51
|
Affiliation(s)
- Oren Cheifetz
- McMaster University; Chair, Oncology Division, Canadian Physiotherapy Association; Clinical Specialist-Oncology, Hamilton Health Sciences, Hamilton, ON
| |
Collapse
|
52
|
Singh C, De Vera M, Campbell KL. The effect of prospective monitoring and early physiotherapy intervention on arm morbidity following surgery for breast cancer: a pilot study. Physiother Can 2014; 65:183-91. [PMID: 24403683 DOI: 10.3138/ptc.2012-23o] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Significant arm morbidity is reported following surgery for breast cancer, yet physiotherapy is not commonly part of usual care. This study compared the effect on arm morbidity after surgery for breast cancer of a clinical care pathway including preoperative education, prospective monitoring, and early physiotherapy (experimental group) to that of preoperative education alone (comparison group). METHODS A prospective quasi-experimental pretest-posttest, non-equivalent group design compared two clinical sites; Site A (n=41) received the experimental intervention, and Site B (n=31) received the comparison intervention. At baseline (preoperative) and 7 months postoperative, shoulder range of motion (ROM), upper-extremity (UE) strength, UE circumference, pain, UE function, and quality of life were assessed. RESULTS The experimental group maintained shoulder flexion ROM at 7 months, whereas the comparison group saw a decrease (mean 1° [SD 9°] vs. -6° [SD 15°], p=0.03). A lower incidence of arm morbidity and better quality of life were observed in the experimental group, but these findings were not statistically significant. Baseline characteristics and surgical approaches differed between the two sites, which may have had an impact on the findings. CONCLUSION Initial results are promising and support the feasibility of integrating a surveillance approach into follow-up care. This pilot study provides the foundation for a larger, more definitive trial.
Collapse
Affiliation(s)
| | | | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver B.C
| |
Collapse
|
53
|
Breast Cancer EDGE Task Force Outcomes: Clinical Measures of Strength and Muscular Endurance: A Systematic Review. REHABILITATION ONCOLOGY 2014. [DOI: 10.1097/01893697-201432040-00003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
54
|
LeBlanc M, Stineman M, DeMichele A, Stricker C, Mao JJ. Validation of QuickDASH outcome measure in breast cancer survivors for upper extremity disability. Arch Phys Med Rehabil 2013; 95:493-8. [PMID: 24095658 DOI: 10.1016/j.apmr.2013.09.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 09/24/2013] [Accepted: 09/24/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To validate the QuickDASH as a patient-reported outcome measure for assessing upper extremity disability in breast cancer survivors. DESIGN Large cross-sectional survey. SETTING Ambulatory care center at a university hospital. PARTICIPANTS Postmenopausal women (N=150) with stage I to III hormone receptor-positive breast cancer currently taking a third-generation aromatase inhibitor. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE QuickDASH, an 11-item self-administered questionnaire, assesses global arm function over the past 7 days. RESULTS Of 150 surveys, 148 (99%) were scorable. The factor analysis demonstrated 1 factor with an eigenvalue of 6.7, which explains 61% of variance. The score was reliable with a Cronbach alpha of .93. The test-retest reliability was .78 over 2 weeks. The mean QuickDASH score ± SD for all patients was 19±19. Those with upper extremity arthralgias reported higher QuickDASH scores than controls without pain (26 vs 12, P=.001). Those with frozen shoulder pain also reported higher QuickDASH scores than controls without pain (37 vs 15, P=.001). CONCLUSIONS The QuickDASH instrument is a convenient, reliable, and valid patient-reported outcome measure to assess upper extremity disability in patients with breast cancer.
