Abstract
Purpose
To evaluate the impact and acceptability of outpatient physical or occupational therapy (PT/OT) for breast cancer survivors (BCS) with varying levels of upper extremity disability (UED).
Methods
We retrospectively extracted patient and therapy characteristics, UED measured by quick-disabilities of the arm, shoulder and hand (QuickDASH, 0–100 pts.), and patient-rated acceptability (1-item, 0–10 pts) from rehabilitation charts of BCS who completed cancer-specialized PT/OT provided by a single national institution in 2019. We summarized characteristics and acceptability using descriptive statistics, then used established parameters to group BCS by baseline UED severity: high- (QuickDASH > 31.5), moderate- (QuickDASH = 18.5–31.5), or low-UED (QuickDASH = 13–18.5). To evaluate within-group pre-to-post QuickDASH change, we used paired samples t test (p < 0.01), then calculated the proportion who achieved the minimally clinical important difference (MCID, 15.9 points). To compare between-groups difference in QuickDASH improvement, we used Kruskal–Wallis test and Chi-squared test.
Results
Patients (N = 417) were 59.89 ± 12.06 years old, 99% female, and attended approximately 10 PT/OT sessions (IQR = 6.0–16.0). Most had high baseline UED (62%), followed by moderate (25%) or low UED (13%). For each severity group, mean pre-to-post change in QuickDASH was significant: high-UED (M∆ = 25.13 ± 20.33, d = 1.24, p < 0.01), moderate-UED (M∆ = 11.36 ± 11.9, d = 0.95, p < 0.01), and low-UED (M∆ = 4.84 ± 9.15, d = 0.53, p < 0.01). Most with high UED achieved the MCID (n = 176, 68.2%). In the moderate- and low-UED groups 44% (n = 46) and 4% (n = 2) achieved the MCID, respectively. Acceptability was high (n = 167, Median = 10).
Conclusion
Outpatient cancer rehabilitation is associated with significant improvement in UED for BCS and was acceptable to patients regardless of UED severity at baseline.
Similar content being viewed by others
Data availability
Data and coding available upon request.
References
Cancer Stat Facts: Female Breast Cancer (2021) Cancer Stat Facts: Female Breast Cancer. In: Natl. Cancer Inst. Surveillance, Epidemiol. End Results Progr. https://seer.cancer.gov/statfacts/html/breast.html. Accessed 12 Jan 2021
Chrischilles EA, Riley D, Letuchy E, et al. Upper extremity disability and quality of life after breast cancer treatment in the Greater Plains Collaborative clinical research network. Breast Cancer Res Treat. 2019;175:675–89. https://doi.org/10.1007/S10549-019-05184-1/TABLES/4.
Stubblefield MD, Keole N. Upper body pain and functional disorders in patients with breast cancer. PM&R. 2014;6:170–83. https://doi.org/10.1016/J.PMRJ.2013.08.605.
Schmitz KH, Speck RM, Rye SA, et al. Prevalence of breast cancer treatment sequelae over 6 years of follow-up: the pulling through study. Cancer. 2012. https://doi.org/10.1002/cncr.27474.
Kootstra JJ, Dijkstra PU, Rietman H, et al. A longitudinal study of shoulder and arm morbidity in breast cancer survivors 7 years after sentinel lymph node biopsy or axillary lymph node dissection. Breast Cancer Res Treat. 2013;139:125–34. https://doi.org/10.1007/S10549-013-2509-Y/TABLES/5.
Fisher MI, Capilouto G, Malone T, et al. Comparison of upper extremity function in women with and women without a history of breast cancer. Phys Ther. 2020;100:500–8. https://doi.org/10.1093/PTJ/PZAA015.
Alfano CM, Pergolotti M. Next-generation cancer rehabilitation: a giant step forward for patient care. Rehabil Nurs. 2018;43:186–94. https://doi.org/10.1097/rnj.0000000000000174.
Runowicz CD, Leach CR, Henry NL, et al. American cancer society/American society of clinical oncology breast cancer survivorship care guideline. J Clin Oncol. 2015;34:611–35. https://doi.org/10.1200/JCO.2015.64.3809.
De Groef A, Van Kampen M, Dieltjens E, et al. Effectiveness of postoperative physical therapy for upper-limb impairments after breast cancer treatment: a systematic review. Arch Phys Med Rehabil. 2015;96:1140–53. https://doi.org/10.1016/j.apmr.2015.01.006.
Naehrig DN, Dhillon HM, Asher R, et al. (2021) Patient-reported outcome measures and supportive care need assessment in patients attending an Australian comprehensive care centre: a multi-method study. Support Care Cancer. 2021;299(29):5037–46. https://doi.org/10.1007/S00520-021-06028-9.
Mercieca-Bebber R, King MT, Calvert MJ, et al. The importance of patient-reported outcomes in clinical trials and strategies for future optimization. Patient Relat Outcome Meas. 2018;9:353. https://doi.org/10.2147/PROM.S156279.
