Investigation of the Factors of Hang-Grip Strength-related Upper Extremity Functionality After Breast Cancer Surgery

Investigation of the Factors of Hand-Grip Strength-related Upper Extremity Functionality in Breast Cancer Survivors

Breast cancer is the most frequent cancer type in women globally. In the United States, there are almost 3 million breast cancer cases and this number gradually increasing in recent years. In conjunction with the new developments, breast cancer survival has increased therefore the management of long-term complications has gained importance. Breast cancer survivors can face the loss of muscle strength, increased fatigue and diminished physical function associated with treatment-related long term effects and psychological affection and thereby reduced quality of life. In addition to the reduced quality of life, breast cancer survivors experience reduced and altered upper extremity function. The Data not only reported by breast cancer survivors but also derived by objective assessment tools state that the high prevalence of disrupted upper extremity function. Studies reported that the deterioration of shoulder function and reduced strength and flexibility in the range of between 16% to 43%, however, these parameters followed a stabile pattern within a year while some parameters which are assessed relatively in short periods were found in higher prevalence. In addition to these, reduced mobility of head and neck, perceived fatigue, reduced upper extremity strength are factors that induce functional limitations in breast cancer survivors.

Upper extremity lymphedema or breast cancer-related lymphedema (BCRL) is one of the most prominent long term complications which affects breast cancer survivors in many ways after breast cancer surgery. Lymphedema is characterized by the inability of the function of the lymphatic system which can result in the accumulation of protein-rich lymphatic fluid in interstitial spaces in addition to skin changes in related body regions and extremities. Untreated lymphedema causes chronic inflammation, cellulitis, pain, fatigue, cosmetic deformity, restriction in mobility and related problems and therefore ineffective usage of the extremity concerning diminished functionality has occurred. It is known that the esthetical concern and emotional stress manifested by lymphedema cause deterioration in physical function. The heaviness feeling, fibrosis and skin infections caused by lymphedema not only can increase psychological stress but also induce musculoskeletal complications in the long term. It has been reported that breast cancer survivors with BCRL have the lower muscle strength and more activity limitations when compared to the ones free of BCRL. In BCRL, affected extremity has been found to 36% more weaker when compared to the unaffected side. Through augmented severity and stage of lymphedema, reduced physical functions are taken place in the clinical condition. Patients without BCRL can increase their cumulative musculoskeletal problems by avoiding physical activity and exercise due to misguidance and fear of lymphedema while the ones with BCRL have to fear the increased severity of lymphedema by doing so. Lymphedema can bring with problems such as reduced physical activity and weight gain thereby constitution of the basis of functional limitations is settled.

Increased fat mass and body mass index are reported in the range of 50% to %96 in breast cancer survivors. Optimal upper extremity function is important for maintaining an independent daily life and day routines and to perform works that need physical strength in terms of the general quality of life. However, affecting factors and incidence of their impact on upper extremity function in the aspect of physical, functional and psychological are still have been the research issue. The literature reports that the frequently reduced muscle strength due to cancer-related symptoms along with the altered motor control in shoulder and neck musculature. Fatigue is one of the most prominent symptoms when considering cancer-related symptoms in cancer survivors. It has been stated that increased fatigue is correlated with increased activity limitation and deterioration in physical function. The hand-grip test which is frequently used in the assessment of decreased muscle function has been stated as a reliable and repeatable test in breast cancer survivors. Besides, this test is frequently applicable to assess mortality, physical and functional capacity, symptoms after surgery and to designate an exercise program.

Some studies investigate upper extremity function associated with handgrip strength in breast cancer survivors. Yet, there is a lack of the objective result or conclusion of the BCRL effect on upper extremity function which is assessed with hang-grip strength when compared without BCRL. Therefore, this study is planned to investigate of cumulative effects of factors such as lymphedema severity, age, fatigue, body mass index, muscle strength, physical activity level, pain level, exercise benefits/barriers scale score on hand-grip strength related upper extremity functionality in breast cancer survivors.