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Supportive Care in Cancer

, Volume 19, Issue 9, pp 1367–1378 | Cite as

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

  • Pamela K. LevangieEmail author
  • Anita M. Santasier
  • Nicole L. Stout
  • Lucinda Pfalzer
Original Article

Abstract

Purpose

As survival rates for breast cancer improve, long-term effects of treatment are receiving increasing attention, including upper quarter impairments and functional limitations. The purpose of this study was to assess, through qualitative means, the long-term effects of breast cancer treatment on upper quarter function as reported by those with expertise in upper quarter dysfunction. Participants were physical therapists who were either breast cancer survivors (“survivors”) or those who specialized in treatment of individuals post-breast cancer (“treaters”).

Subjects and methods

Three focus groups (two groups of survivors [n = 16] and one group of treaters [n = 10]) were convened to discuss their experiences with upper quarter dysfunction post-breast cancer. Qualitative research methods were used to collect and analyze the data, to extract themes, and to assure reliability and validity of the original and extracted data.

Results

Two themes emerged from the data and are supported by participant quotes. The first theme described the presence of upper quarter dysfunction that impacted body structure and function and resulted in activity/participation limitations. The second theme described the contextual factors that impacted the reported dysfunction, including access to comprehensive care, inadequate attention by health care providers, and a resulting need for self-advocacy.

Conclusions

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.

Keywords

Breast neoplasm Shoulder dysfunction Qualitative research Physical therapy 

Notes

Acknowledgements

The authors wish to recognize the Oncology Section and the Section on Research of the American Physical Therapy Association, as well as the facilitators and participants, for their support of this project.

Conflict of interest

This research was not sponsored by any organization, and none of the authors has a financial relationship with any organizations for which this research would present a conflict of interest. The data were in the hands of the authors at all times and are available to the journal upon request.

