Date Presented 04/03/2025
This research demonstrates benefits of preoperative education in informing breast cancer survivors of lymphedema, screening for deficits in range of motion, home exercises, and educating on problem-solving strategies to resume valued occupations.
Primary Author and Speaker: Stephanie Rexing
Contributing Authors: Anne Fleischer, Cheryl Carrico
PURPOSE: This study explores whether pre-operative education improves activity participation and decreases perceived arm dysfunction in breast cancer patients undergoing axillary lymph node dissection.
DESIGN: A static group comparison was used to compare breast cancer survivors’ perceived arm function and activity level among those seen pre-operatively and postoperatively and post-operatively only. Survivors were individuals with breast cancer who had been referred to occupational therapy pre-operatively and/or post-operatively from physicians within the regional health system. Survivors were included in the study if they were English-speaking, had been diagnosed with breast cancer within the last six months and evaluated and/or treated by an occupational therapist no greater than six months post-operatively.
METHODS: Data collection included quantitative data using the Disability, Arm, Shoulder, Hand (DASH) questionnaire, Activity Card Sort-modified (ACSm) scores, and active range of motion (AROM) measurements. Additionally clinical notes and field notes were used to gather qualitative data. Descriptive statistics, figures and charts were used to summarize and illustrate the individuals seen pre-operatively and post-operatively, and individuals seen postoperatively only.
RESULTS: Among those survivors seen pre-operatively and post-operatively, DASH scores indicated higher perceived arm function when compared to those seen post-operatively only. Additionally, ASCm overall activity participation scores were higher among those survivors who were seen pre-operatively and post-operatively.
CONCLUSIONS: This pilot study illustrated that it was feasible for occupational therapy to provide lymphedema prevention education, upper body exercises and strategies to safely complete physically demanding activities pre-operatively. The study highlights the necessity of integrating pre-operative education into standard breast cancer treatment protocols.
References
Lu, S.R., Hong, R.B., Chou, W., & Hisa, P.C. (2015). Role of physiotherapy and patient education in lymphedema control following breast cancer surgery. Therapeutics and Clinical Risk Management, 11, 319–327.
Palmadottir, G. (2010). The role of occupational participation and environment among Icelandic women with breast cancer: A qualitative study. Scandinavian Journal of Occupational Therapy, 17, 299–307.
Schmitz, K.H., Ahmed, R.L., Troxel, A.B., Cheville, A., Lewis-Grant, L., Smith, R., Bryan, C.J., Williams-Smith, C.T., & Chittams, J., (2010). Weightlifting for women at risk for breast cancer-related lymphedema: A randomized trial. Journal of American Medical Association, 304(24), 2699–2705. https://doi.org/10.1001/jama.2010.1837