Pergolotti M, Alfano CM, Cernich AN, et al. A health services research agenda to fully integrate cancer rehabilitation into oncology care. Cancer. 2019. https://doi.org/10.1002/cncr.32382.
Graham JE, Middleton A, Roberts P, et al. Health services research in rehabilitation and disability—the time is now. Arch Phys Med Rehabil. 2018;99:198. https://doi.org/10.1016/J.APMR.2017.06.026.
Kamper SJ. Generalizability: linking evidence to practice. J Orthop Sports Phys Ther. 2020;50:45–6. https://doi.org/10.2519/JOSPT.2020.0701.
Horn SD, Dejong G, Deutscher D. Practice-based evidence research in rehabilitation: an alternative to randomized controlled trials and traditional observational studies. Arch Phys Med Rehabil. 2012;93:S127–37. https://doi.org/10.1016/J.APMR.2011.10.031.
Rafn BS, Christensen J, Larsen A, Bloomquist K. Prospective surveillance for breast cancer-related arm lymphedema: a systematic review and meta-analysis. J Clin Oncol. 2022. https://doi.org/10.1200/JCO.21.01681.
Salaffi F, Di Carlo M, Carotti M, Farah S. Validity and interpretability of the QuickDASH in the assessment of hand disability in rheumatoid arthritis. Rheumatol Int. 2019;39:923–32. https://doi.org/10.1007/S00296-018-4216-9.
Campbell KL, Pusic AL, Zucker DS, et al. A prospective model of care for breast cancer rehabilitation: function. Cancer. 2012;118:2300–11. https://doi.org/10.1002/cncr.27464.
Motheral B, Brooks J, Clark MA, et al. A checklist for retrospective database studies—report of the ISPOR task force on retrospective databases. Value Heal. 2003;6:90–7. https://doi.org/10.1046/J.1524-4733.2003.00242.X.
Franchignoni F, Vercelli S, Giordano A, et al. Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and Its shortened version (QuickDASH). J Orthop Sports Phys Ther. 2013;44:30–9. https://doi.org/10.2519/jospt20144893.
Mintken P, Glynn P, Cleland J. Psychometric properties of the shortened disabilities of the arm, shoulder, and hand Questionnaire (QuickDASH) and numeric pain rating scale in patients with shoulder pain. J shoulder Elb Surg. 2009;18:920–6. https://doi.org/10.1016/J.JSE.2008.12.015.
LeBlanc M, Stineman M, DeMichele A, et al. Validation of QuickDASH outcome measure in breast cancer survivors for upper extremity disability. Arch Phys Med Rehabil. 2014;95:493–8. https://doi.org/10.1016/J.APMR.2013.09.016.
Miale S, Harrington S, Kendig T. Oncology section task force on breast cancer outcomes: clinical measures of upper extremity function. Rehabil Oncol. 2013;31(1):27–34.
McGlothlin AE, Lewis RJ. Minimal clinically important difference: defining what really matters to patients. JAMA. 2014;312:1342–3. https://doi.org/10.1001/JAMA.2014.13128.
Corp IBM. IBM SPSS statistics for Windows, Version 27. New York: IBM Corp; 2020.
Rossen S, Trier K, Christensen B, et al. Municipality-based pragmatic rehabilitation stratified in accordance with individual needs—results from a longitudinal survey study. Support Care Cancer. 2020;28:1951–61. https://doi.org/10.1007/S00520-019-04993-W/TABLES/5.
Brick R, Turner R, Bender C, et al. Impact of non-pharmacological interventions on activity limitations and participation restrictions in older breast cancer survivors: a scoping review. J Geriatr Oncol. 2021. https://doi.org/10.1016/J.JGO.2021.09.010.
Acknowledgements
We would like to thank the individuals who participated in rehabilitation services and our partners: Baylor Scott & White Institute for Rehabilitation, SSM Health Physical Therapy, Banner Physical Therapy, NovaCare Rehabilitation, and KORT Physical Therapy.
Funding
The authors declare no additional funds, grants or other support were received during the preparation of this manuscript.
Author information
Authors and Affiliations
Contributions
KCW: led data extraction, analysis and initial manuscript preparation with support from MH, TK and MP. All authors reviewed and advised on the study and manuscript at each stage.
Corresponding author
Ethics declarations
Conflict of interest
Authors, Wood, Pergolotti, and Kendig receive salaries from Select Medical. Author, Hidde, is an hourly employee of Select Medical. The authors have no other relevant financial or non-financial interested to disclose. The content is solely the responsibility of the authors and does not necessarily represent the official views of Select Medical.
Ethical approval
This retrospective study was approved by the Colorado State University Institutional Review Board (Protocol #19-9379H).
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Wood, K.C., Hidde, M., Kendig, T. et al. Community-based outpatient rehabilitation for the treatment of breast cancer-related upper extremity disability: an evaluation of practice-based evidence. Breast Cancer 29, 1099–1105 (2022). https://doi.org/10.1007/s12282-022-01388-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12282-022-01388-4