Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.
UMR1295, Toulouse III University, Inserm, Equipe EQUITY, Equipe constitutive du CERPOP, Toulouse, France.
BMC Womens Health. 2022 Aug 16;22(1):343. doi: 10.1186/s12905-022-01927-3.
Mastectomy is the first-line treatment approach for more than 90% of breast cancer patients. The numerous physical impairments associated with this surgical procedure negatively impact the patient's quality of life. To date, rehabilitation resources available for breast cancer patients undergoing mastectomy within the institutions affiliated to the Centre intégré universitaire de soins de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS-MCQ) are lacking and do not always seem to reflect the particularities of breast cancer care pathways. The purpose of this review was to identify and describe the conservative interventions and the clinical outcome measures used in the perioperative physical rehabilitation of women with breast cancer who are awaiting or have undergone mastectomy. We also aimed to report on the barriers and facilitators to study participation and completion.
MEDLINE, CINAHL, and the Cochrane Library were searched from inception to January 2021, and we updated the search on July 11, 2022. We included peer-reviewed English and French literature with quantitative designs, describing conservative interventions and clinical outcome measures used within rehabilitation programs designed for women who were awaiting or had undergone mastectomy. Paired reviewers independently reviewed all citations and articles using a two-phase screening process and independently extracted the data.
Of the 6080 articles identified, 57 met the inclusion criteria. Most interventions were multimodal, which combined exercise with patient education, manual therapy, and/or lymphatic drainage. The most frequently used objective measures of physical function were shoulder range of motion, muscle strength, and signs of lymphedema. In contrast, the primary patient-reported outcome measures were quality of life, shoulder function, and pain. Undergoing another breast surgery, death, and cancer recurrence were the most reported barriers to study completion.
This scoping review reports on the heterogeneity and wide range of conservative interventions and clinical outcome measures used in the physical rehabilitation of breast cancer patients who had undergone or were scheduled to undergo mastectomy. Tailoring interventions to breast cancer patients' needs and promoting outpatient rehabilitation interventions appear to be better suited to the particularities of breast cancer care pathways. Further research is needed to better identify barriers and facilitators to study participation and completion.
乳房切除术是 90%以上乳腺癌患者的一线治疗方法。该手术带来的诸多身体损伤对患者的生活质量产生负面影响。迄今为止，魁北克省中心大学健康与社会服务整合中心（CIUSSS-MCQ）附属机构的乳腺癌患者乳房切除术后康复资源匮乏，且似乎并不总是反映乳腺癌护理路径的特殊性。本综述的目的是确定和描述接受或即将接受乳房切除术的女性围手术期物理康复中使用的保守干预措施和临床结局测量指标，并报告研究参与和完成的障碍和促进因素。
从建库开始到 2021 年 1 月，我们在 MEDLINE、CINAHL 和 Cochrane 图书馆进行了检索，并于 2022 年 7 月 11 日进行了更新。我们纳入了具有定量设计的同行评审的英文和法文文献，描述了等待或已接受乳房切除术的女性的康复计划中使用的保守干预措施和临床结局测量指标。配对审查员使用两阶段筛选过程独立审查所有引用和文章，并独立提取数据。
在确定的 6080 篇文章中，有 57 篇符合纳入标准。大多数干预措施是多模式的，结合了运动、患者教育、手法治疗和/或淋巴引流。最常使用的身体功能客观测量指标是肩部活动范围、肌肉力量和淋巴水肿迹象。相比之下，主要的患者报告结局指标是生活质量、肩部功能和疼痛。接受另一次乳房手术、死亡和癌症复发是研究完成的最常见障碍。
本范围综述报告了接受或计划接受乳房切除术的乳腺癌患者的物理康复中使用的保守干预措施和临床结局测量指标的异质性和广泛范围。根据乳腺癌患者的需求调整干预措施并促进门诊康复干预措施似乎更适合乳腺癌护理路径的特殊性。需要进一步研究以更好地确定研究参与和完成的障碍和促进因素。
