Authors (including presenting author) :
Jess Li 1, O K Chun2, Alexis Law 1, P S Leung3, Lily Wong2, Irene Cheng 2, N S Wong 2, Brigitte Fung 1, Regina Leung 1, K Y Tam3, Charlie Li 1, Amy Or2, Miranda Chan2, Gloria Cheung3
Affiliation :
Physiotherapy Department(1), Breast Centre, Department of Surgery (2), Department of Medical Social Service (3), Kwong Wah Hospital
Introduction :
Breast cancer rehabilitation helps restoring or improving quality of life and thus on independence and participation in life. Multidisciplinary Breast Cancer Rehabilitation Program in Kwong Wah Hospital (KWH) was established since November 2001. It was a joint collaborative service of physiotherapists, breast care nurses (BCN) and medical social workers (MSW) for rehabilitation of breast cancer patients. Early interventional rehabilitation for breast cancer patients after operation was established since October 2013. It could enhance rehabilitation and manage early signs of complications thus improving the functioning and quality of life of patients.
Objectives :
To provide seamless rehabilitation program to breast cancer patients To maximize recovery after operation and adjuvant therapy To enhance the cohesiveness of related stakeholders in the team To educate patients on the prevention of any complications induced by the operation or adjuvant therapy
Methodology :
Sample: All breast cancer patients with operation done in KWH were recruited. Phase I (1) Pre-operative Multidisciplinary Education Session by physiotherapists, MSW and BCNs: provide education on pre/ post-operative care, complications prevention and psychological preparation (2) Day 1 Inpatient care: chest physiotherapy and limbs maintenance (3) Day 3, 10 and 17 BCNs and Physiotherapists Joint Outpatient Clinic: provide early intervention to maximize rehabilitation outcomes in mobility, functional outcome, pain relief and psychological support Phase II (4) Day 21 Physiotherapy Outpatient Clinic: monitor rehabilitation progress till completion of chemotherapy or 6 months after radiotherapy, provide treatment for neck and shoulder pain and dysfunction, improve shoulder and chest mobility, and detect early sign of lymphoedema. Outcomes measures: Patient satisfaction rating on Pre-operation physiotherapy education class (0-10) Patient satisfaction survey on nurse rehabilitation clinic Range of shoulder movement and pain visual analogue scale VAS (0-10) Quick DASH questionnaire (Disability of Arm Shoulder and Hand) (0-100) Subjective overall improvement (Numeric Global Rating of Change Scale NGRCS) Memorial Symptoms Assessment Scale (MSAS) questionnaire (distress level)
Result & Outcome :
Results and Outcomes: There were 443 cases included from January 2019 to August 2020. The average rating of Pre-operation physiotherapy education class satisfaction was 8.1. Patient satisfaction on nurse rehabilitation clinic towards self-esteem / quality of life management, wound and drain care and services of the breast nurse clinics was ranging from 88.91% to 99%. Overall satisfaction rate towards the clinics was 99.17%. The improvements in range of shoulder movement (flexion and abduction) were 23.1 % (D3-D14), 36.3 % (D3-D21) and 72.2 % (D3-D/C). The average pain scores (VAS) were 2.6 (D3), 2.89 (D14), 2.3 (D21) and 0.2 (D/C). The Functional score of Quick DASH was improved from 26.4 (D21) to 14.7 (D/C). The subjective overall improvement NGRCS was 8.4 upon discharge. MSAS scores indicated that the distress level progressively decreased after timely and effective physiotherapy and nursing intervention. Conclusion: The Multidisciplinary Breast Cancer Rehabilitation Program demonstrated promising outcome with better patient satisfaction. Multidisciplinary collaboration enhanced rehabilitation with comprehensive risk management against post-operative complications. It showed benefits in restoration of upper limb functions and overall well-being. It helped to prepare breast cancer survivors for everyday life and lay the foundation for a physically active lifestyle.
