Implications of Mobility Impairment on the Diagnosis and Treatment of Breast Cancer

Abstract

Background: Among women with chronic, preexisting mobility impairments, we sought to explore how their mobility difficulties affected the diagnosis and treatment of early-stage breast cancer Methods: This is a qualitative analysis of transcripts from in-depth in-person or telephone interviews with 20 English-speaking women who had early-stage breast cancer, were <60 years of age, and had chronic difficulty walking or used wheeled mobility aids at the time of their breast cancer diagnoses Results: Nine women were disabled by polio as children or had postpolio syndrome, 3 had cerebral palsy, 3 had spinal cord injury, and 5 had other conditions. Most women reported difficulty obtaining mammograms, primarily because of inaccessible equipment, positioning problems, and difficulties with uncontrollable movements. Many women made decisions about surgical approach and chemotherapy by explicitly considering how various therapies would affect their arms, which are essential to their mobility (they use ambulation aids, selfpropel manual wheelchairs, or otherwise rely on their arms for mobility or safety). Managing at home after surgery posed major mobility challenges, especially for women who lived alone. Several women reported feeling they suffered more chemotherapy side effects than do women without mobility problems. Weight gains with endocrine therapy compromised the mobility of several women. Conclusions: Increasing numbers of American women are living with mobility disabilities and entering age ranges with increased risks of breast cancer. Mobility impairments can affect women at every point during earlystage breast cancer diagnosis, therapy, and recovery. Clinicians must consider women's mobility functioning in making therapeutic recommendations to women with impaired mobility who develop breast cancer.

Eliminating Health And Health Care Disparities Among The Growing Population Of People With Disabilities

“…33 Interviews with women with disabilities who had developed early-stage breast cancer found that they frequently confronted physical barriers to care, such as inaccessible examining tables, weight scales, infusion chairs, mammography machines, and radiology equipment. 35,36 For example, a woman who is paraplegic reported that the cancer clinic at a major academic medical center she was referred to did not have a weight scale that was accessible by wheelchair. A woman's weight determines certain chemotherapy dosages.…”

Body image perceptions among women with pre‐existing physical disability who developed breast cancer: a qualitative exploration

“…Although participants’ mobility considerations influenced their decisions about surgical approach and chemotherapy [2], most women did not express that having a physical disability influenced their breast cancer treatment perspectives with regard to body image. While women were not necessarily probed explicitly about whether their disability influenced their body image, it appears that practical considerations may overshadow body-image related concerns.…”

“…This research is part of a larger published study investigating diagnosis and treatment experiences of women with physical disabilities who developed early-stage breast cancer [2, 6]. …”

“…Given that over 24% of women in the United States have a disability and approximately 6% of Americans use mobility aids [1], a significant number of breast cancer survivors will likely have mobility impairments [2]. Physical disability can affect body image, and women with physical disabilities hold more negative body image perceptions than other women [3].…”

“How did that happen?” Public responses to women with mobility disability during pregnancy

“…Drawing upon literature reviews and our previous studies addressing health care experiences of persons with disabilities, 5,16–21 we designed a semi-structured, open-ended interview protocol for this qualitative descriptive study. Qualitative descriptive studies provide comprehensive summaries of events or experiences without over interpretation of the meaning of the event or experience to study participants.…”