Comparison of functional performance, kinesiophobia, muscle strength, quality of life, and fatigue between mastectomy and quadrantectomy in breast cancer survivors
DOI:
https://doi.org/10.29289/2594539420250019Keywords:
breast cancer, functional capacity, kinesiophobia, psychobiological profile, surgeryAbstract
Introduction: Mastectomy and quadrantectomy are the two primary surgical procedures performed on breast cancer survivors. This study aimed to compare functional performance, kinesiophobia, and muscle strength between women who were subjected to mastectomy and those who underwent quadrantectomy. Methods: A total of 27 participants were included, divided into a mastectomy group (mean age 51.0, standard deviation ±7.83 years) and a quadrantectomy group (mean age 53.5±9.33 years). Functional performance was assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; kinesiophobia was measured with the Tampa Scale of Kinesiophobia (TSK); quality of life was evaluated using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire – Breast Cancer module version 23 (EORTC BR-23); fatigue was analyzed with the Functional Assessment of Cancer Therapy – Breast cancer with arm subscale (FACT-B+4); and muscle strength was obtained through the bilateral isometric strength (BIS) and one-repetition maximum (1RM) tests. Data normality was verified using the Kolmogorov–Smirnov test. The unpaired t-test was applied to normally distributed variables, while the Mann–Whitney test was used for non-normally distributed variables. The significance level was set at p≤0.05. Results: No significant differences were found between groups regarding muscle strength (p=0.213), functional performance (p=0.635), or kinesiophobia (p=0.752). However, the mastectomy group reported lower scores in the breast symptoms domain of quality of life (p=0.050). Conclusion: Although no significant differences were observed in muscle strength, functional performance, or kinesiophobia, women in the mastectomy group reported worse quality of life in the breast symptoms domain.
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References
1. Popovic V, Milosavljevic N, Radojevic MZ, Vojinovic RH, Nedovic N, Mitrovic S, et al. Analysis of postoperative radiotherapy effects within risk groups in patients with FIGO I, II, and III endometrial cancer. Indian J Cancer. 2019;56(4):341-7. https://doi.org/10.4103/ijc.IJC_370_18
2. Wilke L, Andratschke N, Blank O, Brunner BT, Combs SE, Grosu AL, et al. ICRU report 91 on prescribing, recording, and reporting of stereotactic treatments with small photon beams: Statement from the DEGRO/DGMP working group stereotactic radiotherapy and radiosurgery. Strahlenther Onkol. 2019;195(3):193-8. https://doi.org/10.1007/s00066-018-1416-x
3. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. https://doi.org/10.3322/caac.21492
4. GLOBOCAN. Global Cancer Observatory. Globocan; 2020.
5. Paek J, Choi YJ. Association between hand grip strength and impaired health-related quality of life in Korean cancer survivors: A cross-sectional study. BMJ Open. 2019;9(9):e030938. https://doi.org/10.1136/bmjopen-2019-030938
6. Simonavice E, Liu PY, Ilich J, Kim JS, Arimandi BK, Panton L. The Effects of Resistance Training on Physical Function and Quality of Life in Breast Cancer Survivors Healthcare (Basel). 2015;3(3):695-709. https://doi.org/10.3390/healthcare3030695
7. Lee TS, Kilbreath SL, Refshauge KM, Herbet RD, Beith JM. Prognosis of the upper limb following surgery and radiation for breast cancer. Breast Cancer Res Treat. 2008;110(1):19-37. https://doi.org/10.1007/s10549-007-9710-9
8. Saulicz M, Saulicz E, Knapick A, Linek P, Rottermund J, Mysliwiec A, et al. Impact of physical activity and fitness on the level of kinesiophobia in women of perimenopausal age. Przgl Menopauzalny. 2016;15(2):104-11. https://doi.org/10.5114/pm.2016.61193
9. Instituto Nacional de Câncer José de Alencar Gomes (INCA). ABC do Câncer: Abordagens Básicas para o Controle do Câncer. Rio de Janeiro: INCA; 2018.
10. Mejdahl MK, Andersen KG, Gartner R, Kroman N and Kehlet H. Persistent pain and sensory disturbances after treatment for breast cancer: Six-year nationwide follow-up study. BMJ. 2013;346:f1865. https://doi.org/10.1136 bmj. f1865
11. Van der Gucht E, Dams L, Meeus M, Devoogdt N, Beintema A, Penen F, et al. Kinesiophobia contributes to pain-related disability in breast cancer survivors: a cross-sectional study. Support Care Cancer. 2020;28(9):4501-8. https://doi.org/10.1007/s00520-020-05304-4.
