NEW ORLEANS--Three fourths of patients experience significant physical
sensations after breast cancer surgery. For many women, these are still
present years later, and many have long-term arm morbidity as well, researchers
reported at the Oncology Nursing Society's 22nd Annual Congress.
"If not adequately prepared preoperatively, patients often interpret
breast sensations as an indication that something is wrong, adding uncertainty
to an already stressful event," said Roberta Baron, RN, of Memorial
Sloan-Kettering Cancer Center.
Ms. Baron and her colleague Dr. Patrick Borgen surveyed 132 patients
during their first postoperative month, using a breast sensation assessment
Seventy patients had breast-conserving surgery, 53 had modified radical
mastectomy, and 9 had total mastectomy. Of the 62 mastectomy patients,
25 had reconstructive surgery.
Sensations of numbness, pulling, tenderness, soreness, or tightness
were each reported by at least 70% of patients. Ms. Baron stated that aching,
tingling, stiffness, or pain were reported by a little more than half of
the patients surveyed.
When present, the sensations that were most often described as "quite
a bit" or "very much" distressing included cramping (31%),
hardness (28%), pain (28%), and sharpness (26%), Ms. Baron said. Sensations
described as sharp, penetrating, burning, numb, and tight were rated as
"severe" or "very severe" in more than 30% of cases
where these symptoms were present.
When asked what brings the sensation on, 88% of patients ascribed it
to movement, 71% to position, and 63% to exercise. When asked what alleviates
the sensation, a change in position was noted by 64% of patients and medication
by 49%, while 34% said that the sensations disappear on their own.
The researchers concluded that patients need to be educated preoperatively
that such sensations may occur. "This may help alleviate some of the
emotional distress associated with these symptoms," Ms. Baron said.
Symptoms Remain Years Later
Margaret M. Hull, PhD, RN, of the University of Maryland at Baltimore,
reported that years after surgery, distressing sensory changes may still
be present but may be ignored by physicians, who often don't ask about
them or who suggest that nothing can be done about them.
Her survey included 17 patients evaluated 2 to 25 years after breast
cancer surgery. Nine had a modified radical mastectomy, six had a bilateral
mastectomy, two had lumpectomy and radiation, and eight had reconstruction.
The evaluation included an in-depth interview and a physical therapy assessment
of seven measures of function.
The findings suggested mild to moderate deficits in range of motion
and grip strength, and the presence of distressing sensory changes, pain,
and lymphedema years after treatment.
Sensory changes included paresthesia, hyperesthesia, dysesthesia, and
allodynia. Palpation of tender points found 15 of 22 areas were tender
more than 60% of the time. Many women had even experienced pain, swelling,
"At times, even basic activities such as dressing and grooming
must be altered to accommodate arm problems," Dr. Hull said. "Most
women have limited knowledge of specific precautions for arm care, and
thus are at risk for serious complications, such as cellulitis."