Collapse
Affiliation(s)
- Mously LeBlanc
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania Health System, Philadelphia, PA; Abramson Cancer Center, University of Pennsylvania Health System, Philadelphia, PA.
| | - Margaret Stineman
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania Health System, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Health System, Philadelphia, PA
| | - Angela DeMichele
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Health System, Philadelphia, PA; Abramson Cancer Center, University of Pennsylvania Health System, Philadelphia, PA
| | - Carrie Stricker
- Abramson Cancer Center, University of Pennsylvania Health System, Philadelphia, PA
| | - Jun J Mao
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Health System, Philadelphia, PA; Abramson Cancer Center, University of Pennsylvania Health System, Philadelphia, PA; Department of Family Medicine and Community Health, University of Pennsylvania Health System, Philadelphia, PA
| |
Collapse
|
55
|
|
56
|
Harrington S, Michener LA, Kendig T, Miale S, George SZ. Patient-reported upper extremity outcome measures used in breast cancer survivors: a systematic review. Arch Phys Med Rehabil 2013; 95:153-62. [PMID: 23932969 DOI: 10.1016/j.apmr.2013.07.022] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 07/23/2013] [Accepted: 07/24/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES (1) To identify English-language published patient-reported upper extremity outcome measures used in breast cancer research and (2) to examine construct validity and responsiveness in patient-reported upper extremity outcome measures used in breast cancer research. DATA SOURCES PubMed, Cumulative Index to Nursing and Allied Health Literature, and ProQuest MEDLINE databases were searched up to February 5, 2013. STUDY SELECTION Studies were included if a patient-reported upper extremity outcome measure was administered, the participants were diagnosed with breast cancer, and the study was published in English. DATA EXTRACTION A total of 865 articles were screened. Fifty-nine full text articles were assessed for eligibility. A total of 46 articles met the initial eligibility criteria for aim 1. Eleven of these articles reported means and SDs for the outcome scores and included a comparison group analysis for aim 2. DATA SYNTHESIS Construct validity was evaluated by calculating effect sizes for known-group differences in 6 studies using the Disabilities of Arm, Shoulder and Hand (DASH), University of Pennsylvania Shoulder Score, Shoulder Disability Questionnaire-Dutch, and 10 Questions by Wingate. Responsiveness was analyzed comparing a treatment and control group by calculating the coefficient of responsiveness in 5 studies for the DASH and 10 Questions by Wingate. CONCLUSIONS Eight different patient-reported upper extremity outcome measures have been reported in the peer-review literature for women with breast cancer; some that were specifically developed for breast cancer survivors (n=3) and others that were not (n=5). Based on the current evidence, we recommend administering the DASH to assess patient-reported upper extremity function in breast cancer survivors because the DASH has the most consistently large effects sizes for construct validity and responsiveness. Future large studies are needed for more definitive recommendations.
Collapse
Affiliation(s)
- Shana Harrington
- Department of Clinical and Applied Movement Sciences, University of North Florida, Jacksonville, FL; K12 Scholar, Department of Physical Therapy, University of Florida, Gainesville, FL.
| | - Lori A Michener
- Department of Physical Therapy, Virginia Commonwealth University - Medical College of Virginia Campus, Richmond, VA
| | - Tiffany Kendig
- Rehabilitation Medicine Service, Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Susan Miale
- Department of Physical Therapy, School of Health Technology and Management, Stony Brook University, Stony Brook, NY
| | - Steven Z George
- Department of Physical Therapy, University of Florida, Gainesville, FL
| |
Collapse
|
57
|
Harrington S, Padua D, Battaglini C, Michener LA. Upper extremity strength and range of motion and their relationship to function in breast cancer survivors. Physiother Theory Pract 2013; 29:513-20. [DOI: 10.3109/09593985.2012.757683] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
58
|
Oncology Section Task Force on Breast Cancer Outcomes: Clinical Measures of Upper Extremity Function. REHABILITATION ONCOLOGY 2013. [DOI: 10.1097/01893697-201331010-00006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
59
|
Stan DL, Rausch SM, Sundt K, Cheville AL, Youdas JW, Krause DA, Boughey JC, Walsh MF, Cha SS, Pruthi S. Pilates for breast cancer survivors. Clin J Oncol Nurs 2012; 16:131-41. [PMID: 22459522 DOI: 10.1188/12.cjon.131-141] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pilates has been advocated for rehabilitation of breast cancer survivors despite little scientific evidence. The authors of this article have examined the feasibility of a Pilates program in postmastectomy breast cancer survivors and the impact on physical and psychological parameters. Fifteen breast cancer survivors were recruited in a one-arm study of 12 weeks of Pilates exercises. The authors assessed recruitment, adherence, and attrition, and measured changes in shoulder and neck range of motion, posture, height, arm volume, quality of life, mood, and body image from pre- to postintervention. Of 26 eligible patients, 15 enrolled, 13 completed the study, and 10 performed more than 50% of the recommended sessions. Statistically significant improvements emerged for shoulder abduction and internal rotation on the affected side, neck rotation toward the unaffected side, and neck flexion. The affected side arm volume and the interlimb volume discrepancy increased. Significant improvements were reported in quality of life, mood, and body image. The improvements in physical and psychological outcomes are promising and deserve further evaluation in a randomized, controlled study. The increase in affected arm volume also warrants additional investigation.
