Current rehabilitation processes do not prevent long-term impairments after treatment for breast cancer in Australia

Authors: Elizabeth S Dylke, Sharon Kilbreath 2015

Reviewed by: Denise Stewart

The aim of the study was to determine if and how advice regarding physical rehabilitation (arm-specific and general exercise) was provided after treatment for breast cancer, as well as the prevalence of physical impairments following treatment for breast cancer in an Australian population.

A questionnaire was completed by 387 women, with 86% having completed their breast cancer treatments in the previous 1-5 years. 80% of the respondents held private health insurance and there was a good representation of city and rural respondents. There was a mix of women with mastectomy and lumpectomy, sentinel node and axillary node dissections, radiotherapy and ongoing aromatase inhibitor treatment.

The findings:

  • Prior to surgery 30% reported having received information about exercises for their recovery.
  • In the month after surgery 77% received general exercise advice and 44% received specific arm exercise advice.
  • Overall 82% received arm specific exercise instructions
  • 71% commenced the exercise program at 2 weeks after surgery
  • A common reason for not commencing exercise was that the women did not experience shoulder problems.
  • 74% reported that they had not regained pre surgery arm movement prior to starting radiotherapy.
  • 28 % reported arm problems after completing radiotherapy
  • 83 % of women on aromatase inhibitors reported joint pain.
  • Only 6% of women experiencing pain were referred to rehabilitation services.

Study conclusions: Current strategies used in Australia do not prevent arm symptoms in the first year after breast cancer.

Clinical Opinion: Women are receiving a high level of advice regarding arm and general exercises- however they are rarely receiving referral to specific rehabilitation services to manage the impairments that result after their treatment.  This indicates that the shoulder movement, pain or swelling impairments that women experienced by women does not improve when women engage in their normal daily tasks and their own exercise program. Breast cancer rehabilitation services are not being considered by the cancer medical profession. Also, even though many women in study held private health insurance, it was difficult for these women to access private rehabilitation services in Australia.

There continues to be many barriers for women after breast cancer to receive the rehabilitation services they need in Australia.