ECSS Paris 2023: OP-MH24
INTRODUCTION: Axillary Lymph Node Dissection (ALND) is associated with long-term upper limb morbidity in breast cancer (BC) survivors. Targeted Axillary Dissection (TAD) is a more conservative approach that may reduce postoperative complications [1]. However, evidence on biomechanical and neuromuscular outcomes after TAD compared to ALND is limited. METHODS: Eighteen women (55.8±12 years), surgically treated for BC at least 6-month before assessment (591±339 days), were enrolled after ALDN or TAD. Functional outcomes included upper limb disability (QuickDASH), physical activity level (IPAQ-SF) and handgrip strength (HGS). Surface EMG (FREEEMG 1000, BTS Bioengineering) recorded pectoralis major (PM), middle deltoid (MD), biceps brachii (BB) and upper trapezius (UT) during five repetitions of forward shoulder flexion and abduction (5-s rest). Upper limb kinematics and gait during 6MWT were assessed using an IMU (G-sensor, BTS Bioengineering). Muscle mechanical properties were assessed using Myoton. Trapezius compensatory co-activation was estimated through the co-contraction index (CCI) [2]. Participants were retrospectively allocated to the ALND and TAD groups and non-parametric statistics used for between-group (Mann–Whitney U test) and intra-group comparisons (Wilcoxon matched pair test). RESULTS: ALND patients were older (p=.018) and had more removed lymph nodes (p=.04). Neoadjuvant therapies were more frequent in TAD group (p<.001), whereas adjuvant hormonal therapy was more common in ALND (p=.01). Late surgical complications were more frequent after ALND (p=.04), including shoulder pain, hypofunction and hand paresthesia. Despite comparable physical activity levels, ALND group showed a trend toward worse functional outcomes, with higher QuickDASH scores (median 34 vs 10 in TAD) and lower 6MWT performance. QuickDASH score was associated with number of removed lymph nodes (p=.04), operated-side shoulder flexion ROM (p=.02), CCI during shoulder flexion (p=.006), and HGS (p=.05). Both groups showed altered shoulder movement patterns with reduced ROM and less smooth (higher jerk). EMG revealed abnormal PM activation during abduction (p=.04), associated with reduced MD activity (p=.04). In ALND, PM contribution during flexion-extension was reduced on the operated side (p=.03), while UT activation remained bilaterally increased (p=.04). CCI was higher on the operated side, especially in ALND (p=.03). Myoton showed higher PM decrement in ALND (p=.03), indicating reduced elasticity. CONCLUSION: Both ALND and TAD are associated with neuromuscular alterations after BC surgery. However, ALND appears linked to more late complications, greater trapezius compensatory co-contraction, and reduced pectoralis elasticity, potentially contributing to higher disability. These findings support the need for targeted rehabilitation. [1] Che Bakri et al. (2023), 277(4), 572–580. [2] Unnithan et al. (1996), 36(8), 487–494.
Read CV Valentina NatalucciECSS Paris 2023: OP-MH24
INTRODUCTION: Despite potential vascular toxicity of chemotherapy for early-stage breast cancer (EBC) and possible mitigating effects of aerobic training, no study has evaluated effects of chemotherapy or AT across the EBC treatment continuum on vascular endothelial health. Hence, this study aimed to evaluate vascular endothelial function across the early-stage breast cancer (EBC) treatment continuum. Secondary objectives were to evaluate effects of AT on endothelial function, and to explore the association between endothelial function and change in cardiorespiratory fitness (CRF). METHODS: A secondary pooled analysis was performed. A total of 161 patients from two randomized AT (16-32 weeks) trials were pooled and categorized into three cross-sectional cohorts: (1) during chemotherapy (initiating (neo)adjuvant chemotherapy; n=53); (2) acute post-treatment (immediately following (neo)adjuvant chemotherapy; n=50); and (3) chronic post-treatment (≥1 to <5 years after completion of primary therapy; n=58). Identical flow mediated dilation (FMD) protocols evaluated endothelial function at baseline (at cohort entry), and post-AT in a subset of n=118 patients randomized to exercise arms. FMD values <5.7% were defined as impaired. Associations between CRF change and (1) baseline FMD and (2) FMD change were quantified via adjusted linear regression. RESULTS: In the overall cohort at baseline, median FMD was 8.0% (IQR: 5.7%, 11.4%); n=33 (24%) patients had impaired FMD. No significant differences in FMD or proportion of patients with impaired FMD were observed across cohorts. Among the patients randomized to AT, change in FMD ranged from -9% to 8%, -9% to 6%, and -16% to 13% in the during, acute post-, and chronic post-chemotherapy cohorts, respectively. Neither baseline FMD nor FMD change after AT with associated with CRF change. CONCLUSION: In this pooled analysis, endothelial function were not significantly different across the EBC treatment continuum, and did not improve following AT. Additional research is needed to elucidate determinants of interindividual variability in vascular function and exercise response to guide targeted interventions.
Read CV Marie MclaughlinECSS Paris 2023: OP-MH24
INTRODUCTION: Breast cancer is one of the most prevalent cancers worldwide, with high survival rates. Consequently, survivors frequently experience challenges related to quality of life, including symptoms of anxiety and depression, which may be associated with physical fitness and body composition. This study aimed to analyze the association between physical fitness variables, body composition and psychological symptoms in breast cancer survivors. METHODS: A cross-sectional study was conducted with 38 women with a diagnosis of breast cancer (57.39 ± 7.94 years). Anxiety and depressive symptoms were assessed using the Generalized Anxiety Disorder-7 GAD-7 (6.37 ± 4.36) and the Patient Health Questionnaire-9-PHQ-9 (4.71 ± 4.30), respectively. Physical variables included body mass index-BMI (26.35 ± 4.53), handgrip strength (left 25.92 ± 5.00; right 26.85 ± 4.93), sit-to-stand test (20.56 ± 6.23) and medicine ball throw (2.46 ± 0.55). Associations were analyzed using Spearman correlations. RESULTS: A moderate positive association was observed between BMI and depressive symptoms (ρ = 0.36; p = 0.025), which remained significant after controlling for age (ρ = 0.40; p = 0.015). A trend towards a negative association between handgrip strength and anxiety symptoms was identified (ρ = −0.28; p = 0.088). CONCLUSION: Body composition appears to be more strongly associated with depressive symptoms than physical fitness indicators in this sample. These findings highlight the importance of considering body composition alongside psychological characteristics when designing clinical exercise interventions for breast cancer survivors, while reinforcing the need for further research with larger samples to clarify the role of physical fitness in mental health outcomes.
Read CV Maia AdrianaECSS Paris 2023: OP-MH24