Authors (including presenting author) :
Kwan M(1), To K(1), Yeung R(1), Or C(1), Lee V(1), Tsang T(1), Cheung WL(1), Suen M(1), Lam HY(1), Au A(1), Kwong S(1), Chan C(1), Leung C(2), Chan C(2), Ng M(2), Ling YH(2)
Affiliation :
(1)Physiotherapy Department (2)Department of Surgery, Ruttonjee and Tang Shiu Kin Hospitals
Introduction :
Operative interventions on breast cancer cases raised 25.6% from 2016 to 2017 in Ruttonjee Hospital. Patients will only be referred for out-patient physiotherapy if complications developed. Therefore, a multidisciplinary team, including physiotherapists, was formed to provide one-stop coordinated care from pre- to post-operation for breast cancer patients in 2018.
Objectives :
- To provide early screening and timely physiotherapy intervention for breast cancer patients undergoing operation to prevent or alleviate complications along their rehabilitation journey - To empower patient with self-management and exercise - To evaluate the effectiveness of the physiotherapy service
Methodology :
Physiotherapy intervention at in-patient phase included: - Pre-admission assessment on potential complicated cases - Post-operative chest physiotherapy and pain management - Early mobilization exercise and postural advice - Home care advice: exercise progression, preventive measures on lymphoedema With collaboration with Ruttonjee Hospital Surgical Unit, direct referral to Tang Shiu Kin Hospital Out-patient Physiotherapy was arranged with first appointment at 3-week and subsequent follow-up at 2-month, 9-month and 2-year post-operatively. Extra session would be provided if indicated or on patient’s request if complications or concerns arose. Full scope of out-patient rehabilitation included: - Pain management and scar management - Shoulder, upper limb mobility and strength training - Wellness advice and exercise coaching - Lymphoedema prophylaxis and treatment
Result & Outcome :
From September 2018 to May 2020, 73 breast cancer patients received operation in Ruttonjee Hospital and were referred to this program. 51 patients had completed the 9-month follow-up and their outcomes were evaluated. There was statistical significant improvement in pain level(decreased from 2.0 to 0.49, p< 0.001), shoulder range of motion(flexion increased from 154.8 to 175.3, p< 0.001), upper limb function(Quick DASH disability score decreased from 28.5 to 13.5, p< 0.001, power grip strength increased from 17.2 to 18.5kg, p< 0.05). About 40% of patients reported onset of arm heaviness or swelling. Early intervention with extra 2 sessions in average were provided to these patients. At 9th month, the percentage difference of estimated arm volume between the operated and non-operated sides did not differ and was maintained (p=0.97). Patients reported 86% overall improvement and 93% of patients were satisfied with the program. In conclusion,the structured physiotherapy rehabilitation program for breast cancer patients improved pain level, upper limb function as well as prevented or alleviated common complications like lymphoedema after operation. Patients were empowered on self-care, therapeutic exercise and lymphoedema management, which in turn enhanced patients’ self-efficacy and wellness.
