Date Presented 03/26/20
This longitudinal study examined the factors associated with participation in meaningful activities following breast cancer. The findings emphasized the participation restrictions women face, even six years after diagnosis, in activities with high physical demands. Also, associations between participation and physical and cognitive symptoms were found. The findings highlight the need and were the basis for developing a unique, occupation-based intervention following breast cancer.
Primary Author and Speaker: Khawla Loubani
Contributing Authors: Naomi Schreuer, Uzi Milman
PURPOSE: Breast cancer survivors report on participation restrictions in daily activities that may be associated with their short and long-term physical, psychological and cognitive symptoms (Egan, McEwen, Sikora, et al., 2013). However, there is a lack of studies that examined their changes in level of participation over time and the factors that are associated with these changes. Understanding these issues can be the basis for developing occupation based interventions for enhancing participation in meaningful activities. The purposes of this study were: (a) to compare women’s participation in daily activities at the subacute phase to their participation five years (follow-up) after diagnosis; (b) to explore factors associated with participation in daily activities at follow-up.
DESIGN: this descriptive, longitudinal study included 30 women with a mean age of 53.9 and standard deviation(SD) 8.3 years, five years after diagnosis of breast cancer (stages I-III). Women were recruited from a sample of 60 women from our previous study (Loubani-Hawaita, Schreuer & Milman, 2016) that examined their participation five years after diagnosis.
METHODS: the Activity Card Sort (ACS) (Baum & Edwards, 2001) was used to assess participation in daily activities. Outcome measures included number of activities the woman is currently doing and the retained activity level (RAL), compared to before diagnosis, in social, physical and instrumental daily activities (IADL). Women filled questionnaires that queried about their physical (e.g. range of motion of arm), cognitive (e.g. attention) and psychological (e.g. anxiety) symptoms. MANOVA repeated measures were used to compare between participation two years and five years after diagnosis. Spearman’s correlations were used to explore associations between symptoms and participation.
RESULTS: number of activities significantly increased at the follow-up (F(4,25)=8.3,p=0.001, ɳ2=0.57) and were similar to the number before diagnosis in IADL and social domains but were significantly lower in the highly demanding physical activities (p=.05). RAL at follow-up was significantly higher than in the sub-acute phase in the IADL (f(1,27)=16.32,ɳ2=0.36,p<0.001) and Social (f(1,27)=29.81,ɳ2=0.51,p<0.001) domains only. At follow-up moderate to high significant correlations were found between lower levels of activity to higher severity of symptoms: lower overall RAL of the ACS correlated with more severe physical (r=-0.71,p<0.01) cognitive (r=-0.51,p<0.01) and psychological (r=-0.44,p<0.05) symptoms; lower RAL in IADL correlated with more severe Physical (r=-0.67,p<0.01) and cognitive (r=-0.5,p<0.01) symptoms and lower RAL in the high physical domain correlated with more severe physical symptoms (r=-0.59,p<0.01).
CONCLUSIONS: This follow-up shows that the interaction between the residual long-term symptoms especially physical and cognitive symptoms restricted women’s participation in daily activities five years following diagnosis. The results highlight the need for occupational therapists to be more involved in the evaluation of women with breast cancer in the short and long term. Moreover, these findings emphasize the need for developing occupational therapy rehabilitation interventions that will be intertwined into women’s daily routine and enable them to regain full participation in their meaningful activities in the short and long-term periods after diagnosis (Loh & Musa, 2015). Thus, these results were our basis for developing an early occupation-based intervention that aims to enhance participation and is currently being tested in a randomized clinical trial. The impact of this proposal is by providing initial practical guidelines for occupational therapy interventions during evaluation and treatment processes.
References
Egan, M.,Y., McEwen, S., Sikora, L., et al.(2013). Rehabilitation following cancer treatment. Disability and Rehabilitation, 35(26): 2245–2258. DOI:10.3109/09638288.2013.774441.
Loubani-Hawaita, K., Schreuer, N. and Milman, U.(2016). Participation in daily activities among working women following Breast Cancer. Open Journal of Therapy and Rehabilitation, 4(3). DOI: 10.4236/ojtr.2016.43014.
Baum, C. & Edwards, D. (2001). Activity Card Sort (ACS). Washington University in St. Louis, School of medicine.
Loh, S. Y., & Musa, A. N. (2015). Methods to improve rehabilitation of patients following breast cancer surgery: a review of systematic reviews. Breast Cancer Targets and Therapy, 7, 81–98. DOI:10.2147/BCTT.S47012.
