Development of a Long Term Surveillance Programme Linked to an Integrated Rehabilitation Pathway for Upper Limb Morbidity in Breast Cancer Survivors in SA
Dr Delva Shamley
Title of the project
Development of a long term surveillance programme linked to an integrated rehabilitation pathway for upper limb morbidity in breast cancer survivors in South Africa.
Lymphoedema and shoulder morbidity are well-documented consequences of treatment for breast cancer. Despite less invasive surgery, the incidence of breast cancer patients presenting with decreased shoulder and/or arm mobility, tightness, oedema, weakness, pain and numbness after treatment varies from 17% to 79%. A recent study of breast cancer survivors presenting for their annual follow-up visit at Groote Schuur Hospital, Cape Town (N=352), has found that 78% were unemployed in spite of being >2 yrs post-treatment; 41% had arm swelling; 48% reported pain associated with shoulder movement at a level shown to interfere with activities of daily living and 43% scored greater than 40 for disability (out of a max of 80)(manuscript in preparation).
Breast cancer survivors who experience shoulder and arm problems have significantly reduced functional use of their upper limb which limits their quality of life and their ability to return to work. These statistics justify the development of a management programme for our breast cancer survivors.
A systematic review has shown that one-on-one physiotherapy, exercise classes and a home programme of exercises supervised every 2 weeks do reduce upper limb morbidity. However, due to resource scarcity, rehabilitation and long term follow-up of this patient group are minimal to nothing in most parts of the world including South Africa (International MACC/ISOO Symposium, 2011). This means that in order for any rehabilitation programme to be sustainable it must target those at risk of developing morbidity and it must look at the most effective form of delivery.