Collapse
Affiliation(s)
- Daniela L Stan
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
60
|
McNeely ML, Binkley JM, Pusic AL, Campbell KL, Gabram S, Soballe PW. A prospective model of care for breast cancer rehabilitation: postoperative and postreconstructive issues. Cancer 2012; 118:2226-36. [PMID: 22488697 DOI: 10.1002/cncr.27468] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Appropriate and timely rehabilitation is vital in the recovery from breast cancer surgeries, including breast conserving surgery, mastectomy, axillary lymph node dissection (ALND), and breast reconstruction. This article describes the incidence, prevalence, risk factors and time course for early postoperative effects and the role of prospective surveillance as a rehabilitation strategy to prevent and mitigate them. The most common early postoperative effects include wound issues such as cellulitis, flap necrosis, abscess, dehiscence, hematoma, and seroma. Appropriate treatment is necessary to avoid delay in wound healing that may increase the risk of long-term morbidity, unduly postpone systemic and radiation therapy, and delay rehabilitation. The presence of upper quarter dysfunction (UQD), defined as restricted upper quarter mobility, pain, lymphedema, and impaired sensation and strength, has been reported in over half of survivors after treatment for breast cancer. Moreover, evidence suggests that survivors who undergo breast reconstruction may be at higher risk of UQD. Ensuring the survivor's optimum functioning in the early postoperative time period is critical in the overall recovery from breast cancer. The formal collection of objective measures along with patient-reported outcome measures is recommended for the early detection of postoperative morbidity. Prospective surveillance, including preoperative assessment and structured surveillance, allows for early identification and timely rehabilitation. Early evidence supports a prospective approach to address and minimize postoperative effects.
Collapse
Affiliation(s)
- Margaret L McNeely
- Department of Physical Therapy and Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Alberta, Canada.
| | | | | | | | | | | |
Collapse
|
61
|
Schmitz KH, Speck RM, Rye SA, DiSipio T, Hayes SC. Prevalence of breast cancer treatment sequelae over 6 years of follow-up: the Pulling Through Study. Cancer 2012; 118:2217-25. [PMID: 22488696 DOI: 10.1002/cncr.27474] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND There is a need to better describe and understand the prevalence of breast cancer treatment-related adverse effects amenable to physical therapy and rehabilitative exercise. Prior studies have been limited to single issues and lacked long-term follow-up. The Pulling Through Study provides data on prevalence of adverse effects in breast cancer survivors followed over 6 years. METHODS A population-based sample of Australian women (n = 287) diagnosed with invasive, unilateral breast cancer was followed for a median of 6.6 years and prospectively assessed for treatment-related complications at 6, 12, and 18 months and 6 years after diagnosis. Assessments included postsurgical complications, skin or tissue reaction to radiation therapy, upper-body symptoms, lymphedema, 10% weight gain, fatigue, and upper-quadrant function. The proportion of women with positive indication for each complication and 1 or more complication was estimated using all available data at each time point. Women were only considered to have a specific complication if they reported the highest 2 levels of the Likert scale for self-reported issues. RESULTS At 6 years after diagnosis, more than 60% of women experienced 1 or more side effects amenable to rehabilitative intervention. The proportion of women experiencing 3 or more side effects decreased throughout follow-up, whereas the proportion experiencing no side effects remained stable around 40% from 12 months to 6 years. Weight gain was the only complication to increase in prevalence over time. CONCLUSIONS These data support the development of a multidisciplinary prospective surveillance approach for the purposes of managing and treating adverse effects in breast cancer survivors.
