Study of quality of life and effectiveness of physical therapy of women after mastectomy in the COVID-19 pandemic conditions
Authors: Karpukhina Yulia , Vasylieva Nataliia , Grygus Igor , Muszkieta Radosław , Zukow Walery 
Published: September 2020

In case of oncological disease there is a deterioration of patients’ quality of life as such of its characteristics as physiological, psychological, emotional and social decrease. These problems are especially worsened by additional threats of social life. Today, such a challenge to the health of all mankind, and especially cancer patients, is the global pandemic caused by the spread of coronavirus disease COVID-19. Fear of death and loss of loved ones, isolation, economic shock and uncertainty about the future – all this certainly affects the quality of life, especially for patients after mastectomy, because they were already in emotional and physiological stress. The problem of determining the patients’ quality of life after mastectomy and correcting the nature of the personal reaction to the disease in the coronavirus pandemic is an integral part of the physical rehabilitation programme.
The objective of the study: to assess the quality of life and effectiveness of physical rehabilitation programmes of women after mastectomy in the conditions of pandemic COVID-19.
Research methods. The study involved 36 women aged from 42-69, who underwent radical mastectomy and were receiving adjuvant treatment at the Kherson Regional Oncological Center. To restore their health, the patients passed an author's programme of physical therapy for people after radical mastectomy. The methodology of building the author's programme was based on continuity, phasing and its implementation both in the mammology department and at home. The quality of life parameters and the volume indicators of mobility of the joints of the upper extremity were evaluated by the operated part before the application of physical therapy methods (early hospital period), after physical therapy (late hospital period) and after discharge from a hospital, but women continued to perform rehabilitation measures independently and were at home during the COVID-19 pandemic (post-hospital period + quarantine). To assess the quality of life, we used the questionnaire "MOS SF-36", which was used at each stage of rehabilitation.
Research results. Based on the conducted goniometry of women after radical mastectomy, it can be concluded that the amplitude of movements in the shoulder joint differs significantly at all periods of physical therapy (early hospital period, late hospital period and post-hospital period + quarantine) from the standard indicators. Extension of the shoulder among most women after the application of an individual rehabilitation programme has fully recovered, forced quarantine and lack of general physical activity did not affect this indicator. Independent performance of therapeutic gymnastics (in the post-hospital period + quarantine) did not significantly improve this indicator and did not lead to complete recovery of movement. The analysis of the obtained results showed that among women, who underwent mastectomy under the influence of physical exercises, already in the late hospital period of rehabilitation, there was not only an improvement in joint mobility, but there was an improvement in quality of life. At the same time, women in the post-hospital period of physical rehabilitation, which coincided with the quarantine period, there was a slight decrease in quality of life. Namely: there was a decrease in physical activity (PF) by 4.5%, which indicated a decrease in daily physical activity; it was found that the role of physical problems in the limitation of vital functions (RF) decreased by 2.7% (this indicator reflected the impact of physical condition on daily role activities). Low RF values indicate that daily activities are significantly limited by the patient's physical condition; women noted an increase in pain indicator (BP) by 9.6% and its effect on the ability to engage in daily activities, which led to limited activity of patients; deterioration of mental health (MH) – by 3.8%, which was characterized by low mood, depression, anxiety and a decrease in the overall rate of positive emotions. Low scores indicated the presence of depressive, anxious experience and mental distress; decrease of the indicator of role functioning, which is due to emotional state (RE), during forced quarantine by 13.6%, interpreted as a restriction in the performance of daily work, which is due to the deterioration of emotional state; vital activity parameters (VT) decreased during quarantine by 11.7%. The obtained indicators testified to higher fatigue of patients, decrease of their vital activity and decrease of their vivacity.
Conclusions. Quarantine conditions and self-isolation, which appeared during the spread of coronavirus disease, are an additional source of concern for patients after mastectomy and have identified a decline in their quality of life and the effectiveness of physical therapy in general. Although before the quarantine measures, the indicators of quality of life and mobility of the shoulder joints on the operated side were significantly increased under the influence of the physical therapy programme for this category of patients.т Assessment of the quality of life of patients after mastectomy is an integral characteristic of physical, mental, social and spiritual condition, which allows determining the effectiveness of physical rehabilitation measures. Therefore, the assessment of the life quality of women after mastectomy, which is made by the patients themselves, is a secure and reliable indicator of their general condition under normal conditions and during the pandemic period of coronavirus disease. The obtained data on the quality of life allow for constant monitoring of the patients’ general condition after undergoing surgery on the mammary, as well as timely, if necessary, to adjust the physical therapy programme.