Current physical therapy care of patients undergoing breast reconstruction for breast cancer: a survey of practice in the United Kingdom and Brazil

Mazuquin, Bruno; Oliveira, Mariana Maia Freire de; Silva, Marcela Ponzio Pinto e; Sarian, Luís Otávio; Williamson, Esther; Bruce, Julie

doi:10.1016/j.bjpt.2020.05.010

Cited by 5 publications

(12 citation statements)

References 38 publications

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“…Targeted and early intervention physical rehabilitation and education have been found to be effective in alleviating or resolving many of the physical side-effects associated with breast cancer surgery and treatment [3,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. Only a few studies, however, have investigated the translation of this physical rehabilitation research into clinical practice.…”

Section: Introductionmentioning

confidence: 99%

“…More than 90% of women with metastatic breast cancer who had either a mastectomy or breast conserving surgery were found to have physical impairments that would, at least in part, be ameliorated by standard rehabilitation measures, and yet less than a third of these women received any rehabilitation treatment [37]. After breast reconstuction surgery, less than 50% of women reported that they were referred to physiotherapy [26]. This research suggests that translation of physical rehabilitation research into clinical practice is limited and might vary after different types of breast cancer surgery.…”

Section: Introductionmentioning

confidence: 99%

“…Most physical rehabilitation research following breast cancer surgery has focused on the physical sideeffects related to shoulder issues and lymphoedema [3,[21][22][23][24][25][26][27][28][29][30]35]. Physical side-effects relating to breast support, scar, or torso issues or physical discomfort disturbing sleep have not commonly been investigated.…”

Section: Introductionmentioning

confidence: 99%

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Physical Rehabilitation: A Gap in Care Following all Types of Breast Cancer Surgery.

McGhee¹,

Steele²

2021

Preprint

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Purpose: To investigate the access to and content of physical rehabilitation received by women after different types of breast cancer surgery. Methods: On-line survey of 632 Australia women (59.8 years SD 9.6) grouped according to their last reported breast cancer surgery: (i) breast conserving surgery (BCS; n=228), (ii) mastectomy (n=208; MAST), and (iii) breast reconstruction (BRS; n=196). Respondents retrospectively reported the physical rehabilitation education and treatment they received for six physical side-effects. Chi square of analysis of the percentage of respondents who received any form of physical rehabilitation for each physical side-effect amongst the three groups. Tabulation of the percentage of the entire cohort (n=632) that had lymph nodes removed, post-operative complications, or pre-existing musculoskeletal issues who received any form of physical rehabilitation as part of standard post-operative care.Results: No significant difference was found in the percentage of respondents who received any form of physical rehabilitation across the three groups, except for the physical side-effects of lymphoedema and breast support issues. Substantial variation was found in the percentage that received physical rehabilitation across the different physical side-effects. Physical rehabilitation for shoulder issues and lymphoedema was received by 75% and 70% of respondents respectively as part of standard care, compared to scar and torso issues and physical discomfort disturbing sleep, where less than 50% received any form of physical rehabilitation. Conclusion: Access to physical rehabilitation is poor following all types of breast cancer surgery, with gaps in the physical rehabilitation provided for specific physical side-effects.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Physical Rehabilitation: A Gap in Care Following all Types of Breast Cancer Surgery.

McGhee¹,

Steele²

2021

Preprint

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“…The physical side-effects following breast cancer surgery are responsive to physical rehabilitation education and treatment provided within research studies [9,10] [2,[11][12][13][14]]. There appears, however, to be limited translation of such physical rehabilitation into clinical practice, with only a minority of women reporting they receive physical rehabilitation education or treatment after their breast cancer surgery [10,[15][16][17][18][19][20][21], even women who have a higher risk of developing more frequent and severe physical side-effects [22].…”

Section: Introductionmentioning

confidence: 99%

“…Patient perceptions on physical rehabilitation have only previously been investigated in focus group studies, where dissatisfaction with physical rehabilitation has been reported [10,11,17]. Further research is therefore required to quantify the content and delivery format of the physical rehabilitation provided to a large cohort of women within clinical practice, in conjunction with patient perceptions on this physical rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