Collapse
Affiliation(s)
- Kathryn H Schmitz
- Division of Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Abramson Cancer Center, Philadelphia, Pennsylvania 19104-6021, USA.
| | | | | | | | | |
Collapse
|
62
|
Campbell KL, Pusic AL, Zucker DS, McNeely ML, Binkley JM, Cheville AL, Harwood KJ. A prospective model of care for breast cancer rehabilitation: function. Cancer 2012; 118:2300-11. [PMID: 22488704 DOI: 10.1002/cncr.27464] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A significant proportion of adult breast cancer survivors experience deficits in function and restriction in participation in life roles that may remain many years after diagnosis. Function is a complex construct that takes into account the interactions between an individual, their health condition, and the social and personal context in which they live. Research to date on limitations in activities of daily living, upper extremity function, and functional capacity in breast cancer survivors illustrates the need for prospective measurement of function using measures that are sensitive to the unique issues of breast cancer survivors and the need for the development of effective rehabilitation interventions to improve function. Limitations in function have a significant impact on quality of life, but less is known about the implications on return to work and survival, as well as the impact of other comorbidities and aging on the function limitations in breast cancer survivors. This review provides a rationale for the integration of measures of function into breast cancer care to more fully appreciate the functional limitations associated with breast cancer diagnosis and treatment and to aid in the development of better rehabilitation care for breast cancer survivors.
Collapse
Affiliation(s)
- Kristin L Campbell
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | | | | | | | | | | | | |
Collapse
|
63
|
Cheville AL, Nyman JA, Pruthi S, Basford JR. Cost considerations regarding the prospective surveillance model for breast cancer survivors. Cancer 2012; 118:2325-30. [PMID: 22488706 DOI: 10.1002/cncr.27473] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
For this article, the authors examined the cost implications of the prospective surveillance model (PSM) for breast cancer (BC) survivors, a comprehensive framework designed to preemptively reduce the incidence and virulence of common impairments. The model clearly has the potential of providing significant benefits. However, its accompanying costs and resource requirements remain unclear and may be substantial. Thus, it is critical to examine which BC survivors may benefit from the PSM, how much they will benefit, and the costs of this benefit before its implementation. Because the PSM is not rigidly prescriptive, its examination must allow for different scenarios with emphasis on 4 critical determinants of cost--whether all or only high-risk BC survivors participate, assessment frequencies and locations, the credentials of the assessors, and requirements for supportive equipment. Another issue is the distribution of its cost: hypothetical implementation strategies vary widely in their distribution of fiscal burden across key stakeholders--survivors, providers, and payers--whose financial responsibilities will be an important factor in whether and how rapidly they adopt the PSM. Accurate valuation of the PSM will require capture of direct and indirect cost savings and benefits. Currently, a lack of data regarding these parameters, as well as outcomes that can be reliably attributed to the PSM, impedes cost-effectiveness analyses. Because the PSM may enhance many health state characteristics, assessments that integrate overall composite measures with evaluations of common, discrete impairments may be required to comprehensively assess its benefits.
Collapse
Affiliation(s)
- Andrea L Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota 55905, USA.
| | | | | | | |
Collapse
|
64
|
Binkley JM, Harris SR, Levangie PK, Pearl M, Guglielmino J, Kraus V, Rowden D. Patient perspectives on breast cancer treatment side effects and the prospective surveillance model for physical rehabilitation for women with breast cancer. Cancer 2012; 118:2207-16. [PMID: 22488695 DOI: 10.1002/cncr.27469] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Women's experience of breast cancer is complex, affecting all aspects of life during and after treatment. Patients' perspectives about common impairments and functional limitations secondary to breast cancer treatment, including upper extremity motion restriction, lymphedema, fatigue, weight gain, pain, and chemotherapy-induced peripheral neuropathy, are addressed. Women often report being uninformed regarding these side effects and surprised that they do not always disappear after treatment, but remain part of their lives. Breast cancer patients express strong, unmet needs for education, information, and intervention for these side effects. Evidence suggests that rehabilitation and exercise are effective in preventing and managing many physical side effects of breast cancer treatment. Nevertheless, few women are referred to rehabilitation during or after treatment, and fewer receive baseline assessments of impairment and function to facilitate early detection of impairment and functional limitations. The prospective surveillance model of rehabilitation will serve the needs of women with breast cancer by providing education and information about treatment side effects, reducing the incidence and burden of side effects through early identification and treatment, and enhancing access to timely rehabilitation. Integration of exercise as a component of the model benefits patients at every phase of survivorship, by addressing individual concerns about exercise during and after treatment and highlighting the important contribution of exercise to overall health and survival. The prospective surveillance model of rehabilitation can meet the evident and often expressed needs of survivors for information, guidance, and intervention--thus addressing, and potentially improving, overall quality of life for individuals diagnosed with and treated for breast cancer.
