The Incidence and risk factor of adhesive capsulitis of shoulder after breast cancer surgical treatement : a National data-based study

Abstract

Background

Breast cancer is the most common cancer in women and is the second most common cause of cancer-related deaths. After breast cancer treatment, many patients experience physical symptoms that can reduce functional ability and diminish the quality of life. Several complications in the upper extremity have been reported. Adhesive capsulitis is the most common complication of breast cancer surgery, causing decreased patient satisfaction and quality of life. The purpose of this study was to analyze the incidence and risk factors of adhesive capsulitis after breast cancer surgery using a nation-wide database.

Materials and Methods

Korean Health Insurance Review and Assessment Service data were used to extract all patients who underwent breast cancer surgery between January 2007 and December 2016 using the International Classification of Diseases, 10th Revision(ICD-10) diagnosis and procedure codes. Odds ratios were calculated to identify the risk factors for adhesive capsulitis using age, underlying disease, radiotherapy, chemotherapy, and hormone therapy as independent variables. Additionally, diabetes mellitus and thyroid disease, which are strongly associated with adhesive capsulitis, were analyzed together.

Results

Of the 156,014 total cases, 30,654 were diagnosed with adhesive capsulitis. Of those, 2,694 cases of adhesive capsulitis occurred within one year before surgery, and 5,529 cases occurred within one year after surgery. Odds ratios for tamoxifen citrate and aromatase inhibitor were 1.092 and 1.420, respectively, and that for cancer chemotherapy was 0.610. However, radiotherapy showed no significant effect on adhesive capsulitis. The incidence of adhesive capsulitis in one year after breast cancer surgery was 2.1 times higher than that in one year before surgery.

Conclusions

Risk factors for adhesive capsulitis included age, hormone therapy, diabetes mellitus, and thyroid disease. In particular, hormone therapy administered after surgery was associated with an increased risk for adhesive capsulitis. Awareness of these risk factors for adhesive capsulitis will help both clinicians and patients to anticipate and manage shoulder pain after breast cancer treatment.