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Upper Extremity Functional Outcomes After Breast Cancer Treatment: An Analysis of DASH Score in Breast Reconstruction Patients
Pooja Humar, BS; Anjali C. Raghuram, MD; Elizabeth A. Moroni, MD MHA; Zainab Balogun, BS; Casey Zhang, MD; Carolyn De La Cruz, MD
University of Pittsburgh Medical Center
2023-01-31
Presenter: Pooja Humar
Affidavit:
All work on this project represents the original work of the included authors
Director Name: J. Peter Rubin
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background: Patients undergoing post-oncologic breast reconstruction can experience upper extremity (UE) functional deficits. In this study, we utilized the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire to quantify these differences in UE functional recovery.
Methods: Breast cancer patients who underwent reconstruction performed by a single surgeon from 2014-2019 were surveyed. DASH scores were calculated as summative values, ranging from 0-120, with a score of 0 indicating no functional impairment. Additionally, a retrospective review was performed to assess these patients' overall comorbidities, oncologic treatment, and reconstructive modalities.
Results: Results: A total of 146 patients completed the questionnaire. The average DASH score was 9.7 (range 0-63), with 74.1% of patients having a score greater than 0. A majority (70.4%) of patients underwent implant-based reconstruction and had significantly higher DASH scores than patients who underwent autologous-based reconstruction (10.1 vs. 5.4, p<0.05). Patients who completed postoperative exercises had significantly lower DASH scores than patients who did not (8.3 vs. 13.7, p<0.05). Patients with BMI>27 had significantly higher DASH scores than patients with BMI<27 (11.7 vs 7.4, p<0.05). Patients that underwent radiation therapy (21.8% of patients in our study) reported a DASH score that was almost two times higher than those without a history of radiation (15.2 vs. 7.8, p<0.01).
Conclusion: Implant-based reconstruction, higher patient BMI, radiation history, and lack of postoperative exercise were associated with increased UE functional impairment in patients undergoing breast reconstructive surgery. Future work will involve generating a predictive model to identify patients at increased risk of UE impairment.