12. Kummerou KL, Du L, Penson DF, Shyr Y, Hooks MA. Nationwide trends in mastectomy for early-stage breast cancer. JAMA Surg. 2015;150(1):9-16. https://doi.org/10.1001/jamasurg.2014.2895
13. Runowicz CD, Leach CR, Henry LN, Henry KS, Mackey HT, Cowens-Alvarado RL, et al. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. CA Cancer J Clin. 2016;66(1):43-73. https://doi.org/10.3322/caac.21319
14. Doscher ME, Schreiber JE, Weichman KE, Garfein ES. Update on Post-mastectomy Lymphedema Management Breast J. 2016;22(5):553-60. https://doi.org/10.1111/tbj.12625
15. Luz CM, Prim AC, Deitos J, Heck APF, Recchia TL, Mayer AF. Reliability and validity of the Upper Limb Functional Test (ULIFT) for women after breast cancer surgery,” Disabil Rehabil. 2022;44(15):4096-103. https://doi.org/10.1080/09638288.2021.1897885
16. Altas EU, Dermidal US. The effects of post-mastectomy lymphedema on balance, Kinesiophobia and fear of falling. J Community Health Nurs. 2021;38(2):130-8. https://doi.org/10.1080/07370016.2021.1887564
17. Paolucci T, Bernetti A, Bai VA, Segatori L, Monti M, Maggi M et al. The sequelae of mastectomy and quadrantectomy with respect to the reaching movement in breast cancer survivors: evidence for an integrated rehabilitation protocol during oncological care. Support Care Cancer. 2021;29(2):899-908. https://doi.org/10.1007/s00520-020-05567-x
18. Huang Y, Wu H, Luo Z. A retrospective study of optimal surgical management for occult breast carcinoma: Mastectomy or quadrantectomy? Medicine (Baltimore). 2017;96(52):e9490. https://doi.org/10.1097/MD.0000000000009490
19. Bertioli J, Bezerra ES, Reis AD, Barros EAC, Gobbo LA, Freitas Júnior IF. Long-Term Side Effects of Breast Cancer on Force Production Parameters. J Strength Cond Res. 2022;36(5):1450-8. https://doi.org/10.1519/JSC.0000000000003631
20. Moss T, Chirico A, Mallia L, Lucidi F, Fucito A, D’Aiuto M, et al. Psychosocial Outcomes of Quadrantectomy Versus Mastectomy in a Southern Italian Sample: Development and Needs of the Italian Derriford Appearance Scale 24. Anticancer Res. 2016;36(4):1519-26. PMID: 27069127.
21. Coswig VS, Neves AHD, Del Vechio FB. Características físicas e desempenho motor no jiu-jitsu brasileiro: estudo com iniciantes e experientes na modalidade. Lec Educ Fis Desport. 2011;162(16):1-10.
22. Matsudo S, Araujo T, Andrade D, Andrade E, Oliveira L et al. International Physical Activity Questionare (IPAQ): study of validity and reliability in Brazil. Rev. Bras de Ativ Fís e Saud. 2001;6(2):5-18. https://doi.org/10.12820/rbafs.v.6n2p5-18
23. Orfale AG, Araújo PMP, Ferraz MB, Natour J. Translation into Brazilian Portuguese, cultural adaptation and evaluation of the reliability of the Disabilities of the Arm, Shoulder and Hand Questionnaire. Braz J Med Biol Res. 2005;38(2):293-302. https://doi.org/10.1590/s0100-879x2005000200018
24. Cheng HMS. Disabilities of the arm, shoulder, and hand-dash: análise da estrutura fatorial da versão adaptada para o português [thesis]. Belo Horizonte: Universidade Federal de Minas Gerais; 2006.