Patient perceptions of physical rehabilitation education and treatment after breast cancer surgery: A mixed methods study

McGhee¹,

At²,

Steele³

2021

Preprint

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Purpose To investigate the content and delivery of physical rehabilitation education and treatment received by women following breast cancer surgery and to establish patient perceptions of this physical rehabilitation.Methods 509 Australian women (55 years SD 6.5) who previously had breast cancer surgery retrospectively completed an online survey about the content, delivery, satisfaction with and perceptions of the physical rehabilitation they received for six physical side-effects. The percentage of respondents who received each delivery format for the six physical side-effects and their satisfaction levels were tabulated. A thematic analysis was conducted on patients’ perceptions of the physical rehabilitation they received.Results Pamphlets were the most common delivery format of physical rehabilitation following breast cancer surgery. Common physical side-effects, however, were not included in the content and at less than 50% of women were satisfied with their physical rehabilitation. Three major themes emerged: Women perceived (i) they were unaware of and unprepared for the physical side-effects of their surgery/treatment, (ii) information delivery was unsuitable in terms of the timing, delivery format and cognisance of patient needs, and (iii) follow-up was insufficient at critical time points of recovery.Conclusion The physical rehabilitation received by women after all types of breast cancer surgery is perceived to be poor in terms of its content, delivery format and follow-up and women perceive that their needs at various stages of recovery are not being met. Physical rehabilitation needs to improve after all types of breast cancer surgery.

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Social Determinants of Health and Patient-reported Outcomes Following Autologous Breast Reconstruction, Using Insurance as a Proxy

Plotsker,

Graziano,

Kim

et al. 2024

J Reconstr Microsurg

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Introduction: Insurance type can serve as a surrogate marker for social determinants of health and can influence many aspects of the breast reconstruction experience. We aimed to examine the impact of insurance coverage on patients reported outcomes with the BREAST-Q in patients receiving deep inferior epigastric artery perforator (DIEP) flap breast reconstruction. Methods: We retrospectively examined patients who received DIEP flaps at our institution from 2010-2019. Patients were divided into categories by insurance: commercial, Medicaid, or Medicare. Demographic factors, surgical factors, and complication data were recorded. Descriptive statistics, Fisher’s exact, Kruskal-Wallis rank sum tests, and generalized estimating equations were performed to identify associations between insurance status and five domains of the BREAST-Q Reconstructive module. Results: 1,285 patients were included, of which 1,011 (78.7%) had commercial, 89 (6.9%) had Medicaid, and 185 (14.4%) had Medicare insurances. Total flap loss rates were significant higher in the Medicare and Medicaid patients as compared to commercial patients; however, commercial patients had a higher rate of wound dehiscence as compared to Medicare patients. With all other factors controlled for, patients with Medicare had lower Physical Well-Being of the Chest (PWBC) than patients with commercial insurance (β =-3.1, 95% CI: -5.0, -1.2, p=0.002). There were no significant associations between insurance classification and other domains of the BREAST-Q. Conclusion: Patients with government issued insurance had lower success rates of autologous breast reconstruction. Further, Patients with Medicare had lower PWBC than patients with commercial insurance regardless of other factors, while other BREAST-Q metrics did not differ. Further investigation as to the causes of such variation is warranted in larger, more diverse cohorts.

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Current physical therapy care of patients undergoing breast reconstruction for breast cancer: a survey of practice in the United Kingdom and Brazil

Cited by 5 publications

References 38 publications

Physical Rehabilitation: A Gap in Care Following all Types of Breast Cancer Surgery.

Physical Rehabilitation: A Gap in Care Following all Types of Breast Cancer Surgery.

Patient perceptions of physical rehabilitation education and treatment after breast cancer surgery: A mixed methods study

Social Determinants of Health and Patient-reported Outcomes Following Autologous Breast Reconstruction, Using Insurance as a Proxy

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