References

  1. 1.
    Peintinger F, Reitsamer R, Stranzl H, Ralph G (2003) Comparison of quality of life and arm complaints after axillary lymph node dissection vs sentinel lymph node biopsy in breast cancer patients. Br J Cancer 89(4):648–652PubMedCrossRefGoogle Scholar
  2. 2.
    Chirikos TN, Russell-Jacobs A, Jacobsen PB (2002) Functional impairment and the economic consequences of female breast cancer. Women Health 36(1):1–20PubMedCrossRefGoogle Scholar
  3. 3.
    Bentzen SM, Dische S (2000) Morbidity related to axillary irradiation in the treatment of breast cancer. Acta Oncol 39(3):337–347PubMedCrossRefGoogle Scholar
  4. 4.
    Lauridsen MC, Christiansen P, Hessov I (2005) The effect of physiotherapy on shoulder function in patients surgically treated for breast cancer: a randomized study. Acta Oncol 44(5):449–457, Stockholm, SwedenPubMedCrossRefGoogle Scholar
  5. 5.
    Rietman JS, Dijkstra PU, Hoekstra HJ, Eisma WH, Szabo BG, Groothoff JW, Geertzen JH (2003) Late morbidity after treatment of breast cancer in relation to daily activities and quality of life: a systematic review. Eur J Surg Oncol 29(3):229–238PubMedCrossRefGoogle Scholar
  6. 6.
    Tengrup I, Tennvall-Nittby L, Christiansson I, Laurin M (2000) Arm morbidity after breast-conserving therapy for breast cancer. Acta Oncol 39(3):393–397PubMedCrossRefGoogle Scholar
  7. 7.
    Karki A, Simonen R, Malkia E, Selfe J (2005) Impairments, activity limitations and participation restrictions 6 and 12 months after breast cancer operation. J Rehabil Med 37(3):180–188PubMedGoogle Scholar
  8. 8.
    Purushotham AD, Upponi S, Klevesath MB, Bobrow L, Millar K, Myles JP, Duffy SW (2005) Morbidity after sentinel lymph node biopsy in primary breast cancer: results from a randomized controlled trial. J Clin Oncol 23(19):4312–4321PubMedCrossRefGoogle Scholar
  9. 9.
    Mols F, Vingerhoets AJ, Coebergh JW, van de Poll-Franse LV (2005) Quality of life among long-term breast cancer survivors: a systematic review. Eur J Cancer 41(17):2613–2619PubMedCrossRefGoogle Scholar
  10. 10.
    Waldmann A, Pritzkuleit R, Raspe H, Katalinic A (2007) The OVIS study: health related quality of life measured by the EORTC QLQ-C30 and -BR23 in German female patients with breast cancer from Schleswig-Holstein. Qual Life Res 16(5):767–776PubMedCrossRefGoogle Scholar
  11. 11.
    Satariano WA, Ragland DR (1996) Upper-body strength and breast cancer: a comparison of the effects of age and disease. J Gerontol 51(5):M215–M219Google Scholar
  12. 12.
    Satariano WA, Ragheb NE, Branch LG, Swanson GM (1990) Difficulties in physical functioning reported by middle-aged and elderly women with breast cancer: a case-control comparison. J Gerontol 45(1):M3–M11PubMedGoogle Scholar
  13. 13.
    Haid A, Kuehn T, Konstantiniuk P, Koberle-Wuhrer R, Knauer M, Kreienberg R, Zimmermann G (2002) Shoulder-arm morbidity following axillary dissection and sentinel node only biopsy for breast cancer. Eur J Surg Oncol 28(7):705–710PubMedGoogle Scholar
  14. 14.
    Hojris I, Andersen J, Overgaard M, Overgaard J (2000) Late treatment-related morbidity in breast cancer patients randomized to postmastectomy radiotherapy and systemic treatment versus systemic treatment alone. Acta Oncol 39(3):355–372PubMedCrossRefGoogle Scholar
  15. 15.
    Leidenius M, Leivonen M, Vironen J, von Smitten K (2005) The consequences of long-time arm morbidity in node-negative breast cancer patients with sentinel node biopsy or axillary clearance. J Surg Oncol 92(1):23–31PubMedCrossRefGoogle Scholar
  16. 16.
    Schulze T, Mucke J, Markwardt J, Schlag PM, Bembenek A (2006) Long-term morbidity of patients with early breast cancer after sentinel lymph node biopsy compared to axillary lymph node dissection. J Surg Oncol 93(2):109–119PubMedCrossRefGoogle Scholar
  17. 17.
    Sugden EM, Rezvani M, Harrison JM, Hughes LK (1998) Shoulder movement after the treatment of early stage breast cancer. Clin Oncol 10(3):173–181, R.Coll.RadiolCrossRefGoogle Scholar
  18. 18.
    Kuehn T, Klauss W, Darsow M, Regele S, Flock F, Maiterth C, Dahlbender R, Wendt I, Kreienberg R (2000) Long-term morbidity following axillary dissection in breast cancer patients—clinical assessment, significance for life quality and the impact of demographic, oncologic and therapeutic factors. Breast Cancer Res Treat 64(3):275–286PubMedCrossRefGoogle Scholar
