Turkish Journal of Physical Medicine and Rehabilitation 2011 , Vol 57 , Num 4

The Presence of Upper Extremity Problems and the Effect on Quality of Life in Breast Cancer Patients who Undergone Breast Surgery and Axillary Dissectio

Nilgün Şimşir Atalay 1 ,Selin Taflan Selçuk 2 ,Özlem Ercidoğan 1 ,Nuray Akkaya 1 ,Ayşe Sarsan 3 ,Arzu Yaren 4 ,Füsun Şahin 5
1 Pamukkale Üniversitesi Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, Denizli, Türkiye
2 Dr. Abdurrahman Yurtaslan Ankara Onkoloji Eğitim ve Araştırma Hastanesi, Ankara, Türkiye**Başkent Üniversitesi, Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Ankara, Türkiye
3 Pamukkale Üniversitesi Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, Denizli, Türkiye
4 Pamukkale Üniversitesi Tıp Fakültesi, Medikal Onkoloji Anabilim Dalı, Denizli, Türkiye
5 Pamukkale Üniversitesi Tıp Fakültesi, Fizik Tedavi ve Rehabilitasyon Anabilim Dalı, Denizli, Türkiye
DOI : 10.4274/tftr.62134

Aim: The purpose of this study was to determine the prevalence of upper extremity problems in patients who had undergone breast cancer surgery, to compare the risk factors associated with these problems and to investigate their effects on quality of life.


Materials and Methods: One hundred thirty-two patients who had undergone either modified radical mastectomy or breast conserving surgery (lumpectomy) were enrolled to the study. Lymphedema, shoulder pain and restriction of shoulder motion were considered as upper extremity problems. Type of surgery, body mass index (BMI), radiotherapy, chemotherapy, disease stage and dominant hand involvement were recorded. The World Health Organisation (WHO) Quality of Life-BREF–Turkish Version (WHOQOLBREF–TR) was used for the assessment of quality of life.


Results: Shoulder pain was the most common symptom (45.5%), followed by lymphedema (34.8%) and shoulder motion restriction (22%). No significant relation was found between lymphedema and age, type of surgery, restriction of shoulder motion, pain and dominant hand involvement. Increased BMI, treatment with chemotherapy or radiotherapy, advanced-disease stage and lymph node involvement were associated with lymphedema (p< 0.05). It was seen that doing regular exercise had positive effect on lymphedema, pain and shoulder motion restriction reduction ( p<0.05). Lymphedema, pain and shoulder motion restriction were related with physical and psychological subgroups of WHOQOL-BREF TR, whereas shoulder motion restriction was also associated with the environmental subgroup (p<0.05). When lymphedema, pain and shoulder motion restriction was searched for to determine which one was more effective on quality of life shoulder pain had negative effect in the physical and psychological subgroups; motion restriction had negative effect in the physical subgroup, whereas lymphedema did not affect the quality of life subgroups. Exercise also had positive contribution to environmental and psychological subgroups of quality of life (p<0.05).


Conclusion: Arm problems are frequently encountered following breast surgery and affect the daily living of patients by decreasing their quality of life. The major aim in these patients must be taking preventive precautions and preserving the quality of life by minimizing complications with regular follow-up. 

Keywords : Breast cancer, lymphedema, pain, shoulder restriction, quality of life