Breast Cancer Female
Conditions
Keywords
Breast cancer surgery, Postoperative rehabilitation, Early rehabilitation, Physical Therapy
Brief summary
Breast cancer is one of the most common tumours in women. Advances in diagnosis and treatment have increased survival, but many women experience functional sequelae after breast and/or axillary surgery, including pain, reduced shoulder range of motion, loss of strength, difficulties in daily activities, axillary web syndrome, and possible lymphoedema. These impairments may affect autonomy, self-care, return to daily life, and correct arm positioning during adjuvant treatments such as radiotherapy. Although therapeutic exercise and rehabilitation are recommended within oncology care, the implementation of early rehabilitation programmes after breast cancer surgery remains variable. This study aims to evaluate a structured, individualised, and supervised early rehabilitation protocol, EMOVE-BCS-LaFe, applied in routine clinical practice during the first three months after surgery. The main hypothesis is that the protocol is safe and feasible, with a low frequency of physiotherapy-related adverse events requiring urgent care or programme suspension for more than 7 days, and high completion and adherence rates. Secondary outcomes include improvements in shoulder mobility, pain, upper limb function, strength, overall functional capacity, satisfaction, and differences according to type of breast and axillary surgery. A prospective, single-centre, observational, single-arm cohort study will be conducted at HUIP La Fe. Adult women undergoing breast cancer surgery and referred to the programme will be consecutively included. The intervention includes preoperative education, therapeutic exercise initiated from the first postoperative day, home-based and supervised sessions, individualised progression, self-care recommendations, and early detection and management of axillary web syndrome and lymphoedema. Follow-up will extend from preoperative assessment to three months after surgery. Safety, adherence, programme completion, range of motion, pain, upper limb function, shoulder strength, functional capacity, and satisfaction will be assessed using adverse event records, adherence data, goniometry, VAS, QuickDASH, dynamometry, 30-second Sit-to-Stand test, CSQ-8, and specific satisfaction items. Data analysis will be descriptive, estimating proportions, clinical-functional changes over time, and exploratory differences according to surgery type.
Interventions
PROCEDUREEarly Postoperative Rehabilitation Protocol
A structured, individualized, phase-based early postoperative rehabilitation protocol after breast cancer surgery. The intervention includes preoperative education, therapeutic exercise initiated from the first postoperative day, home-based exercise with adherence monitoring, supervised progression according to breast and axillary surgery type, self-care recommendations, and early detection and management of axillary web syndrome and lymphedema. The protocol is delivered as part of routine clinical practice and followed for three months after surgery.
Sponsors
Marta Aguilar-Rodriguez
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
Prospective single-group study with no control group. All participants will receive the structured EMOVE-BCS-LaFe early rehabilitation protocol after breast cancer surgery, integrated into routine clinical practice. The study does not include randomization or comparison between groups. The aim is to assess the safety and feasibility of the protocol during the three months following surgery, and to describe changes in clinical and functional outcomes, including shoulder range of motion, pain, upper limb function, strength, overall functional capacity, axillary web syndrome, adherence, and satisfaction.
