med hensyn til arm/skulderfunksjon og lymfødem. Det ble gjort en undersøkelse av bevegelighet i arm/skulder med goniometer. For å kartlegge lymfødem i armen ble det brukt en metode hvor flere omkretsmål av armene ble omregnet til volummål og sammenlignet. I tillegg ble det brukt et spørreskjema og intervju for å kartlegge langtidseffekter i arm/skulder. Resultater I RM gruppen hadde 20% utviklet lymfødem i armen versus 8% i BCT gruppen (p=0,01). I multivariat analyse var lymfødem assosiert med RM [OR 2,98(95%CI 1.16-7.67), p=0,02], økende antall tumorinfiltrerte lymfeknuter i axillen [OR1,14 (95%CI 1,02-1,26), p=0.02] og økende BMI [OR 1,11 (95%CI 1,04-1,19), p<0,01]. I RM gruppen hadde 18% av pasienten nedsatt fleksjon i skulder sammenlignet med 4% i BCT gruppen (p<0,01). Tilsammen 32% i RM gruppen rapporterte smerte i skulder i forhold til12% i BCT gruppen (p=0,001). Økende observasjonstid, RM, større felt som ble bestrålt i axillen og økende BMI var significant assosiert med nedsatt arm/skulder funksjon. Konklusjon Arm/skulder problemer inkludert lymfødem var signifikant mer hyppig etter RM sammenlignet med BCT hos brystkreft pasienter som hadde gjort axilleglandeltoilette og fått stråleterapi. BCT bør anbefales som operasjonsmetode når forholdene ligger til rette for det

Chemotherapy-Induced Peripheral Neuropathy and Physiotherapy

Introduction:The trend with continuing increase in cancer incidence, more advanced treatment and higher survival rates results in an increasing number of survivors with possibly long-term adverse effects from the cancer treatment. Chemotherapy-induced peripheral neuropathy (CIPN) represents one of many adverse effects related to cancer treatment. So far guidelines for testing and treatment are almost absent. Thus, there is a demand for competence among physiotherapists concerning tests and treatment within this area. The aim of this article is to give an account of present knowledge of CIPN and to present relevant methods of assessment. Main section:Neurotoxic chemotherapy, which is used in treatment of cancer, is mainly vinca-alkaloids, taxanes and cisplatin. The adverse effects of the treatment may give CIPN, mainly limited to sensory functions with paresthesias as numbness, pain or other disturbed sensibilities in the peripheral part of the limbs. Furthermore, motor functions can also be impaired and can affect the postural control (balance) and thereby an increased risk of fall. A questionnaire and different physical tests measuring strength, balance and physical function are presented. Conclusion:Systematic surveys to identify CIPP symptoms, including both self-report and clinical tests are important aspects of physiotherapy for these patients. There is a demand for research in this area, including tools for both testing and treatment of CIPN

Registering patient reported symptoms in patients with lymphoedema – is there a validated questionnaire with good psychometric properties?

Purpose: Patients with lymphoedema report various symptoms. In Norway objective treatment measures have primarily been utilized. Hence we saw a need to study available questionnaires and identify those which register patient reported symptoms. Method: Standard text books were reviewed and searches made in PubMed, Embase, BNI, Ovid Nursing Database and CINAHL. Text books and the identified articles were reviewed to get an overview of registered symptoms, clinical viability of the questionnaires, their psychometric properties and other relevant factors for registering lymphoedema and evaluating treatment. Results: Fourteen articles met the inclusion criteria, and 16 questionnaires were identified. Swelling or a feeling of swelling, heaviness, numbness, tightness and pain were most frequently registered. Four questionnaires did not describe the psychometric properties and the remaining 12 had varying levels of validity and reliability. Several methods of scoring were utilized; categorical yes/no, various Likert scales and VAS. Several time scales were used. Five questionnaires had 50 questions or more. Conclusion: Several validated questionnaires which register subjective symptoms in patients with lymphoedema were identified. Some provide the means to ensure a more accurate assessment. LYMFQOL arm and LYMFQOL leg assess the most frequently reported subjective symptoms on a user-determined time scale. A 4-part Likert scale for grading the severity of the symptoms is used. Both questionnaires are tested for validity and reliability with satisfactory results. LYMFQOL arm and leg register health related quality of life and can help the physiotherapist to select appropriate treatment. A Norwegian version of both questionnaires has been pilot tested