Self-monitoring to improve physiotherapy care for women after surgery and treatment for breast cancer

Awardee: Kendra Zadravec

Graduate Program: PhD

Institution: University of British Columbia

Supervisor(s): Kristin Campbell

ARCC Program Area(s):

Competition: 2020

Project Summary:

After breast cancer surgery, many women experience shoulder and arm problems, including pain, decreased shoulder mobility, muscle weakness, and persistent arm swelling (lymphedema). Research has shown that physiotherapy (PT) can help prevent and manage these issues. However, if not dealt with promptly, these problems can result in chronic loss of shoulder and arm function and negatively affect quality of life years after breast cancer treatment is complete. Breast cancer survivors (BCS) need an easy way to monitor for shoulder and arm problems and know when PT may be needed. Several different patient-reported outcome measures are commonly used to assess shoulder and arm function after breast cancer surgery, including Disabilities of Arm, Shoulder, and Hand (DASH), Upper Extremity Functional Index (UEFI), and Kwan’s Arm Problem Scale (KAPS). These questionnaires come up with a total score reflecting overall shoulder and arm function by asking BCS to rate the severity of any symptoms they may be experiencing (e.g., pain, swelling) and how well they can complete activities of daily living (e.g., carrying groceries, buttoning a shirt). However, for this approach to be effective, BCS need to know what questionnaire score (cut point) would indicate when their shoulder and arm problems are severe enough to need PT. The aims of this study are twofold: 1) estimate a cut point for each of DASH, UEFI, and KAPS based on a shoulder and arm assessment by a trained physiotherapist; 2) determine which of the three questionnaires most accurately assesses limitations in shoulder and arm function using this cut point. Identifying an accurate cut point can help BCS self-monitor for shoulder and arm problems after breast cancer surgery and know when may be appropriate to seek PT. Proactive detection and management of shoulder and arm issues after breast cancer surgery can help reduce the number of BCS who develop these problems and who experience the associated long-term negative effects on health and overall wellbeing.