A qualitative assessment of upper quarter dysfunction reported by physical therapists treated for breast cancer or treating breast cancer sequelae

Abstract

The study supports the problem of late effects from breast cancer treatment on upper quarter function and points out the need for better education for health care providers, increased long-term surveillance of survivors, and a more proactive model of health care delivery for this population.

Patient perspectives on breast cancer treatment side effects and the prospective surveillance model for physical rehabilitation for women with breast cancer

“…Miedema et al22 found that 48.5% of women who completed a survey less than a year after breast cancer surgery reported difficulty with activities requiring “some force or impact,” and 44% reported limitations in activities that involved “moving their arm freely.” Women >2 years postdiagnosis (median, 5.9 years) encountered similar difficulties 4…”

“…“I think that the biggest functional deficit that I have is related to the TRAM [breast reconstruction] in that I have adequate upper extremity muscle strength but I can't set my abdominals…I can no longer get the bags of mulch out of the car.” (Source: unpublished data collected in qualitative study by Levangie et al4)…”

“…Although each woman's experience with breast cancer is unique, they share common perspectives related to the physical and functional side effects of breast cancer treatment. Activity limitation, upper extremity motion restriction, lymphedema, fatigue, pain, and chemotherapy‐induced peripheral neuropathy (CIPN) are well‐documented concerns of breast cancer survivors 1‐5. Impairments such as limited range of motion, pain, and fatigue appear to be inter‐related, and may have an additive effect.…”

Effectiveness of Physiotherapy Intervention on the Quality of Life of Women with Breast Cancer who Underwent Sentinel Lymph Node Biopsy.

“…There is evidence that it is possible to prevent some complications (or minimize their effect) throughout the acute phase of cancer treatment with oncological therapies through an early rehabilitation program [13][14][15][16][17][18][19] and it is known that physiotherapy and a program with specific exercises can contribute to the improvement in QoL in women with breast cancer throughout the acute phase of survival [20][21][22][23][24][25][26][27][28][29][30][31][32]. However, clinical practice suggests that patients undergoing SLNB surgery are rarely included in a functional rehabilitation program because it is assumed that in this surgery there is an absence of morbidity and consequently a minimal impact in their QoL.…”

Toward a National Initiative in Cancer Rehabilitation: Recommendations From a Subject Matter Expert Group

“…115 Patients want to be empowered decision-makers in their care. 116 Understanding impairment risk and symptoms associated with early impairment identification activates patients toward better self-management and self-advocacy for care, 117 improves patient satisfaction and quality of life, and reduces anxiety. [118][119][120][121] A multipronged approach that targets provider, process, and patients is needed to improve the integration of cancer rehabilitation services into the cancer continuum.…”