Date Presented 04/05/19
This study provides support for client-centered perceived function evaluation tools compared to nonindividualized physical function assessment to assess breast cancer survivors' function. The COPM detected 30 to 39% perceived impairment (PI) in self-care, 40 to 44% PI in productive activities, and 40 to 47% PI in leisure activities. The DASH detected approximately 8% more physical function impairments and symptoms than the general population (17.8 vs 10.1).
Primary Author and Speaker: Anne Fleischer
Additional Authors and Speakers: Mary Fisher, Laurie Bunger
PURPOSE: Fatigue and at least one physical impairment are reported among breast cancer survivors (BCS) up to 5 years post-surgery (Hayes et al., 2012; Huang, Chen, Liang, & Miaskowski, 2014). However, few studies have sought to illustrate how these impairments from breast cancer and its treatment influence BCS ability to complete daily activities (Fleischer & Howell, 2017). This study sought to describe the typical activities completed among BCS who are 1-5 years post-surgery, and activities which BCS wanted to perform better. BCS quantified their perceived ability and satisfaction completing the activities, which they wanted to perform better using the Canadian Occupational Performance Measure (COPM).
DESIGN: Concurrent cross-sectional mixed method study
METHOD: Women were recruited who were between 30-69 years of age and diagnosed with Stage 1-3 breast cancer between 12-60 months prior to recruitment. Women with metastatic breast cancer, past shoulder injury, shoulder or neck or chest surgery, gross cognitive deficits, recurrence of cancer, cardiovascular contraindications or were non-English speaking were excluded. This study was a component of a larger study examining the association between perceived stress (PS) and perceived arm function (PAF). Physical therapy students administered objective physical functioning and self-reported quality of life, PS, PAF, and fear of physical activity measurements were administered in a clinic. Occupational therapy students at another university administered the COPM via videoconferencing. For this component of the study, COPM and the Disabilities Arm Shoulder and Hand (DASH) survey data were analyzed. Using data derived from the COPM and average DASH score, descriptive statistics illustrated the perceived ability and satisfaction of completing activities that the survivors wanted to perform better. Typical daily activities listed by BCS were categorized by self-care, productive and leisure activities, then quantified. This process was repeated for the specific activities that BCS wanted to improve.
RESULTS: BCS included 25 women with a mean age of 52 years (range 31-68). During the COPM interview, BCS listed 50 self-care activities which were grouped into 20 unique categories, 98 productive activities grouped into 3 categories; and 95 leisure activities grouped into 3 categories. Of these activities, BCS mentioned 18 self-care, 48 productive and 24 leisure activities that they wanted to improve. Their average perceived performance (PP) with self-care activities was M = 6.1, Mdn = 7 (s = 2.5, R= 2-9) and perceived satisfaction (PSat) was M = 6.3, Mdn = 7 (s =3.2, R = 1-10) or 30-39% perceived impairment. Their average PP with productive activities was M = 5.6, Mdn = 6 (s =2.4, R = 1-9) and PSat was M = 5.5, Mdn = 6 (s = 2.6, R= 1-9) or 40-44% perceived impairment. Their average PP with leisure activities was M = 5.7, Mdn = 6 (s =2.5, R = 0-9) and PSat was M = 5.3, Mdn = 5 (s =2.7, R = 1-10) or 40-47% impairment. The average DASH score was 17.7, Mdn = 15.7, R= 0-47.41, s= 12.1. While the general population score was 10.1, s = 14.68 (Hunsaker, 2002).
CONCLUSIONS: BCS continue to express perceived dissatisfaction with how they perform self-care, productive and leisure activities that they complete. Instrumental activities of daily living (IADL) and leisure activities were the most common category of activities mentioned by survivors. COPM within this study detected greater impairments than the DASH, which is not individualized.
IMPACT: The study provides support for using client centered perceived function evaluation tools among women treated for breast cancer. The COPM is client centered compared to the commonly used DASH which is not individualized and only evaluates upper body function.
References
Fleischer & Howell (2017). The experience of breast cancer survivors’ participation in important activities during and after treatments. British Journal of Occupational Therapy. 80(8), 470-478. https://doi.org/10.1177/0308022617700652
Hayes, S. C., Johansson, K., Stout, N., Prosnitz, R., Armer, J., Gabram, S., & Schmitz, K. H. (2012). Upper-body morbidity after breast cancer: incidence and evidence for evaluation, prevention, and management within a prospective surveillance model of care. Cancer, 118(8), 2237-2249.
Huang, H.-P., Chen, M.-L., Liang, J., & Miaskowski, C. (2014). Changes in and predictors of severity of fatigue in women with breast cancer: A longitudinal study. International Journal of Nursing Studies, 51(4), 582-592. doi:10.1016/j.ijnurstu.2013.09.003
Hunsaker FG, Cioffi DA, Amadio PC, Wright JG, Caughlin B. (2002). The American Academy of Orthopaedic Surgeons Outcomes Instruments – Normative Values from the General Population. Journal of Bone and Joint Surgery, 84-A(2),208-215.
