Perceived Stress Levels May Impact Upper Extremity Function Among Women Treated for Breast Cancer

Abstract

Date Presented 4/20/2018

Positive relationships between lower perceived arm function and higher perceived stress and fear of physical activity were demonstrated among breast cancer survivors with functional shoulder range of motion. Stress-reducing techniques when engaging in occupations to restore function may be beneficial.

Primary Author and Speaker: Anne Fleischer

Contributing Authors: Mary Fisher

PURPOSE AND BACKGROUND: Often objective measures of the upper extremity do not explain the level of perceived dysfunction that breast cancer survivors describe. The purpose of this study was to investigate the relationships between perceived stress levels and fear of physical activity and self-reported upper extremity function among women with a history of breast cancer.

Self-reported upper body function appears to be inconsistent with objective measures of upper body function but to be consistent with self-reported quality of life. In a study of 24 women in the first year after treatment, upper extremity deficits in strength and motion explained approximately 40% of the self-reported disability scores; therefore, 60% of the scores could not be explained by objective measures (Harrington et al., 2013).

Possible explanations for this discrepancy were described by Hwang et al. (2015) in a study of cancer survivors’ functional deficits and quality of life; the explanations included pain, physical energy and endurance, need to manage stressful situations, emotional recovery from hurt or disappointment, feelings of fear, and feelings of depression. Hwang et al. did not specifically address breast cancer survivors or upper extremity deficits; however, they provided evidence of psychosocial deficits among cancer survivors. In a study of breast cancer survivors during and 6 mo after treatment, Fleischer and Howell (2017) found personal stress to be a reason for participating in important activities less or differently during treatment. With the information from all these studies, we sought to specifically explore the possible role of stress in perceived arm function because this is a body function significantly affected by breast cancer treatment.

METHOD: This observational cross-sectional cohort study took place in a general community setting. Participants were 25 women (M age = 52, range = 31–68) diagnosed with Stage 1–3 breast cancer 12–60 mo prior to data collection. Participants completed three self-report outcome scales and measurements of their active shoulder flexion, internal rotation, and external rotation within a single visit. Outcome scale data were analyzed with Pearson’s correlation to determine whether there was a relationship between self-reported upper extremity function and perceived stress level and fear of physical activity. Active range of motion (AROM) measurements were averaged. Main outcome measures were shoulder AROM; the Disabilities of the Arm, Shoulder and Hand (DASH), a 30-item self-report scale of upper extremity function; the Perceived Stress Scale (PSS), a 10-item self-report scale of stress in the past month; and Fear of Physical Activity/Exercise Scale–Breast Cancer (FPAX–B), a 17-item self-report scale concerning participation in physical activity for breast cancer survivors.

RESULTS: There was a significant relationship between DASH scores and scores on both the PSS, r = .074, p (one-tailed) < .001, and the FPAX–B, r = .072, p (one-tailed) < .001. Average shoulder AROM was within functional limits: dominant flexion = 149.58°, nondominant flexion = 146.00°, dominant internal rotation = 69.30°, nondominant internal rotation = 71.29°, dominant external rotation = 89.35°, and nondominant external rotation = 84.83°.

CONCLUSION: A significant positive relationship was found between perceived stress levels and fear of physical activity and self-reported upper extremity function among women treated for breast cancer who had AROM within functional limits. Results suggest that perceived stress and fear of physical activity may influence self-reported upper extremity functional abilities among survivors who have functional shoulder range of motion. This study supports the importance of interventions for breast cancer survivors up to 5 yr posttreatment that focuses on improving perceived arm function through the use of stress-reducing techniques while engaging in important occupations. Further research should be done to investigate the role of stress and fear of physical activity in perceived ability to complete important and meaningful occupations so the most effective interventions can be developed.

References

Fleischer, A., & Howell, D. (2017). The experience of breast cancer survivors’ participation in important activities during and after treatments. British Journal of Occupational Therapy, 80, 470–478. https://doi.org/10.1177/0308022617700652

Groarke, A., Curtis, R., & Kerin, M. (2013). Cognitive–behavioural stress management enhances adjustment in women with breast cancer. British Journal of Health Psychology, 18, 623–641. https://doi.org/10.1111/bjhp.12009

Harrington, S., Padua, D., Battaglini, C., & Michener, L. A. (2013). Upper extremity strength and range of motion and their relationship to function in breast cancer survivors. Physiotherapy Theory and Practice, 29, 513–520. https://doi.org/10.3109/09593985.2012.757683

Hwang, E. J., Lokietz, N. C., Lozano, R. L., & Parke, M. A. (2015). Functional deficits and quality of life among cancer survivors: Implications for occupational therapy in cancer survivorship care. American Journal of Occupational Therapy, 69, 6906290010. https://doi.org/10.5014/ajot.2015.015974