Meme kanserli hastalarda uygulanan tedavi yöntemlerinin uzun dönemde omuz ve üst ekstremite morbiditesi, lenfödem ve yaşam kalitesi üzerine etkileri
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2016
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Uludağ Üniversitesi
Abstract
Çalışmamızda meme kanseri tanısı konulan ve farklı tedavi yöntemleri uygulanan hastalarda, tedavi yöntemlerinin üst ekstremite, omuz fonksiyonları ve lenfödem ile ilişkisini belirlemek ve bunların yaşam kalitesi üzerine olan etkisini araştırmak amaçlandı. Çalışmaya tek taraflı meme kanseri nedeniyle opere olan, postoperatif 3. ayını tamamlamış 200 kadın hasta dahil edildi. Hastaların omuz istirahat ağrısı VAS (Vizüel Analog Skala), aktif omuz eklem hareket açıklığı (EHA) gonyometre, lenfödem varlığı çevre-hacim ölçümü, sağlıkla ilişkili yaşam kalitesi SF-36 (Kısa Form-36) ve EORTC QLQ-C30 (Avrupa Kanser Araştırma ve Tedavi Organizasyonu Yaşam Kalitesi Anketi) ile değerlendirildi. Çalışmamızda en sık saptanan üst ekstremite morbiditesi %94 sıklıkla omuz ağrısı idi. Hastaların %49,5'inde lenfödem ve %20,5'inde en az bir yöne EHA kısıtlılığı saptandı. Aksiller radyoterapi (RT) uygulanması ve çıkarılan aksiller (metastatik) lenf nodu sayısında artış ve modifiye radikal mastektomi (MRM) tipinde cerrahi uygulanması ile lenfödem gelişimi arasında anlamlı ilişki bulundu. Lenfödem varlığının yaşam kalitesine etkisine bakıldığında, EORTC QLQ-C30 yaşam kalitesi ölçeğinin rol fonksiyon alt parametresine negatif yönde etkisi bulunurken, SF-36 ölçeğinin herhangi bir parametresine etkisi saptanmadı. MRM uygulanan hastalarda SF-36 yaşam kalitesi ölçeğinin emosyonel rol kısıtlanması skoru, EORTC QLQ-C30 yaşam kalitesi ölçeğinin kognitif fonksiyon ve bulantı-kusma alt grup skorları anlamlı olarak daha kötüydü. Omuz EHA kısıtlılığı ile EORTC QLQ-C30 yaşam kalitesi ölçeğinin tüm alt parametreleri arasında negatif yönde anlamlı ilişki tespit edildi. MRM uygulanan hastalarda, aksiller RT uygulanan hastalarda ve lenfödemi olan hastalarda omuz EHA kısıtlılığı daha fazla oranda bulundu. Çalışmamızda aksillaya RT uygulanması, aksiller lenf nodu çıkarılması ve MRM tipte cerrahi uygulanması ile lenfödem gelişimi arasında anlamlı ilişki saptandı. Omuz EHA kısıtlılığı da MRM yapılan, aksiller RT uygulanan ve lenfödemi olan hastalarda daha fazla oranda bulundu. Lenfödem, MRM tipinde cerrahi ve omuz EHA kısıtlılığı ise daha kötü yaşam kalitesi ile ilişkilendirildi.
In our study, we investigated the effect of different treatment modalities on upper extremity, shoulder motion and lymphedema in patients with breast cancer, and their effect on quality of life. 200 patients that underwent operation for single sided breast cancer and had a follow up of 3 months were included. Patients shoulder resting pain was assessed with VAS (visual analog scale), active range of motion of shoulder joint was evaluated with goniometer, lymphedema was assessed with circumference-volume measurement, health-related quality of life was assessed with SF-36 and EORTC QLQ-C30. Our study revealed that most common upper extremity morbidity was shoulder pain. 49,5% of patients had lymphedema and 20,5% had a restricted range of motion at least in a single plane. There was a significant correlation between use of axillary radiotherapy, increased number of resected metastatic lymph node and modified radical mastectomy with development of lymphedema. Lymphedema's effect on quality of life was suggested by negative impact on lower parameter function in EORTC QLQ-C30, however it had no effect on SF-36. Modified radical mastectomy patients had emotional role restriction score in SF-36, whereas in EORTC QLQ-C30, scores for cognitive function and nausea-vomiting subgroup were significantly lower. Restricted range of motion had a negative correlation with all parameters in EORTC QLQ-C30. Axillary radiotherapy, modified radical mastectomy and lymphedema rates were higher in patients with restricted range of motion in shoulder. Our study showed a significant correlation between use of axillary radiotherapy, increased number of resected metastatic lymph node and modified radical mastectomy with development of lymphedema. Restricted range of motion in shoulder was higher in patients with axillary radiotherapy, modified radical mastectomy and lymphedema. Lymphedema, use of modified radical mastectomy and restricted range of motion in shoulder were correlated with a poorer quality of life.
In our study, we investigated the effect of different treatment modalities on upper extremity, shoulder motion and lymphedema in patients with breast cancer, and their effect on quality of life. 200 patients that underwent operation for single sided breast cancer and had a follow up of 3 months were included. Patients shoulder resting pain was assessed with VAS (visual analog scale), active range of motion of shoulder joint was evaluated with goniometer, lymphedema was assessed with circumference-volume measurement, health-related quality of life was assessed with SF-36 and EORTC QLQ-C30. Our study revealed that most common upper extremity morbidity was shoulder pain. 49,5% of patients had lymphedema and 20,5% had a restricted range of motion at least in a single plane. There was a significant correlation between use of axillary radiotherapy, increased number of resected metastatic lymph node and modified radical mastectomy with development of lymphedema. Lymphedema's effect on quality of life was suggested by negative impact on lower parameter function in EORTC QLQ-C30, however it had no effect on SF-36. Modified radical mastectomy patients had emotional role restriction score in SF-36, whereas in EORTC QLQ-C30, scores for cognitive function and nausea-vomiting subgroup were significantly lower. Restricted range of motion had a negative correlation with all parameters in EORTC QLQ-C30. Axillary radiotherapy, modified radical mastectomy and lymphedema rates were higher in patients with restricted range of motion in shoulder. Our study showed a significant correlation between use of axillary radiotherapy, increased number of resected metastatic lymph node and modified radical mastectomy with development of lymphedema. Restricted range of motion in shoulder was higher in patients with axillary radiotherapy, modified radical mastectomy and lymphedema. Lymphedema, use of modified radical mastectomy and restricted range of motion in shoulder were correlated with a poorer quality of life.
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Keywords
Meme kanseri, Lenfödem, Yaşam kalitesi, Omuz fonksiyonu, Breast cancer, Lymphedema, Quality of life, Shoulder function
Citation
Aslan, İ. (2016). Meme kanserli hastalarda uygulanan tedavi yöntemlerinin uzun dönemde omuz ve üst ekstremite morbiditesi, lenfödem ve yaşam kalitesi üzerine etkileri. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.