Nur Amalina Che Bakri, BMedSc1; Richard M. Kwasnicki, PhD, MRCS1; K Dhillon, O Ghandour, N Khan, A Cairns, H Ashrafian, A Darzi, D Leff
1Imperial College of London, London, UK.
Anecdotal evidence shows that patients who have axillary node clearance (ANC) are more likely to experience shoulder morbidities such as reduced range of motion, pain, and lymphedema compared with those who undergo sentinel lymph node biopsy (SLNB). However, the evidence is largely subjective and based on patient surveys. Wearable activity monitors (WAMs) are increasingly used in oncology trials to monitor patients’ daily activities. We aimed to use WAMs in order to capture a more reliable and objective measure of physical function; this could help define the recovery process across different treatments, specifically looking at the impact of ANC vs SLNB on patient recovery.
Materials and Methods
A single-center, prospective, observational study was conducted involving 41 patients. Consecutive patients undergoing breast and axillary surgery were identified from theater lists. Patients with movement disorders (eg, Parkinson disease), those using mobility devices or aids, and those who were unable to provide informed consent were excluded from the study. Eligible consented patients wore WAMs (triaxial accelerometer [AX3]; Axivity, UK) on both wrists at least 1 day pre- and up to 2 weeks postoperatively, and completed Disability of the Arm, Shoulder and Hand (DASH) and quality-of-life (EQ-5D) questionnaires. Analysis was focused on patients who had SLNB and ANC. Statistical analysis was performed to determine the recovery plateau and differences in activity between arms (operated vs control) and surgeries.
Regain of function was seen through the increase of activity during the postoperative period, with the greatest increase between day 1 (mean, 41.5+/–19.6; P <.05) and 2 (mean, 51.5+/–22.1; P <.05), with recovery plateau at day 5. Greater activity was observed in the control arm compared with the operated arm, with a significant difference (P <.05) in week 1. Greater reduction of activity from preoperative level was observed in ANC patients compared with SLNB cohort throughout the 2-week period, with significant differences of 14.5% (P <.05) in week 1 and 18.8% in week 2 (P <.005). Moderate negative correlation was found between the postoperative activity levels and postoperative DASH questionnaires (Spearman = –0.512; P <.05).
ANC patients took longer to reach preoperative activity levels compared with SLNB patients, in concordance with anecdotal evidence in the literature. Monitoring recovery objectively after breast cancer treatment may help patients and clinicians to choose the best option, particularly where oncological outcomes are equivocal. This information can also be used to ensure optimization of patient outcomes by encouraging physical activity and keeping track of personalized activity goals, which could be integrated into the feedback-enabled and personalized prehabilitation and rehabilitation care plan.