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Publication Date

8-19-2023

Keywords

breast cancer, occupational therapy, physical therapy, continuum of care, quality of life, rehabilitation, oncology

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Presentation: 20:54

Presentation completed in partial fulfillment of a Post Professional Occupational Therapy Doctorate degree at Thomas Jefferson University.

Abstract

Introduction: Advances in health care for those with breast cancer (BC), have led to people living longer lives, however many continue to have difficulty completing daily activities (Hwang et al., 2015; Keesing et al., 2018; Lovelace et al., 2019; Stout et al., 2015; Stubblefield, ). Research explains that physical rehabilitation is beneficial for people with BC, however is not always being recommended (Cheville et al., 2008; Hwang et al., 2015; Pergoletti, 2014; Rafn et al., 2020; Stout et al., 2016; Stout et al., 2015).

Objectives: This study looked at rehabilitation referral patterns and trends for women diagnosed with BC who had undergone a mastectomy.

Methods: A retrospective descriptive chart review was conducted. Medical records of 164 individuals with BC were reviewed. Data collected included demographics, cancer stage, adjuvant treatment types, referral orders for occupational therapy (OT) and physical therapy (PT), referring provider’s specialty, phase along continuum of care in which referral was ordered, common comorbidities, and performance measures scores.

Results: Data analysis revealed that only forty-eight (29.3%) were referred for physical rehabilitation, with 9.1% being referred to OT and forty-six (29.3%) to PT. Most referrals were ordered during the adjuvant/survivorship phases, while only one was ordered during the pre-operative phase. A total of 233 instances of impairments were found where no referrals were ordered, but may have been indicated.

Conclusion: Results suggest that rehabilitation services continue to be severely underutilized. Several areas were identified that could be utilized to assist providers with referral decision making.

References:

  • Cheville,A., Troxel, A., Basford, J., & Kornblith, A. (2008). Prevalence and treatment patterns of physical impairments in patients with metastatic breast cancer. Journal of Clinical Oncology, 26(16), 2621–2629. https://doi.org/10.1200/JCO.2007.12.3075
  • Hwang, E. J., Lokietz, N. C., Lozano, R. L., & Parke, M. A. (2015). Functional deficits and quality of life among cancer survivors: Implications for occupational therapy in cancer survivorship care. The American Journal of Occupational Therapy, 69(6), 6906290010–6906290010. https://doi.org/10.5014/ajot.2015.015974
  • Keesing, S., Rosenwax, L., & McNamara, B. (2018). Identifying the contribution of occupational therapy in meeting the needs of women survivors of breast cancer. The British Journal of Occupational Therapy, 81(7), 402–412. https://doi.org/10.1177/0308022618762080
  • Lovelace, McDaniel, L. R., & Golden, D. (2019). Long‐term effects of breast cancer surgery, treatment, and survivor care. Journal of Midwifery & Women’s Health, 64(6), 713–724. https://doi.org/10.1111/jmwh.13012
  • Pergoletti, M., Cutchin, M.P., Weinberger, M., & Meyer, A.M. (2014). Occupational therapy use by older adults with cancer. American Journal of Occupational Therapy, 68, 597-607. https://doi.org/10.5014/ajot.2014.01.011791
  • Rafn, B. S., Midtgaard, J., Camp, P. G., & Campbell, K. L. (2020). Shared concern with current breast cancer rehabilitation services: A focus group study of survivors’ and professionals’ experiences and preferences for rehabilitation care delivery. BMJ open, 10(7), e037280.
  • Stubblefield, M. D. (2017). The underutilization of rehabilitation to treat physical impairments in breast cancer survivors. Pm&r, 9(9), S317-S323.
  • Stout, Silver, J. K., Raj, V. S., Rowland, J., Gerber, L., Cheville, A., Ness, K. K., Radomski, M., Nitkin, R., Stubblefield, M. D., Morris, G. S., Acevedo, A., Brandon, Z., Braveman, B., Cunningham, S., Gilchrist, L., Jones, L., Padgett, L., Wolf, T., … Chan, L. (2016). Toward a national initiative in cancer rehabilitation: recommendations from a subject matter expert group. Archives of Physical Medicine and Rehabilitation, 97(11), 2006–2015. https://doi.org/10.1016/j.apmr.2016.05.002
  • Stout, N. L., Harrington, S. E., Pfalzer, L. A., & Fisher, M. I. (2015). Breast cancer rehabilitation. Topics in geriatric rehabilitation, 31(4), 258-272.

Synopsis: This study shows that there needs to a better job of making sure those with breast cancerknow about and use rehabilitation services. If doctors understand when to recommend therapy, it can help bridge the gap in care and make patients’ lives better. In the future, studies should look at how much doctors know about these therapies and how they can work together to provide better care for these patients. This could help to find where medical training needs to be improved to give patients a more complete and coordinated care.

Acknowledgments: Dr AnnaMarie Lopez, Dr Kelley Wood, Dr Cathy Piersol, Dr MJ Mulcahey, MaclainCapron, Joe Kardine

Language

English

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