Role of physiotherapy in supporting recovery from breast cancer treatment: a qualitative study embedded within the UK PROSPER trial

Abstract

ObjectivesTo explore the experiences of women with breast cancer taking part in an early physiotherapy-led exercise intervention compared with the experiences of those receiving usual care. To understand physiotherapists’ experience of delivering the trial intervention. To explore acceptability of the intervention and issues related to the implementation of the Prevention Of Shoulder Problems (PROSPER) programme from participant and physiotherapist perspective.DesignQualitative semistructured interviews with thematic analysis.SettingUK National Health Service.ParticipantsTwenty participants at high risk of shoulder problems after breast cancer surgery recruited to the UK PROSPER trial (10 each from the intervention arm and control arm), and 11 physiotherapists who delivered the intervention. Trial participants were sampled using convenience sampling. Physiotherapists were purposively sampled from high and low recruiting sites.ResultsParticipants described that the PROSPER exercise intervention helped them feel confident in what their body could do and helped them regain a sense of control in the context of cancer treatment, which was largely disempowering. Control arm participants expressed less of a sense of control over their well-being. Physiotherapists found the exercise intervention enjoyable to deliver and felt it was valuable to their patients. The extra time allocated for appointments during intervention delivery made physiotherapists feel they were providing optimal care, being the ‘perfect physio’. Lessons were learnt about the implementation of a complex exercise intervention for women with breast cancer, and the issues raised will inform the development of a future implementation strategy.ConclusionsA physiotherapist-delivered early supported exercise intervention with integrated behavioural strategies helped women at risk of shoulder problems following breast cancer treatment to feel more confident in their ability to mobilise their arm post-surgery. A physiotherapist-delivered early supported exercise intervention with integrated behavioural strategies may address the sense of powerlessness that many women experience during breast cancer treatment.Trial registration numberISRCTN35358984.

Prescribing pre‐ and post‐operative physical activity interventions for people undergoing breast cancer surgery: A qualitative systematic review

“…In total, 14 studies were included within this systematic review (see Table 2 for Study Characteristics). The studies spanned seven different countries, including Canada, [30][31][32] USA, [33][34][35][36] Sweden, 37,38 Ireland, 39 England, 40 Korea 41,42 and Scotland, 43 and were conducted between the years of 2008-2021. The included studies shared the perspectives of 418 breast cancer patients who had either undergone, or were about to undergo, surgery as a treatment for breast cancer.…”

“…Of the included studies, only one explored and implemented a preoperative physical activity intervention 30 ; the remaining 13 studies focused on interventions that occurred postoperatively. Across the included papers, there was variation in the descriptions used to define the type of breast cancer surgery, these included: mastectomy (or total mastectomy) 30,[33][34][35][36][38][39][40][41][42] ; partial mastectomy (or breast conserving surgery or lumpectomy) 30,[33][34][35][36][38][39][40][41][42] ; reconstruction [34][35][36]39 ; sentinel lymph node biopsy 30,36,37,40,41 ; and axillary node dissection/clearance. 30,36,37,40,41 Three of the papers did not specify a surgery type.…”

“…Across the included papers, there was variation in the descriptions used to define the type of breast cancer surgery, these included: mastectomy (or total mastectomy) 30,[33][34][35][36][38][39][40][41][42] ; partial mastectomy (or breast conserving surgery or lumpectomy) 30,[33][34][35][36][38][39][40][41][42] ; reconstruction [34][35][36]39 ; sentinel lymph node biopsy 30,36,37,40,41 ; and axillary node dissection/clearance. 30,36,37,40,41 Three of the papers did not specify a surgery type. 31,32,43 With regards to the physical activity intervention explored, there was variation in both the (i) type and (ii) delivery method used; two studies undertook vigorous aerobic exercise as their intervention 30,31 ; one study focused on water-based exercise classes 38 ; two of the articles studied physiotherapist-led exercises 40 ; and one of these studies also implemented digital strategies via a mobile health intervention.…”

“…30,36,37,40,41 Three of the papers did not specify a surgery type. 31,32,43 With regards to the physical activity intervention explored, there was variation in both the (i) type and (ii) delivery method used; two studies undertook vigorous aerobic exercise as their intervention 30,31 ; one study focused on water-based exercise classes 38 ; two of the articles studied physiotherapist-led exercises 40 ; and one of these studies also implemented digital strategies via a mobile health intervention. 39 Other interventions with digital elements included kinetic lymphatic exercises, 36 and a weight loss programme over 6 months with weekly video call sessions.…”

Association of social service counseling in breast cancer patients with financial problems, role functioning and employment—results from the prospective multicenter BRENDA II study

“…Breast cancer (BC) is by far the most common type of cancer in women, with one in eight woman developing in the course of her lifetime. About one third of cases occur in women younger than 55 years [ 1 ] and, for them, successfully returning to work is often an important aim of supportive care and rehabilitation [ 2 ]. Technical advances in diagnostics and treatment have significantly improved disease prognosis [ 3 ].…”