Date Presented 03/26/20
The goal of the study was to evaluate the long-term implications of breast cancer on upper-extremity function, participation, and perceived quality of life among Israeli women and to examine the utilization of OT services in the rehabilitation process. The study included two steps: (1) an online survey and (2) face-to-face in-depth evaluation. Women with breast cancer reported a wide range of impairments that are within the domain of OT, but only a small minority received OT services.
Primary Author and Speaker: Danit Langer
Additional Authors and Speakers: Asnat Bar-Haim Erez
Contributing Authors: Hagit Magen, Shlomit Tendler
PURPOSE: Breast cancer (BC) is the most common cancer diagnosed in women. The average risk of a woman in the United States to develop BC sometime in her life is about 12%. (American cancer society). The disease and the various medical treatment may lead to a decrease in physical functioning and participation in social, work, and leisure activities compared with pre morbid functioning. All of these changes can lead to a decline in quality of life (QoL) (Hunter et al., 2017; Jakobsen, et al., 2017). The research in Israel is mostly focused on emotional and medical implications. Therefore the goal of the study was to evaluate the implications of BC on upper extremity function, participation and perceived quality of life (QoL) among Israeli women; examine the utilization of occupational therapy (OT) services in the rehabilitation process.
DESIGN & METHODS: The study includes two steps: (a) an online survey and (b) face to face in depth evaluation. (a) The survey was distributed thru various support groups for women with breast cancer, via electronic media in a convenience and snowball sampling. Measures included The Quick Disabilities of Arm Shoulder and Hand (QuickDASH) questionnaire; the Functional Assessment of Cancer Therapy-Breast (FACT-B) as a QoL measure; the short version of the World Health Organization Disability Assessment Schedule (WHODAS 2). (2) The in-depth face-to-face evaluation is carried out with women (from the online survey) who were willing to participate. At this stage, we collected data from 10 women and expect to reach 20 women for the final analysis. Assessments for this group of women are: FACT-B; the interview long version of the WHODAS; QuickDASH; Functional Assessment of Chronic Illness Therapy-Fatigue 4th Ed (FACIT-F); Shoulder active range of motion (AROM); Pain characteristics and intensity; Hand sensation is measured using the Moberg pick-up test. The BC group was compared to 55 healthy women.
RESULTS: The online survey. A hundred and twenty women participated during a four months collection period (average age 47.66 SD=8.3, rang 31-65), 1 month to 10 years (mean = 3 years SD=2.23) post-diagnosis. 70% of the women reported developing upper extremity disability during or after the medical treatment, and 60% reported that this disability continued after the treatment ended. The average Quick DASH score was 33.19 (25.17), significantly higher (t(df)=8.853(97) p=.001) than normative data (mean=10.68, SD=11.35) and QoL (mean=73.49, SD=19.13) was significantly lower than normative data (mean=85.5, SD=16.4). However only 30% of the women reported receiving a referral to OT. The face to face in depth evaluation. At this point, we present analysis of 10 women. In general, the interviews supported the survey and pointed to difficulties in mobility, household work, participation in society, upper extremity disability, fatigue, memory difficulties self-reported sensory deficiencies and pain compared to the control group. However, no significant disabilities were found in sensation using Moberg pick-up test and in shoulder AROM. The women also gave insights as to specific factors that assisted in their healing process, such as, support from family & friends; finding meaningful leisure activities. Barriers to healing were mainly connected to fear from cancer re-occurrence and insufficient information and empathy from medical team. The women stressed that they received no rehabilitation services.
CONCLUSION: Women with BC reported a wide range of impairments that are within the domain of OT but only a small minority received OT services. OT should be involved in intervention both in the acute and the survivorship stage.
References
American cancer association. Retrieved from: https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html. Jun 4th 2019.
Hunter, E. G., Gibson, R. W., Arbesman, M., & D’Amico, M. (2017). Systematic Review of Occupational Therapy and Adult Cancer Rehabilitation: Part 1. Impact of Physical Activity and Symptom Management Interventions. American Journal of Occupational Therapy, 71(2), 7102100030p1. http://doi.org/10.5014/ajot.2017.023564
Jakobsen, K., Magnus, E., Lundgren, S., & Reidunsdatter, R. J. (2017). Everyday life in breast cancer survivors experiencing challenges: A qualitative study. Scandinavian Journal of Occupational Therapy, 25:4, 298-307, DOI:10.1080/11038128.2017.1335777.
