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Post-Breast Therapy Pain Syndrome and Lymphedema: A Web-based Approach to Patient & Physician Education on
Joint Women's Health-Breast Oncology Program Scientific Retreat on Early Detection and Interventions in Breast, Ovarian, and Cervical Cancers Poster Session 5:00-7:00 pm, Thursday, March 13, 2003
Robert Wascher, MD, Charles Dollbaum, MD, PhD, Alexandra Andrews, Richard Shapiro, MD, E. Shelley Hwang,MD, Jean Chan, Francine Manuel, RPT, Ernest H. Rosenbaum, MD

Post Breast Therapy Pain Syndrome (PBTPS) remains an underreported-yet often debilitating-consequence of breast cancer therapy. PBTPS is estimated to affect 10 to 30% of women who have had breast cancer surgery. Because PBTPS is not well understood by many physicians, breast cancer patients are often not advised about this risk prior to surgery, or the risk may be otherwise minimized. Subsequently, many patients unexpectedly experience chronic pain and other serious sensory disturbances that detract from their quality of life. In post-surgery follow-up visits, patients may describe some early postoperative pain, but often PBTPS does not manifest as an ongoing chronic problem until at least 30-90 days afterwards.

Forty percent of women previously diagnosed with PBTPS report increased pain with movement, leading to clinically significant arm and shoulder restriction of motion. Over 50% of patients with PBTPS experience discomfort that interferes with active daily living, and sleep. Indeed, many patients are advised to seek psychiatric care by well-intentioned physicians who are unfamiliar with PBTPS.

PBTPS may arise from injury to the intercostobrachial nerves (cutaneous sensory branches of T1-2). These nerves are often intentionally sacrificed during axillary dissection in an effort to recover all level I and II axillary lymph nodes. With the advent of the sentinel lymph node mapping technique for breast cancer, there have been several reports of a reduced incidence of PBTPS. At the same time, there are also studies that suggest the careful preservation of these sensory nerves may not prevent all postoperative chronic pain complications. In view of these factors, it is important that all patients are carefully counseled about the risk of PBTPS prior to undergoing surgical treatment for their breast cancer.

Additional factors that have been linked to PBTPS include polyneuropathies caused by chemotherapy (including taxanes, vinca alkaloids and platinum compounds) and radiation therapy, and these may be additive to impairments caused by surgery.

Lymphedema (chronic swelling of an extremity) is also a potential complication of axillary dissection, especially when combined with axillary radiation therapy, may also further contribute to postoperative pain syndromes.

A pilot questionnaire was developed to evaluate the perceived utility of the online information for the Cancer Supportive Care, Lymphedema Issues and Post Breast Therapy Pain Syndrome Modules

Response Ratings from 26 Countries Sep 2002 - Jan 2003
Very helpful and supportive 51.30%
Helpful and supportive 26.12%
Somewhat helpful and supportive 21.62%
Not helpful or supportive 0.05%

Conclusion: The issues raised in this discussion indicate that there is a need for an ongoing interdisciplinary approach between the different medical specialties that provide care to breast cancer patients, and to promote better understanding of PBTPS.

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