  19. 19.
    Strauss A, Corbin J (1990) Basics of qualitative research. Sage Publ, Thousand OaksGoogle Scholar
  20. 20.
    Jette AM (2006) Toward a common language for function, disability, and health. Phys Ther 86(5):726–734PubMedGoogle Scholar
  21. 21.
    Shamley DR, Srinanaganathan R, Weatherall R, Oskrochi R, Watson M, Ostlere S, Sugden E (2007) Changes in shoulder muscle size and activity following treatment for breast cancer. Breast Cancer Res Treat 106(1):19–27PubMedCrossRefGoogle Scholar
  22. 22.
    Rietman J, Dijkstra P, Debreczeni R, Geertzen J, Robinson D, De Vries J (2004) Impairments, disabilities and health related quality of life after treatment for breast cancer: a follow-up study 2.7 years after surgery. Disabil Rehabil 26(2):78–84PubMedCrossRefGoogle Scholar
  23. 23.
    Helms G, Kuhn T, Moser L, Remmel E, Kreienberg R (2009) Shoulder-arm morbidity in patients with sentinel node biopsy and complete axillary dissection—data from a prospective randomised trial. Eur J Surg Oncol 35(7):696–701PubMedGoogle Scholar
  24. 24.
    Hayes S, Battistutta D, Newman B (2005) Objective and subjective upper body function six months following diagnosis of breast cancer. Breast Cancer Res Treat 94(1):1–10PubMedCrossRefGoogle Scholar
  25. 25.
    Lauridsen MC, Overgaard M, Overgaard J, Hessov IB, Cristiansen P (2008) Shoulder disability and late symptoms following surgery for early breast cancer. Acta Oncol 47(4):569–575, Stockholm, SwedenPubMedCrossRefGoogle Scholar
  26. 26.
    Nesvold IL, Dahl AA, Lokkevik E, Marit Mengshoel A, Fossa SD (2008) Arm and shoulder morbidity in breast cancer patients after breast-conserving therapy versus mastectomy. Acta Oncol 47(5):835–842PubMedCrossRefGoogle Scholar
  27. 27.
    Thomas-MacLean R, Miedema B, Tatemichi SR (2005) Breast cancer-related lymphedema: women's experiences with an underestimated condition. Can Fam Physician 51:246–247PubMedGoogle Scholar
  28. 28.
    Rietman JS, Dijkstra PU, Geertzen JH, Baas P, De Vries J, Dolsma WV, Groothoff JW, Eisma WH, Hoekstra HJ (2004) Treatment-related upper limb morbidity 1 year after sentinel lymph node biopsy or axillary lymph node dissection for stage I or II breast cancer. Ann Surg Oncol 11(11):1018–1024PubMedCrossRefGoogle Scholar
  29. 29.
    van Gestel YR, Voogd AC, Vingerhoets AJ, Mols F, Nieuwenhuijzen GA, van Driel OJ, van Berlo CL, van de Poll-Franse LV (2007) A comparison of quality of life, disease impact and risk perception in women with invasive breast cancer and ductal carcinoma in situ. Eur J Cancer 43(3):549–556PubMedCrossRefGoogle Scholar
  30. 30.
    Kwan W, Jackson J, Weir LM, Dingee C, McGregor G, Olivotto IA (2002) Chronic arm morbidity after curative breast cancer treatment: prevalence and impact on quality of life. J Clin Oncol 20(20):4242–4248PubMedCrossRefGoogle Scholar
  31. 31.
    Lash TL, Silliman RA (2000) Patient characteristics and treatments associated with a decline in upper-body function following breast cancer therapy. J Clin Epidemiol 53(6):615–622PubMedCrossRefGoogle Scholar
  32. 32.
    McCredie MR, Dite GS, Porter L, Maskiell J, Giles GG, Phillips KA, Redman S, Hopper JL (2001) Prevalence of self-reported arm morbidity following treatment for breast cancer in the Australian Breast Cancer Family Study. Breast 10(6):515–522PubMedCrossRefGoogle Scholar
  33. 33.
    Lauridsen MC, Torsleff KR, Husted H, Erichsen C (2000) Physiotherapy treatment of late symptoms following surgical treatment of breast cancer. Breast 9(1):45–51PubMedCrossRefGoogle Scholar
  34. 34.
    Cinar N, Seckin U, Keskin D, Bodur H, Bozkurt B, Cengiz O (2008) The effectiveness of early rehabilitation in patients with modified radical mastectomy. Cancer Nurs 31(2):160–165PubMedCrossRefGoogle Scholar
  35. 35.
    Chachaj A, Malyszczak K, Pyszel K, Lukas J, Tarkowski R, Pudelko M, Andrzejak R, Szuba A (2010) Physical and psychological impairments of women with upper limb lymphedema following breast cancer treatment. Psychooncology 19:299–305PubMedCrossRefGoogle Scholar
  36. 36.
    Mutrie N, Campbell AM, Whyte F, McConnachie A, Emslie C, Lee L, Kearney N, Walker A, Ritchie D (2007) Benefits of supervised group exercise programme for women being treated for early stage breast cancer: pragmatic randomised controlled trial. BMJ 334(7592):517PubMedCrossRefGoogle Scholar
  37. 37.
