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 scale.
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, and throbbing.
"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."