Collapse
Affiliation(s)
- Jill M Binkley
- TurningPoint Women's Healthcare, Alpharetta, Georgia 30022, USA.
| | | | | | | | | | | | | |
Collapse
|
65
|
Levy EW, Pfalzer LA, Danoff J, Springer BA, McGarvey C, Shieh CY, Morehead-Gee A, Gerber LH, Stout NL. Predictors of functional shoulder recovery at 1 and 12 months after breast cancer surgery. Breast Cancer Res Treat 2012; 134:315-24. [PMID: 22527107 DOI: 10.1007/s10549-012-2061-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 04/01/2012] [Indexed: 11/26/2022]
Abstract
The objective of this study are (1) to determine if upper extremity function, as represented by shoulder ROM, self-reported symptoms and upper extremity functional limitations in activities of daily living could be predictively related to demographic and cancer characteristics post-surgery for breast cancer. And (2) to examine if variables related to early onset impairment contribute to late onset impairments in women after breast cancer surgery. Subjects were assessed preoperatively and 1, 3, 6, 9, and 12+ months post breast cancer surgery for impairments and symptoms and at 12+ months for shoulder functional limitations using a physical therapy surveillance model. Body weight, shoulder ROM, manual muscle testing, and upper limb volume were recorded. At 12+ months, the Harvard Alumni Health Study Physical Activity Questionnaire, and an Upper Limb Disability Questionnaire were administered. Symptoms and ROM impairments were compared by functional limitations. Characteristics significantly associated with early ROM impairment (but not later impairment) were axillary lymph node dissection, removal of ≥15 nodes, mastectomy surgery and stage II breast cancer. Positive nodes, older age, and BMI≥25 were significantly associated with reduced shoulder ROM at 12+ months. At 12+ months, only 10 % of the patients experienced ROM impairments while rates of self-reported symptoms in the affected upper extremity at 12+ months were as follows: pain-49%, weakness-47.1%, numbness-55.9%, feeling tired-42.5%. The majority of patients used the affected upper extremity for reaching without limitation, but ≥35% reported limitation with household chores, carrying and lifting. Difficulty carrying and lifting could be predicted by BMI≥25 and use of the dominant affected upper limb. Different factors are associated with early versus later ROM loss. Symptoms reported by breast cancer survivors are frequently associated with functional limitations in upper extremity tasks and warrant intervention. Physical therapy using a prospective surveillance model of care may reduce severity of ROM loss, symptoms and functional upper extremity limitations 1 year after breast cancer surgery.
Collapse
Affiliation(s)
- Ellen W Levy
- Physical Therapy Section, Rehabilitation Medicine, National Institutes of Health, Hatfield Clinical Research Center, 10/1-1469, Rockville Pike, Bethesda, MD 20892, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
66
|
Stout NL, Binkley JM, Schmitz KH, Andrews K, Hayes SC, Campbell KL, McNeely ML, Soballe PW, Berger AM, Cheville AL, Fabian C, Gerber LH, Harris SR, Johansson K, Pusic AL, Prosnitz RG, Smith RA. A prospective surveillance model for rehabilitation for women with breast cancer. Cancer 2012; 118:2191-200. [PMID: 22488693 DOI: 10.1002/cncr.27476] [Citation(s) in RCA: 195] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
67
|
Petito EL, Nazário ACP, Martinelli SE, Facina G, De Gutiérrez MGR. Application of a domicile-based exercise program for shoulder rehabilitation after breast cancer surgery. Rev Lat Am Enfermagem 2012; 20:35-43. [DOI: 10.1590/s0104-11692012000100006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 01/09/2012] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate the effectiveness of an exercise program for the recuperation of the range of motion (ROM) of the shoulder. This is a quasi-experimental study developed at the Mastology Outpatient Clinic of the Federal University of São Paulo - Brazil, from August 2006 to June 2008, with 64 breast cancer patients undergoing surgery. The intervention consisted of: preoperative evaluation of the ROM, verbal and written guidance, demonstration and implementation of the exercises and revaluation at the outpatient follow-up appointments until the 105th postoperative day (PO). From the 7th PO a significant increase was observed in the ROM, which continued until the 105th PO. The minimum time for recovery was 105 days for the women undergoing mastectomy, and 75 days for those undergoing quadrantectomy. There was satisfactory adherence of 78.6% of the women. The domicile program was effective for the recovery of ROM in the study population, benefiting women who can not attend a presential program.
