Patient Perceptions of Physical Rehabilitation and Its Method of Delivery for a Variety of Adverse Physical Effects following Breast Cancer Surgery: An Observational Mixed Methods Study

Abstract

Purpose. To investigate patient perceptions of physical rehabilitation received for various adverse physical effects following breast cancer surgery and the content and delivery methods of the physical rehabilitation received. Methods. Cross-sectional study of 509 Australian women living with breast cancer (n = 178 (35%) (Breast Conserving Surgery (BCS)), n = 168 (33%) (Mastectomy (MAST)), and n = 163 (32%) (Breast Reconstruction Surgery (BRS)). Retrospective, online survey investigated the physical rehabilitation received after surgery/treatment. The survey explored the respondents′ perceptions (open response) and satisfaction levels with the physical rehabilitation received and its content and delivery method (closed responses). Perceptions were analyzed using a thematic analysis; satisfaction levels and delivery methods for each adverse physical effect were tabulated. Results. Major perceptions: (i) unaware of and unprepared for adverse physical effects, (ii) unsuitable information delivery, and (iii) insufficient follow-up from health professionals. Physical rehabilitation content focused on shoulder issues and lymphedema; less than half of respondents received any information about scars, torso, and donor site issues or physical discomfort disturbing sleep. The proportion that received each delivery method varied for each adverse physical effect. Pamphlets and verbal instruction were the most common delivery methods and sessions with health professionals where issues were physically assessed, checked, or progressed the least common. Satisfaction levels varied for each adverse physical effect; all were less than 50%. Conclusion. Women perceived their physical rehabilitation did not prepare them for the adverse physical effects they experienced, the method and timing of delivery did not meet their needs at various stages of recovery, and the follow-up was insufficient. Quantitative data on the content and delivery method support these perceptions. Explanations of why these perceptions occurred and recommendations to improve physical rehabilitation through greater use of patient-related outcome measures and spreading limited physical rehabilitation resources using a three-level model of care are recommended. Although many women recover from breast cancer, improved physical rehabilitation could enable women to manage any immediate or long-term side effects of their breast cancer surgery and treatment.