This year over 3,400 women in British Columbia (BC) will be diagnosed with breast cancer. For the vast majority of cases, treatment starts with surgery. In the past 5 years, a team of frontline physiotherapists, plastic surgeons, researchers and leaders from Providence Health Care, Fraser Health and UBC Department of Physical Therapy have been collaborating on ways to optimize the pre-operative and post-operative care of women receiving surgery for breast cancer. The overarching goal of this work is to reduce the impact of common post-surgical arm impairments (e.g. reduced function, pain and development of lymphedema) on women’s lives. .
This work is focussed on identifying efficient ways to recognize women who are the most likely to experience arm impairments and then target treatment resources to those women. Our initial work has explored models of ‘prospective surveillance’ – serially monitoring women for arm issues at set time points over the first year following surgery and directing those who are identified with persistent arm issues to physiotherapy services. This approach has been well received by the patients, who generally are keen to be proactive in addressing arm issues and report that the surveillance approach is not overly burdensome. While range of motion and strength were key indicators of arm issues from the perspective of the research team, overall function, as assessed by a self-report questionnaire, was reported by the patients to be the most meaningful measure. The main results from this study will be presented at the upcoming American Physical Therapy Association Annual Meeting and a cost analysis of this approach will be presented at the Annual Canadian Physiotherapy Association Congress.
A key next step for the research team is to better understand what physiotherapy services are currently available for women receiving surgery for breast cancer in BC. Our team is preparing a survey that will be sent to all the public practice physiotherapy leaders in the province. This survey will ask about the number of physiotherapists with a case load that includes oncology patients, as well as specific questions about the current service delivery model if surgery for breast cancer is provided at the clinical site. We are also working on determining valid and reliable ways for women to self-monitor their arm function after surgery. If successful, the next step will be to test whether this self-monitoring approach can be synchronized with existing PT services in order provide even better delivery of and outcomes from physiotherapy services, by allowing more time for physiotherapists to provided treatment for arm morbidity.
This project is one of many currently underway that illuminate impressive collaborations between researchers, front-line clinicians and practice leaders to ultimately enhance patient care.
For more information about this project please contact: Dr. Kristin Campbell at firstname.lastname@example.org
For more information: http://cepl.rehab.med.ubc.ca/
PTs: Fatima Inglis, Chiara Singh, Kelly Kavanagh, Jill Kipnis, Chelsey Funk, Belinda Wagner and Keum Choi
Providence Health Care Breast Centre (PHCBC) staff at Mount St. Joseph Hospital: Imelda Villeneuve and the clinic staff
Surgeons and Physicians: Dr. Urve Kuusk, Dr. Nancy Van Laeken, Dr. Carol Dingee, Dr. Elaine McKevitt, Dr. Winkle Kwan and Dr. Jinsi Pao
British Columbia Cancer Agency: Dr. Dean Regier
UBC: Dr. Kristin Campbell, Alison Hoens, Stanley Hung, Bolette Rafn and Sarah Sayyari