Collapse
Affiliation(s)
| | | | | | - Gil Facina
- Universidade Federal de São Paulo, Brazil
| | | |
Collapse
|
68
|
Breast cancer-related lymphedema: comparing direct costs of a prospective surveillance model and a traditional model of care. Phys Ther 2012; 92:152-63. [PMID: 21921254 PMCID: PMC3258414 DOI: 10.2522/ptj.20100167] [Citation(s) in RCA: 133] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Secondary prevention involves monitoring and screening to prevent negative sequelae from chronic diseases such as cancer. Breast cancer treatment sequelae, such as lymphedema, may occur early or late and often negatively affect function. Secondary prevention through prospective physical therapy surveillance aids in early identification and treatment of breast cancer-related lymphedema (BCRL). Early intervention may reduce the need for intensive rehabilitation and may be cost saving. This perspective article compares a prospective surveillance model with a traditional model of impairment-based care and examines direct treatment costs associated with each program. Intervention and supply costs were estimated based on the Medicare 2009 physician fee schedule for 2 groups: (1) a prospective surveillance model group (PSM group) and (2) a traditional model group (TM group). The PSM group comprised all women with breast cancer who were receiving interval prospective surveillance, assuming that one third would develop early-stage BCRL. The prospective surveillance model includes the cost of screening all women plus the cost of intervention for early-stage BCRL. The TM group comprised women referred for BCRL treatment using a traditional model of referral based on late-stage lymphedema. The traditional model cost includes the direct cost of treating patients with advanced-stage lymphedema. The cost to manage early-stage BCRL per patient per year using a prospective surveillance model is $636.19. The cost to manage late-stage BCRL per patient per year using a traditional model is $3,124.92. The prospective surveillance model is emerging as the standard of care in breast cancer treatment and is a potential cost-saving mechanism for BCRL treatment. Further analysis of indirect costs and utility is necessary to assess cost-effectiveness. A shift in the paradigm of physical therapy toward a prospective surveillance model is warranted.
Collapse
|
69
|
Pace do Amaral MT, Freire de Oliveira MM, Ferreira NDO, Guimarães RV, Sarian LO, Gurgel MSC. Manual therapy associated with upper limb exercises vs. exercises alone for shoulder rehabilitation in postoperative breast cancer. Physiother Theory Pract 2011; 28:299-306. [PMID: 22007656 DOI: 10.3109/09593985.2011.604709] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Our objective was to evaluate the effectiveness of manual therapy (MT) associated with upper limb (UL) exercises in women with impaired shoulder range of motion (ROM) after axillary lymph node dissection (ALND) for breast cancer. A randomized, prospective, blinded clinical trial with 131 women with a ROM <- 100° for shoulder flexion and/or abduction on the first day postoperatively were evaluated. Sixty-six women were allocated to group exercises and 65 underwent the exercises followed by MT. Shoulder ROM was measured by goniometry, and function was evaluated by the Modified-University of California at Los Angeles Shoulder Rating Scale--the UCLA Scale, in the 1st, 6th, 12th, and 18th month after surgery. The chi-square test was used for the relationship between clinical characteristics and oncological treatment between groups, and ANOVA for repeat measures was used. No difference in recovery of shoulder ROM as well as UL function was observed between groups. Improvement in ROM was gradual from the 1st to the 18th month, and the function achieving a good classification at 18th month. MT associated with exercises did not enhance the results obtained with exercises alone for shoulder ROM and ipsilateral UL function.
