Needs and Model of Physical Therapy Service for Breast Cancer Patients

• Main Authors: Heui-Fen Lin, 林慧芬
• Other Authors: Jau-Yih Tsauo
• Format: Others
• Language: zh-TW
• Published: 2017
• Online Access: http://ndltd.ncl.edu.tw/handle/nf856v

博士 === 國立臺灣大學 === 物理治療學研究所 === 105 === Significant progress in breast cancer treatment made prolonging survival of patients with breast cancer. Many cancer survivors experience lasting, adverse effects caused by cancer and cancer treatment. Survivorship issues and quality of life of patients related to breast cancer treatment has recently drawn significant attention. Breast cancer survivors deserve the best possible care to manage the complications of breast cancer treatment and restore optimal function. Physical therapists are members of the multi-professional team to prevent and to decrease physical sequelae. In addition to traditional rehabilitation, physical therapy has important role on surveillance for early identification and intervention of upper extremity morbidities caused by breast cancer surgery and related treatment. Physical training for the sake of health promotion is also needed and may be provided by physical therapist. The purpose of this dissertation was to find a possible need-met and functioning based service model of physical therapy for women with breast cancer during their cancer trajectory. This dissertation included three studies. Study I was a cross-sectional questionnaire survey investigating common breast cancer treatment related upper body morbidities, upper body function and quality of life as well as physical rehabilitation needs. A total 249 valid questionnaires were analyzed. The results revealed that 81.5% of participants reported having at least one, with average 4.5±3.6 symptoms, of a total 12 common arm symptoms listed. Pain at least one site was reported by 73.7% of the subjects. Motion restriction was reported among 60% of subjects. Weakness was reported among 38% of subjects. And about 30% reported arm or axillary swelling. Pain, weakness and shoulder range of motion limitation related to upper extremity dysfunction and quality of life. In the second part of the questionnaire survey about physical rehabilitation needs, participants reported that post-surgical rehabilitation instruction was mostly given by nurse. Only 20% of participants reported had received post-surgical rehabilitation instruction by a physical therapist, which was much lower than expectation. Besides need of PT for post-surgical education and symptom management, high need of physical training was also found in this study In the second study, a longitudinal surveillance care model was provided in order to observe functional recovery trajectory of breast cancer patient after surgery, and to examine the effect of PT surveillance care model in preventing further functional impairment by early detection and intervention. Newly diagnosed unilateral breast cancer patients are recruited after surgery. Physical therapy evaluations and questionnaire survey including upper extremity disability and quality of life were assessed at 3, 6, 12, months post-surgery. Self-management instruction and counselling will be given if needed after evaluation. Total 155 participants were included and attended follow-up assessment and they were randomized into surveillance group (76 participants) or usual care group (79 participants). The primary outcomes including upper extremity disability, upper body morbidities such as insufficient shoulder range of motion or muscle flexibility, pain, edema and weakness. The secondary outcome was quality of life. The results revealed no significant difference between the two groups. Most upper body symptoms; disability and quality of life were recovered 3 months after surgery. However, presence of shoulder ROM limitation and mild upper extremity disability were found among near 10% of participants. A trend of prevalence increase over time among such as round shoulder, pectoralis minor tightness, and myofascial pain were found. Study III examined the effect of progressive resistance training for breast cancer survivors which conducted by a randomized controlled trial. A total 34 breast cancer survivors were recruited in this study. Participant assigned to exercise group received a 12 -week, twice weekly progressive resistant training programs instructed by a physical therapist. There was no significant difference between groups on physical fitness, function, and quality of life, which may be due to small sample size, insufficient training intensity or ceiling effect. In summary, breast cancer treatment related upper body morbidities were prevalent and found higher in subjective symptom survey than objective physical examination. Pain, shoulder range of motion limitation and feeling weakness were found having negative impact on upper extremity function. Higher prevalence of reporting edema, scar tightness and shoulder range of motion limitation were found among subjects underwent more extensive surgery. However, surgical type only influenced muscle flexibility and AWS for short term according to the longitudinal observation. Further research on the association between posture, muscle flexibility and myofascial pain was needed. In the surveillance of upper extremity function, physical therapist must pay attention to the evaluation and intervention of posture change and myofascial conditions, although research on the effect of intervention is still lacking. Our participants were highly educated, with high information need and internet user. Information and screening by using web and computer system is suggested.