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



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.


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.


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.


Breast neoplasm Shoulder dysfunction Qualitative research Physical therapy 



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.


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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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