Collapse
Affiliation(s)
- Maria Teresa Pace do Amaral
- Department of Obstetrics and Gynecology-DObGyn, University of Campinas-UNICAMP School of Medicine-SM, Campinas, Brazil.
| | | | | | | | | | | |
Collapse
|
70
|
Morehead-Gee AJ, Pfalzer L, Levy E, McGarvey C, Springer B, Soballe P, Gerber L, Stout NL. Racial disparities in physical and functional domains in women with breast cancer. Support Care Cancer 2011; 20:1839-47. [PMID: 21979903 DOI: 10.1007/s00520-011-1285-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 09/26/2011] [Indexed: 01/22/2023]
Abstract
INTRODUCTION African-American women are more likely than white women to have functional impairments after breast cancer (BC) surgery; however, no differences were found in self-reported health status surveys at 12+ months postsurgery. PURPOSE This analysis compared white and African-American BC survivors' (BCS) health status, health-related quality of life, and the occurrence of physical impairments after BC treatment. METHODS One hundred sixty-six women (130 white, 28 African-American, 8 other) were assessed for impairments preoperatively and at 1, 3, 6, 9, and 12+ months postsurgery. Health status was assessed at 12+ months using the Short Form Health Survey (SF36v2™). Analysis of variance estimated differences between groups for health status and impairment occurrence. RESULTS No differences were found between groups for BC type, stage, grade, or tumor size; surgery type; or number of lymph nodes sampled. African-American BCS had more estrogen/progesterone receptor-negative tumors (p < 0.001; p = 0.036) and received radiation more frequently (p = 0.03). More African-American BCS were employed (p = 0.022) and reported higher rates of social activities (p = 0.011) but less recreational activities (p = 0.020) than white BCS. African-American BCS had higher rates of cording (p = 0.013) and lymphedema (p = 0.011) postoperatively. No differences were found in self-reported health status. CONCLUSION In a military healthcare system, where access to care is ubiquitous, there were no significant differences in many BC characteristics commonly attributed to race. African-American women had more ER/PR-negative tumors; however, no other BC characteristics differed between racial groups. African-American women exhibited more physical impairments, although their BC treatment only differed regarding radiation therapy. This suggests that African-American BCS may be at higher risk for physical impairments and should be monitored prospectively for early identification and treatment.
Collapse
Affiliation(s)
- Alicia J Morehead-Gee
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | | | | | | | | |
Collapse
|
71
|
Arsalani-Zadeh R, ElFadl D, Yassin N, MacFie J. Evidence-based review of enhancing postoperative recovery after breast surgery. Br J Surg 2011; 98:181-96. [PMID: 21104705 DOI: 10.1002/bjs.7331] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The introduction of enhanced recovery after surgery (ERAS) protocols has revolutionized preoperative and postoperative care. To date, however, the principles of enhanced recovery have not been applied specifically to patients undergoing breast surgery. METHODS Based on the core features of ERAS, individual aspects of postoperative care in breast surgery were defined. A comprehensive search of MEDLINE, PubMed, Embase and the Cochrane Library database was performed from 1980 to 2010 to determine the best evidence for perioperative care in oncological breast surgery. A graded recommendation based on the best level of evidence was then proposed for each feature of ERAS. RESULTS Twelve core features of enhanced recovery after breast surgery were identified. Use of the thoracic block, from both analgesic and anaesthetic viewpoints, is well supported by evidence and should be encouraged. Trials specific to breast surgery regarding aspects such as perioperative fasting, preanaesthetic medication, prevention of hypothermia and postdischarge support are scarce, and evidence was extrapolated from non-breast trials. Trials on postoperative analgesia and prevention of postoperative nausea and vomiting in breast surgery are generally of small numbers. In addition, there is heterogeneity between studies. CONCLUSION This review suggests that the principles of enhanced recovery can be adopted in breast surgery. A 12-point protocol is proposed for prospective evaluation.
Collapse
Affiliation(s)
- R Arsalani-Zadeh
- Postgraduate Medical Institute, University of Hull, Hull HU6 7RX, UK
| | | | | | | |
Collapse
|
72
|
Comparison of shoulder flexibility, strength, and function between breast cancer survivors and healthy participants. J Cancer Surviv 2011; 5:167-74. [DOI: 10.1007/s11764-010-0168-0] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 12/20/2010] [Indexed: 11/26/2022]
|