Background: Upper-extremity morbidity after breast cancer surgery—including pain, lymphedema, and restricted shoulder range of motion—often develops gradually, emerging months after treatment and limiting daily activities. We aimed to characterize morbidity trajectories, physical therapy utilization, and predictors of physical therapy use. Methods: A retrospective multicenter cohort included 1602 women treated with breast surgery 0–36 months earlier. Patient-reported outcomes included Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), pain, range of motion limitation, axillary web syndrome, and lymphedema. Clinical variables included surgery type and nodal procedure. Outcomes were summarized across four postoperative windows (0–6, 7–12, 13–24, 25–36 months). Logistic and multinomial regression identified predictors of physical therapy uptake and timing (early, ≤3 months vs. late, >3 months; No physical therapy). Results: Anxiety declined across postoperative windows (p< 0.001), and axillary web syndrome decreased from early to later periods (p< 0.001). In contrast, range of motion restriction and decreased function remained common without significant differences between windows (p= 0.145 andp= 0.273). Pain was generally low-to-moderate by median [interquartile range], with a modest rise at 7–12 months (p< 0.001). In adjusted multinomial models (reference: Early physical therapy ≤ 3 months), higher pain was associated with No physical therapy and Late physical therapy (bothp< 0.05); lymphedema with No PT and Late physical therapy (bothp< 0.05); and axillary web syndrome with Late physical therapy (p= 0.001). Other symptoms (range of motion, function level, anxiety and physical activity) were not independently associated with physical therapy timing. Conclusions: Long-term postoperative morbidity is common. Early assessment and structured follow-up can mitigate its impact and should be embedded as core elements of survivorship health-promotion policy.
背景：乳腺癌术后上肢并发症——包括疼痛、淋巴水肿及肩关节活动范围受限——常呈渐进性发展，于治疗后数月逐渐显现并影响日常活动。本研究旨在分析并发症演变轨迹、物理治疗利用情况及其预测因素。方法：通过多中心回顾性队列研究纳入1602例接受乳腺癌手术后0-36个月的女性患者。患者报告结局包括上肢功能障碍快速评定量表（QuickDASH）、疼痛程度、关节活动度受限、腋网综合征及淋巴水肿。临床变量涵盖手术类型及淋巴结处理方式。研究结果按四个术后时间窗（0-6、7-12、13-24、25-36个月）进行汇总分析。采用逻辑回归与多项回归模型识别物理治疗使用及时机（早期≤3个月 vs 晚期>3个月 vs 未接受治疗）的预测因素。结果：焦虑水平随术后时间推移显著下降（p<0.001），腋网综合征发生率从早期到后期逐渐降低（p<0.001）。相比之下，关节活动度受限与功能减退持续普遍存在，各时间窗间无显著差异（p=0.145；p=0.273）。疼痛程度总体处于中低水平[中位数（四分位距）]，在术后7-12个月出现轻度升高（p<0.001）。经校正的多项回归模型（以早期物理治疗≤3个月为参照）显示：较高疼痛程度与未接受治疗及晚期治疗均相关（p均<0.05）；淋巴水肿与未治疗及晚期治疗相关（p均<0.05）；腋网综合征与晚期治疗相关（p=0.001）。其他症状（关节活动度、功能水平、焦虑及体力活动）与物理治疗时机无独立相关性。结论：术后长期并发症普遍存在。早期评估与结构化随访可减轻其影响，应作为癌症幸存者健康促进政策的核心要素加以实施。
肿瘤(癌症)患者之家