New tools to help recovery from breast cancer surgery
Physiotherapist Deirdre McGhee from Breast Research Australia at the University of Wollongong led a team to develop resources for women about to have breast reconstruction surgery. Here, Deirdre discusses how those resources can help patients’ physical recovery after surgery.
A free online educational resource to guide women to self-manage their physical recovery after breast reconstructive surgery has been developed by the Breast Cancer Network Australia and Breast Research Australia at the University of Wollongong, in conjunction with clinical experts including plastic surgeons, breast surgeons, breast care nurses, physiotherapists and lymphoedema specialists, cancer researchers and patients.
The catalyst for the resource was research conducted by myself and involved a survey study of 231 women across Australia who had previously had breast reconstructive surgery. The study investigated the incidence and severity of the physical side-effects reported by women following breast reconstructive surgery and their impact on physical activity and function. Participants ranked eight physical side-effects using a combined
incidence/severity score (ranked from 0 to 10), in conjunction with the combined impact of these physical side-effects on their physical activity and function, at three time points (six, 12 and 24 months) after surgery. The physical side-effects and physical functions were identiﬁed prior to the
study, from one-on-one semi-structured interviews with 12 women who had previously had a breast reconstruction and 12 health professionals (plastic and oncology breast surgeons, oncologists, physiotherapists, clinical nurse specialists and lymphoedema therapists) involved in treating women with breast cancer.
The study found that women commonly experience a range of physical side-effects across multiple body regions following breast reconstructive surgery. About 50 per cent of the participants reporting moderate to severe physical side-effects (incidence/severity scores ranked >6/10), across multiple body regions six months following surgery, which were perceived to negatively impact physical function and activity for over 50 per cent of participants.
The study highlighted the urgent need to improve the physical recovery of women after breast reconstructive surgery and the need for early intervention, education and treatment to alleviate these physical side-effects and to minimise their negative impact. It provides evidence that many women require physical rehabilitation after their surgery, to enable them to be physically active. It also identiﬁed, through regression analysis, the characteristics of women most at risk of developing physical side-effects with the highest incidence/severity scores. This provided evidence of the women most in need of early intervention physiotherapy to manage their physical rehabilitation post-surgery, who are unlikely to manage their physical recovery on their own.
Work in practice
The immediate translation of this research was to develop a freely available public health educational resource to guide women on how to physically prepare for breast reconstructive surgery and manage their recovery. The study found that most of the women were not aware of the physical limitations they would experience after their surgery or how to manage the physical side-effects of surgery. They were also not aware that exercise before and after their surgery could have a signiﬁcant impact on recovery.
Help at hand
The resource guides women on how to physically prepare for surgery and manage their recovery in the ﬁrst two weeks after surgery. It is designed for women having all different types of breast reconstructive surgery, immediate and delayed, implant and tissue-based. It is the ﬁrst part of a ﬁve-stage program (still to be made), which will guide women on their physical recovery from the postop period to return-to-sport and full activity.
The resource consists of ﬁve videos, a podcast and a webinar. The ﬁrst two videos guide women on exercises to physically prepare their shoulder/ upper torso (video 1 for women having a delayed breast reconstruction) and trunk (video 2 for women having TRAM/DIEP/SIEA reconstructions) for surgery. Video 3 provides practical information to guide women on how to prepare their home environment for their restricted activity level in the immediate post-op period and is suitable for women having either an immediate or delayed breast reconstruction. It includes demonstrations of comfortable sleeping positions, how to get out of bed, guidance on showering and dressing, and wound and drain care.
The last two videos cover post-surgery exercise videos to start shoulder mobility (video 4) and promote circulation and lymphatic drainage (video 5), to maximise healing and minimise any risk of lymphoedema. Women are advised to practise these exercises before surgery. The exercises are demonstrated in real-time and include guidance on the early detection of lymphoedema.
The podcast involves myself and a patient (two years post-reconstructive surgery) discussing how the right exercises and asking the right questions before surgery can make a big difference to a women’s recovery.
In the webinar, I am joined by plastic surgeon Dr Dean Trotter, breast care nurse Monique Baldacchino and lymphoedema specialist Louise Koelmeyer. We discuss the beneﬁts of physical preparation and recovery for reconstructive surgery patients and look at ways to help remove any barriers to physical recovery that women undergoing surgery may encounter. We guide women on what they should discuss with their surgeon before their surgery, and the beneﬁt of early intervention to manage the physical side- effects of breast reconstructive surgery.
The resource also has a link to a feasibility/ acceptability survey about the resource, to guide the development of future resources.
Practical use for physios
The resource can be used by physiotherapists as a guide of exercises, deemed by clinical experts to be suitable to prescribe to their patients, both before and after their breast reconstructive surgery. It also summarises information on wound and drainage care, and pain management in the post-op period that is commonly given by breast care nurses, as well as practical information to recommend to patients to help them to manage at home in the acute post-op period.
It is particularly useful to physiotherapists living in rural and remote areas who might have limited access to breast cancer-speciﬁc professional expertise. It is also a useful resource to recommend to patients to follow up treatment sessions. The period around breast reconstructive surgery is commonly stressful and overwhelming, making it difﬁcult for women to take in all of the information they need to. The format of the resource (online videos and podcasts) allows women to go back and listen and watch this information in short bursts, multiple times, when they feel they are able to take the information in.
The resources can be accessed at tinyurl.com/sh22j64. For more information contact Deirdre McGhee, Breast Research Australia, University of Wollongong at firstname.lastname@example.org.
>> APA Sports and Exercise Physiotherapist Deirdre McGhee is co-director of Breast Research Australia (University of Wollongong), a Fellow and board member of Sports Medicine Australia and an associate professor in the School of Medicine at the University of Wollongong. Deirdre has been researching breast health biomechanics for the past 17 years, in particular breast support during exercise, breast-related musculoskeletal issues (after breast cancer surgery and in women with large breasts) and breast injuries in contact sports.
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