    Stout Gergich NL, Levy E, Springer B, Pfalzer L, McGarvey C, Gerber L, Soballe P (2009) Pre operative assessment enables early detection and treatment of shoulder impairments related to breast cancer treatment (abstract). Cancer Res 69(suppl 2):4091CrossRefGoogle Scholar
  38. 38.
    Karki A, Simonen R, Malkia E, Selfe J (2004) Postoperative education concerning the use of the upper limb, and exercise and treatment of the upper limb: cross-sectional survey of 105 breast cancer patients. Support Care Cancer 12(5):347–354PubMedCrossRefGoogle Scholar
  39. 39.
    Morimoto T, Tamura A, Ichihara T, Minakawa T, Kuwamura Y, Miki Y, Sasa M (2003) Evaluation of a new rehabilitation program for postoperative patients with breast cancer. Nurs Health Sci 5(4):275–282PubMedCrossRefGoogle Scholar
  40. 40.
    Box RC, Reul-Hirche HM, Bullock-Saxton JE, Furnival CM (2002) Shoulder movement after breast cancer surgery: results of a randomised controlled study of postoperative physiotherapy. Breast Cancer Res Treat 75(1):35–50PubMedCrossRefGoogle Scholar
  41. 41.
    Milne HM, Wallman KE, Guilfoyle A, Gordon S, Corneya KS (2008) Self-determination theory and physical activity among breast cancer survivors. J Sport Exerc Psychol 30(1):23–38PubMedGoogle Scholar
  42. 42.
    Blanchard CM, Cokkinides V, Courneya KS, Nehl EJ, Stein K, Baker F (2003) A comparison of physical activity of posttreatment breast cancer survivors and noncancer controls. Behav Med 28(4):140–149PubMedCrossRefGoogle Scholar
  43. 43.
    Lee TS, Kilbreath SL, Sullivan G, Refshauge KM, Beith JM, Harris LM (2009) Factors that affect intention to avoid strenuous arm activity after breast cancer surgery. Oncol Nurs Forum 36(4):454–462PubMedCrossRefGoogle Scholar
  44. 44.
    Sagen A, Karesen R, Risberg MA (2009) Physical activity for the affected limb and arm lymphedema after breast cancer surgery. A prospective, randomized controlled trial with two years follow-up. Acta Oncol 48:1102–1110PubMedCrossRefGoogle Scholar
  45. 45.
    Engel J, Kerr J, Schlesinger-Raab A, Sauer H, Holzel D (2003) Axilla surgery severely affects quality of life: results of a 5-year prospective study in breast cancer patients. Breast Cancer Res Treat 79(1):47–57PubMedCrossRefGoogle Scholar
  46. 46.
    Kerr J, Engel J, Schlesinger-Raab A, Sauer H, Holzel D (2003) Communication, quality of life and age: results of a 5-year prospective study in breast cancer patients. Ann Oncol 14(3):421–427PubMedCrossRefGoogle Scholar
  47. 47.
    Bartsch HH, Weis J, Moser MT (2003) Cancer-related fatigue in patients attending oncological rehabilitation programs: prevalence, patterns and predictors. Onkologie 26(1):51–57PubMedCrossRefGoogle Scholar
  48. 48.
    Levangie PK, Drouin J (2009) Magnitude of late effects of breast cancer treatments on shoulder function: a systematic review. Breast Cancer Res Treat 116(1):1–15PubMedCrossRefGoogle Scholar
  49. 49.
    Beaver K, Twomey M, Witham G, Foy S, Luker KA (2006) Meeting the information needs of women with breast cancer: piloting a nurse-led intervention. Eur J Oncol Nurs 10(5):378–390PubMedCrossRefGoogle Scholar
  50. 50.
    Badger T, Segrin C, Meek P, Lopez AM, Bonham E (2005) Profiles of women with breast cancer: who responds to a telephone interpersonal counseling intervention. J Psychosoc Oncol 23(2–3):79–99PubMedGoogle Scholar
  51. 51.
    Salonen P, Tarkka MT, Kellokumpu-Lehtinen PL, Astedt-Kurki P, Luukkaala T, Kaunonen M (2009) Telephone intervention and quality of life in patients with breast cancer. Cancer Nurs 32(3):177–190, quiz 191–172PubMedCrossRefGoogle Scholar
  52. 52.
    Bland KL, Perczyk R, Du W, Rymal C, Koppolu P, McCrary R, Carolin KA, Kosir MA (2003) Can a practicing surgeon detect early lymphedema reliably? Am J Surg 186(5):509–513PubMedCrossRefGoogle Scholar
  53. 53.
    Ganz PA, Hahn EE (2008) Implementing a survivorship care plan for patients with breast cancer. J Clin Oncol 26(5):759–767PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Pamela K. Levangie
    • 1
    Email author
  • Anita M. Santasier
    • 2
  • Nicole L. Stout
    • 3
  • Lucinda Pfalzer
    • 4
  1. 1.MGH Institute of Health ProfessionsBostonUSA
  2. 2.Stony Brook UniversityStony BrookUSA
  3. 3.National Naval Medical CenterBethesdaUSA
  4. 4.University of MichiganFlintUSA

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