Prevalence and Influencing Factors of Upper Limb Musculoskeletal Disorders Associated with Paclitaxel in Surgically Treated Women with Breast Cancer: A Secondary Cross-Sectional Descriptive Study

Moharrami, M; Nejati, Babak

Prevalence and Influencing Factors of Upper Limb Musculoskeletal Disorders Associated with Paclitaxel in Surgically Treated Women with Breast Cancer: A Secondary Cross-Sectional Descriptive Study

Document Type : Original Article

Authors

M Moharrami

Babak Nejati

Associate Professor, Department of Orthopedics, Faculty of Medicine, Tabriz University of Medical Sciences, Shohada Hospital

Abstract

Background and Objective: Breast cancer is the most prevalent malignancy among women worldwide. Despite significant advances in surgical techniques, radiotherapy, and chemotherapy, complications such as paclitaxel-induced peripheral neuropathy continue to severely impact patients' quality of life. Paclitaxel disrupts microtubule dynamics and axonal transport, leading to nerve damage and functional impairments in the upper limbs. The combined effects of surgical interventions, radiotherapy, and paclitaxel treatment further increase the risk of developing musculoskeletal disorders. Therefore, this study aims to investigate the prevalence and contributing factors of upper limb musculoskeletal disorders associated with paclitaxel in women who have undergone surgical treatment for breast cancer.
Materials & Methods: This descriptive cross-sectional study was conducted at Tabriz University of Medical Sciences. The study sample consisted of women aged 18 years and older who had been diagnosed with breast cancer, undergone surgery, and were candidates for treatment with paclitaxel and radiotherapy. A convenience sampling method was employed based on a pre-calculated sample size, resulting in the inclusion of 100 patients. Demographic and clinical data were systematically collected, and musculoskeletal issues were evaluated through standardized physical examinations focusing on the shoulder, elbow, carpal tunnel syndrome, and tenosynovitis of the thumb. Patients were classified according to the affected—either the affected side or the healthy side—and the prevalence of musculoskeletal disorders on each side was assessed. Statistical analyses included the Mann-Whitney U test, Chi-square test, and t-tests for qualitative data assessment, with a significance level set at p < 0.05.
Results: The physical examination of the shoulder revealed significant findings, with the highest rates of negative outcomes observed in the Cross Over test (69%; 69 patients) and the Yergason test (66%; 66 patients). The Empty Can test indicated a positive response in 21% (21 patients) on the affected side, while 8% (8 patients) exhibited bilateral positive responses. Furthermore, the Neer Impingement test showed positive findings in 23% (23 patients) on the affected side and 12% (12 patients) bilaterally. The Hawkins-Kennedy test revealed positive results in 20% (20 patients) on the affected side and 9% (9 patients) bilaterally. The Compression test was positive in 25% (25 patients) on the affected side, with only 2% (2 patients) reporting bilateral positive findings on the Cross Over test, illustrating varied patterns of shoulder structural involvement among participants.
Conclusion: The findings of this study indicate that musculoskeletal disorders and shoulder pathologies in surgically treated women with breast cancer receiving paclitaxel predominantly occur on the affected side, with a notably high prevalence of subacromial impingement, while acromioclavicular joint involvement is minimal. These results highlight the significant interplay among surgical effects, drug-induced neuropathy, and radiotherapy in the development of these disorders, underscoring the need for targeted assessments and rehabilitation strategies.

Keywords

Breast Neoplasms

Paclitaxel

Cross-Sectional Studies

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