Upper Limb Morbidity in Newly Diagnosed Individuals After Unilateral Surgery for Breast Cancer: Baseline Results from the AMBER Cohort Study

Purpose: We aimed to examine potential associations between post-surgical upper limb morbidity and demographic, medical, surgical, and health-related fitness variables in newly diagnosed individuals with breast cancer. Methods: Participants were recruited between 2012 and 2019. Objective measures of health-related fitness, body composition, shoulder range of motion, axillary web syndrome, and lymphedema were performed within 3 months of breast cancer surgery, and prior to or at the start of adjuvant cancer treatment. Results: Upper limb morbidity was identified in 54% of participants and was associated with poorer upper limb function and higher pain. Multivariable logistic regression analysis identified mastectomy versus breast-conserving surgery (odds ratio [OR] 3.51, 95% confidence interval [CI] 2.65–4.65), axillary lymph node dissection versus sentinel lymph node dissection (OR 2.67, 95% CI 1.73–4.10), earlier versus later time from surgery (OR 1.58, 95% CI 1.15–2.18), and younger versus older age (OR 1.01, 95% CI 1.00–1.03) as significantly associated with a higher odds of upper limb morbidity, while mastectomy (OR 1.57, 95% CI 1.10–2.25), axillary lymph node dissection (OR 2.20, 95% CI 1.34–3.60), lower muscular endurance (OR 1.10, 95% CI 1.01–1.16) and higher percentage body fat (OR 1.04, 95% CI 1.00–1.07) were significantly associated with higher odds of moderate or greater morbidity severity. Conclusions: Upper limb morbidity is common in individuals after breast cancer surgery prior to adjuvant cancer treatment. Health-related fitness variables were associated with severity of upper limb morbidity. Findings may facilitate prospective surveillance of individuals at higher risk of developing upper limb morbidity.