P4-12-08: Five Year Preliminary Outcomes of a Prospective Surveillance Model To Reduce Upper Extremity Morbidity Related to Breast Cancer Treatment.
Authors: Stout NL , Pfalzer L , Levy E , McGarvey C , Gerber L , Springer B , Soballe P 
Published: June 2012

Background

Early detection and management of physical impairments after breast cancer treatment contribute to successful functional outcomes and improved quality of life throughout disease treatment and survivorship. Assessment of upper extremity (UE) morbidity including; shoulder dysfunction, scarring, pain, fatigue and lymphedema should be conducted through a prospective surveillance model of care to promote early identification of impairments and provide intervention while functional limitations are minimal, thereby preventing long term loss of function. This report highlights 5-year findings related to physical function in patients participating in a prospective surveillance model of care.

Methods: A prospective, observational study enrolled women with breast cancer at the point of disease diagnosis (n=196) and measured UE morbidity, impairments and functional disability over a 5 year period. Patient demographics, cancer characteristics, measures of UE strength, range of motion (ROM) and limb volume were taken pre-operatively and repeated at 1, 3, 6, 9, 12 and 60 months post-operatively. Subjective assessment of physical activity, health status and quality of life were assessed by questionnaire at 12 and 60 months. 166 subjects completed visits at 1 year and 95 completed visits at 5 years. All subjects received education regarding exercise, risk reduction and advice on return to activity. If physical impairments were detected during the study, immediate physical therapy intervention was initiated to alleviate the impairment.

Results: The incidence of objective UE impairments at five years after treatment was 9% with loss of shoulder ROM, 25% with subclinical lymphedema (defined as a ≥ 3% change in limb volume from baseline), 5.6% with advanced lymphedema (Stage I or II) and 27.8% with clinically significant fatigue (defined as ≥ 3 on a visual analog scale). Subjectively 8.4% reported feeling moderately or severely disabled with their affected arm, 11.1% reported moderate to severe difficulty carrying heavy objects, 4.2% reported moderate to severe limitations with heavy household chores.

Discussion: This is the first prospective cohort study in the United States to specifically monitor physical and functional outcomes to 5-years post breast cancer treatment. The prospective surveillance model of care, conducted by the physical therapist, enabled early detection and treatment of breast cancer treatment-related impairments resulting in improved long-term function. Long-term incidence of UE morbidity after breast cancer treatment has been documented in the literature as high as 40–60% with lymphedema and up to 60% with fatigue. This study clearly demonstrates the potential for substantial reduction in UE dysfunction related to breast cancer treatment when using an early identification and intervention model. Morbidity such as pain, reduced range of motion, decreased strength and sub-clinical lymphedema were detected early and managed through the prospective model. These results strongly suggest that prospective surveillance monitoring for functional impairments is an optimal construct to assure long-term function in women after breast cancer treatment.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-12-08.