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Women aged ≥18 years undergoing breast cancer surgery at Hospital Universitari i Politècnic La Fe and referred to the early postoperative rehabilitation programme through the usual care pathway. * Any type of breast surgery, including breast-conserving surgery and/or mastectomy, with or without reconstruction/prosthesis, and bilateral surgery. * Any type of axillary surgery, including sentinel lymph node biopsy (SLNB) and/or axillary lymph node dissection (ALND). * Patients undergoing surgery for recurrence and/or reoperation, for example margin widening, reoperation due to complications, or reoperation for oncological reasons, provided that it is clinically possible to start the programme. * Ability to understand instructions, complete questionnaires, and sign the informed consent form.-
Exclusion criteria
* Inability to safely start the protocol during the first postoperative weeks due to medical or surgical contraindication, or due to severe clinical complications, for example the need for strict immobilization, specific restrictions, or prolonged hospital admission, according to the criteria of the surgical team or the rehabilitation service, preventing the protocol from being initiated according to the usual care schedule. * Severe pre-existing upper limb condition, unilateral or bilateral, causing significant limitation of mobility or function before surgery and making the interpretation of clinical progression unreliable, for example shoulder arthroplasty, recent fracture, frozen shoulder in the inflammatory phase with severe limitation, or untreated massive rotator cuff tear with marked functional impairment. * Severe neurological or musculoskeletal disease that significantly affects upper limb function and may influence the main outcome variables, for example stroke with major sequelae, spinal cord injury, or severe neuropathy. * Cognitive impairment, severe decompensated psychiatric disorder, or language barrier without available support, preventing the participant from understanding instructions and completing assessments. * Participation in another study that may substantially interfere with the results, according to the investigator's judgment.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Physiotherapy-related adverse events | From Day 1 after surgery up to 3 months after surgery | Percentage of participants with at least one physiotherapy-related adverse event requiring urgent medical care and/or suspension of the rehabilitation protocol for more than 7 days. Adverse events will be prospectively recorded at each postoperative visit and through review of the medical record. |
| Protocol completion rate | At the end of the protocol, at three months after surgery | Percentage of participants who complete the 3-month follow-up assessment and the early postoperative rehabilitation protocol. Reasons for non-completion will also be recorded. |
| Adherence to the home-based exercise program | From Day 1 after surgery up to 3 months after surgery | Percentage of participants who adhere to the home-based exercise program, defined as performing the prescribed exercises at least 4 days per week. Adherence will also be recorded as the mean number of exercise days per week |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Shoulder range of motion | Baseline, 1 week, 10-15 days, 1 month, 2 months, and 3 months after surgery | Active shoulder flexion, abduction and rotation range of motion will be measured in degrees using standardized goniometry. Changes from baseline to the final 3-month assessment will be described. |
| Postoperative pain | 1 week, 10-15 days, 1 month, 2 months, and 3 months after surgery | Postoperative pain intensity will be assessed using a 0-10 visual analogue scale (VAS) where higher scores indicate greater pain. Changes in pain intensity will be assessed during postoperative follow-up. |
| Incidence of Axillary web syndrome | 1 week, 10-15 days, 1 month, 2 months, and 3 months after surgery | Percentage of participants who develop axillary web syndrome during postoperative follow-up, assessed by clinical examination based on the presence or absence of visible or palpable axillary cords. |
| Persistence of axillary web syndrome at 3 months | 3 months after surgery | Percentage of participants with axillary web syndrome still present at the final follow-up visit, assessed by clinical examination based on the presence or absence of visible or palpable axillary cords. |
| Upper limb function | Baseline and 3 months after surgery | Upper limb function will be assessed using the Spanish version of the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Scores range from 0 to 100, with higher scores indicating greater disability and worse upper limb function. Changes from baseline to the 3-month assessment will be evaluated. |
| Shoulder strength | Baseline and 3 months after surgery | Shoulder strength will be assessed in kilograms using a handheld dynamometer according to a standardized protocol. The mean value of three attempts will be recorded. Changes from baseline to the 3-month assessment will be evaluated. |
| Overall functional capacity | Baseline and 3 months after surgery | Overall functional capacity will be assessed using the 30-second Sit-to-Stand test. Changes in the number of repetitions from baseline to the final assessment will be described. |
| Early detection of lymphedema | 1 week, 10-15 days, 1 month, 2 months, and 3 months after surgery | Percentage of participants with suspected lymphedema during postoperative follow-up. Suspected lymphedema will be recorded as present or absent based on clinical assessment and comparison between upper limbs according to routine clinical practice. |
| Handgrip strength | Baseline and 3 months after surgery | Handgrip strength will be assessed using a hand dynamometer according to a standardized protocol. Changes from baseline to the final 3-month assessment will be described. |
| Patient satisfaction | At 3 months after surgery | Patient satisfaction with physiotherapy care will be assessed using the Spanish version of the Client Satisfaction Questionnaire-8 (CSQ-8). Total scores range from 8 to 32, with higher scores indicating greater satisfaction. Additional protocol-specific satisfaction items will be reported descriptively. |
Outcome results
None listed