Racial disparities in upper extremity functional outcomes in post-mastectomy and breast reconstruction patients: A systematic review.

Abstract

Breast cancer survivors experience considerable upper extremity (UE) functional impairments following mastectomy and breast reconstruction. These can severely impact the patients' quality of life and are pronounced among racial minority groups. This mixed-methods systematic review examined racial disparities in post-surgical UE functional outcomes. A comprehensive literature search was conducted using the PubMed, Embase, and Scopus databases. Studies with racial data on UE function after mastectomy or breast reconstruction were included. Case reports or studies not written in English were excluded. Owing to heterogeneity, data from eligible studies were extracted and synthesized thematically based on objective vs. subjective outcomes. Appraisal Tool for Cross-Sectional Studies (AXIS) was used to evaluate the risk of bias in cross-sectional studies and the Newcastle-Ottawa Scale (NOS) was used for cohort studies. Eight studies were included in this study. Significant disparities were identified in UE function among the minority groups. Black, Hispanic, Asian, and Pacific Islander patients reported poorer functional outcomes compared to White patients, with higher incidences of limitations in shoulder motion, pain, and lower quality-of-life scores. Physiological factors unique to certain minority populations, such as increased fibrosis and heightened risk of lymphedema, further contributed to these disparities. There is a dearth of research addressing racial disparities in UE function following breast cancer surgery. Providing equitable care requires nuanced understanding of physiological and socioeconomic factors affecting minority populations after breast surgery. Further research with emphasis on objective measures is necessary to better understand these challenges and develop targeted interventions.