25. Trocoli TO, Botelho RV. Prevalência de ansiedade, depressão e cinesiofobia em pacientes com lombalgia e sua associação com os sintomas da lombalgia. Rev Bras de Reumatol. 2016;56(4):330-6. https://doi.org/10.1016/j.rbr.2015.09.009
26. Rogers BH, Brown JC, Gater DR, Schmitz KH. Association Between Maximal Bench Press Strength and Isometric Handgrip Strength Among Breast Cancer Survivors. Arch Phys Med Rehabil. 2017;98(2):264-9. https://doi.org/10.1016/j.apmr.2016.07.017
27. Hagstrom AD, Marshall PWM, Lonsdale C, Cheema BS, Fiatarone Singh MA, Green. Resistance training improves fatigue and quality of life in previously sedentary breast cancer survivors: A randomised controlled trial. Eur J Cancer Care. 2016;25(5):784-94. https://doi.org/10.1111/ecc.12422
28. Simão R, Farinatti PTV, Polito MD, Maior AS, Fleck SJ. Influence of exercise order on the number of repetitions performed and perceived exertion during resistance exercises. J Strength Cond Res. 2005;19(1):152-6. https://doi.org/10.1519/1533-4287(2005)19<152: IOEOOT>2.0.CO;2
29. Santos WDN, Vieira A, De Lira CAB, Mota JF, Gentil P, Freitas Junior R, et al. Once a Week Resistance Training Improves Muscular Strength in Breast Cancer Survivors: A Randomized Controlled Trial. Integr Cancer Ther. 2019;18(1):1-9. https://doi.org/10.1177/1534735419879748.
30. Supplementary Questionnaire Breast Cancer Module (SQBCM), Questionário EORTC QLQ-BR 23. 2008. p. 1-32.
31. Michels FAS, Latorre MRDO, Maciel MS. Validity, reliability and understanding of the EORTC-C30 and EORTC-BR23, quality of life questionnaires specific for breast cancer. Rev Bras Epidemiol. 2013;16(2):352-63. https://doi.org/10.1590/S1415-790X2013000200011.
32. Zabit F, Iyigun G. A comparison of physical characteristics, functions and quality of life between breast cancer survivor women who had a mastectomy and healthy women. J Back Musculoskelet Rehabil. 2019;32(6):937-45. https://doi.org/10.3233/BMR-181362
33. Akoochakian M, Davari HA, Alizadeh MH, Rahnama N. Evaluation of shoulder girdle strength more than 12 month after modified radical mastectomy and axillary nodes dissection. J Res Med Sci. 2017;22(3):1-5. https://doi.org/10.4103/jrms.JRMS_649_16
34. Jackson RS, Sanders T, Park A, Buras R, Lian W, Harris C. Prospective Study Comparing Surgeons’ Pain and Fatigue Associated with Nipple-Sparing versus Skin-Sparing Mastectomy. Ann Surg Oncol. 2017;24(10):3024-31. https://doi.org/10.1245/s10434-017-5929-9
35. Williams AM, Khan CP, Heckler CE, Barton DL, Ontko M, Geer J, et al. Fatigue, anxiety, and quality of life in breast cancer patients compared to non-cancer controls: a nationwide longitudinal analysis. Breast Cancer Res Treat. 2021;187(1):275-85. https://doi.org/10.1007/s10549-020-06067-6
36. Zehra S, Doyle F, Barry M, Walsh S, Kell MR. Health-related quality of life following breast reconstruction compared to total mastectomy and breast-conserving surgery among breast cancer survivors: a systematic review and meta-analysis. Breast Cancer. 2020;27(4):534-66, 2020. https://doi.org/10.1007/s12282-020-01076-1
37. Kulisnski W, Kosno M. Quality of life in women after mastectomy. Clinical and social study. Wiad Lek. 2021;74(3):429-35. https://doi.org/10.36740/wlek202103109
38. Baran E, Yildiz TI, Gursen C, Üzelpasaci E, Özugül S, Düzgün I, et al. The association of breast cancer-related lymphedema after unilateral mastectomy with shoulder girdle kinematics and upper extremity function. J Biomech. 2021;121:110432. https://doi.org/10.1016/j.jbiomech.2021.110432
39. Erdoganoglu Y, Çalik M, Vural M. Functional evaluation of patients with mastectomy lymphedema. Tuk J Phys Med Rehabil. 2021;67(1):56-61. https://doi.org/10.5606/TFTRD.2021.4616
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Copyright (c) 2026 Vitor Alves Marques, Wanderson Divino Nilo dos Santos, Maria Sebastiana Silva, João Ferreira-Batista Junior, Leonardo Ribeiro Soares, Naiany Pereira Silva, Ruffo Freitas-Junior, Carlos Alexandre Vieira

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