MCQS
Year : 2021  |  Volume : 58  |  Issue : 2  |  Page : 207-209

MCQs on “A descriptive study on prevalence of arm/shoulder problems and its impact on quality of life in breast cancer survivors”

HS Darling¹, Pradeep Jaiswal², Nishant Lohia³, Nishant R Tiwari^4
1 Department of Medical Oncology and Hemato-Oncology, Command Hospital Air Force, Bangalore, Karnataka, India
² Department of Surgical Oncology, Command Hospital Air Force, Bangalore, Karnataka, India
³ Department of Radiation Oncology, Command Hospital, Lucknow, Uttar Pradesh, India
⁴ Department of Internal Medicine, B.J. Government Medical College, Pune, Maharashtra, India

Correspondence Address:
H S Darling
Department of Medical Oncology and Hemato-Oncology, Command Hospital Air Force, Bangalore, Karnataka
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/ijc.ijc_508_21

1. Compression Pumps
2. Complex decongestive physiotherapy
3. Infrared therapy
4. Manual lymphatic drainage

1. 90%
2. 40%
3. 65%
4. 75%

1. Numbness
2. Lymphedema
3. Restriction of shoulder movements
4. Arm/shoulder pain

1. Restriction of shoulder movement
2. Lymphedema
3. Arm/shoulder pain
4. None of the above

1. ACOSOG Z0011
2. IBCSG 23-01
3. UK START Trials A and B
4. AMAROS Trial

1. 15
2. 20
3. 25
4. 10

1. 68%
2. 56%
3. 49%
4. 42%

1. Numerical Pain Rating Scale
2. Shoulder Pain and Disability Index
3. Psychometric properties of the shortened disabilities of the Arm, Shoulder, and Hand Questionnaire
4. Spasticity-Associated Arm Pain Scale

1. It is a neuropathic pain.
2. It is a pain persisting for at least 1 year after the surgery.
3. It can occur as paroxysms of lancinating pain.
4. Tenderness may be present.

1. Brushing hair, pulling up sweater
2. Fastening bra, pulling back zipper
3. Reaching overhead, pulling up sweater
4. Reaching overhead, brushing hair

1. (c) Infrared therapy


Various treatment regimens have been used to treat lymphedema. The compression pump, along with skincare, exercise, and compression garments, is one. A second treatment is known as complex decongestive physiotherapy or complex physical therapy. Arm care, therapeutic exercises, manual lymph node drainage, and compression bandages or garments constitute this treatment regimen.

(Goyal S, Buchholz TA, Haffty BG. Chapter 59: Breast cancer: Early stage. In: Halperin EC, Wazer DE, Perez CA, Brady LW, editors. Perez and Brady's Principles and Practice of Radiation Oncology. 7^th ed. Philadelphia: Wolters Kluwer; 2018.)


2. (c) 65%


Survivorship care following treatment of breast cancer is assuming increasing importance in the past few decades in view of the enhanced survival rates. The average 5-year survival rate for women with breast cancer is 90% in the West, and the average 10-year survival rate is 83%.Consequently, the population of long-term survivors is increasing, emphasizing the need for knowledge on long-term sequelae of treatment. India too has a growing population of survivors even though the mortality rates remain high (5-year survival of 66.1%), as compared with their Western counterparts.

(Available from: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/breast-cancer-facts-and-figures-2015-2016.pd (last accessible on 01 June 2021)).


3. (a) Numbness


ASPs constitute one of the most prevalent long-term sequelae, adversely affecting the quality of life of breast cancer survivors. ASPs are defined as lymphedema, restriction of shoulder mobility (ROM), and/or arm/shoulder pain. Nesvold et al. reported the prevalence of arm/shoulder pain to be 30% to 40%, LE 10% to 15%, and restricted arm mobility 15% to 30% in BCSs.

(Nesvold IL, Reinertsen KV, Fosså SD, Dahl AA. The relation between arm/shoulder problems and quality of life in breast cancer survivors: A cross-sectional and longitudinal study. J Cancer Surviv 2011;5:62-72).


4. (a) Restriction of shoulder movement


The most prevalent ASP in this study was the restriction of shoulder motion (51%). In the literature, different criteria for defining ROM have been used and have provided different results. Tengrup et al. used the criteria of >15° difference between the two arms as a significant restriction and reported a rate of 49%, which is almost similar to the results of this study.

(Tengrup I, Tennvall-Nittby L, Christiansson I, Laurin M. Arm morbidity after breast-conserving therapy for breast cancer. Acta Oncol 2000;39:393-7).


5. (c) UK START Trials A and B


The excellent regional control after both treatments matches the results of the ACOSOG Z001, and IBCSG 23-01 trials that showed patients with limited sentinel node metastasis who were treated with breast conserving treatment, including whole-breast irradiation and adjuvant systemic treatment, could be spared an axillary lymph node dissection without compromising locoregional control or survival outcome.

UK START Trials A and B are trials that established hypofractionated whole-breast radiotherapy.

(Donker M, van Tienhoven G, Straver ME, Meijnen P, van de Velde CJ, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): A randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol 2014;15:1303-10.)

(Giuliano AE, McCall L, Beitsch P, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010;252:426–32.)

(Galimberti V, Cole BF, Zurrida S, et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial. Lancet Oncol. 2013;14:297–305).


6. (a) 15


As outlined in the “Materials and Methods” section of this study, an ROM of 15 degrees or more was considered to be significant. One hundred and eight BCSs (51%) in this study were found to have a significant ROM.


7. (c) 49%


In this study, as mentioned in the “Results” section, 104 BCSs had a KAPS score of >21.5, suggesting significant ASPs.


8. (a) Numerical Pain Rating Scale


This scoring system uses a scale numbered 0 to 10. The patients are expected to inform the caregiver about the intensity of their pain on this scale as a complete integer.

(Vilholm OJ, Cold S, Rasmussen L, Sindrup SH. The postmastectomy pain syndrome: An epidemiological study on the prevalence of chronic pain after surgery for breast cancer. Br J Cancer 2008;99:604-10).


9. (b) It is a pain persisting for at least 1 year after the surgery


The International Association for Study of Pain (IASP) defines postmastectomy pain syndrome as chronic pain in the anterior aspect of thorax, axilla, and/or upper half of the arm, beginning after mastectomy or quadrantectomy and persisting for more than 3 months after the surgery.


10. (c) Reaching overhead, pulling up sweater