U-Reach:Shoulder function after breast cancer treatment

• Research type

  Research Study

• Full title

  U-Reach:Shoulder Function after Breast Cancer Treatment Study.

• IRAS ID

  280706

• Contact name

  Mary Wells

• Contact email

  mary.wells5@nhs.net

• Sponsor organisation

  Imperial College Healthcare NHS Trust

• Duration of Study in the UK

  0 years, 11 months, 28 days

• Research summary

  Research Summary

  Sixty percent of breast cancer patients have shoulder and arm pain and problems affecting their quality of life, ability to return to work and resume normal activities (1). Despite evidence that physiotherapy interventions improve function and alleviate pain, existing oncology pathways do not promote early detection of shoulder problems or onward referral to physiotherapy (2, 3). Preliminary work suggests this may be because patients don’t tell their clinicians about the problem, and clinicians may focus more on the cancer treatment than on the consequences of that treatment.
  This project aims to understand what the barriers, facilitators and triggers are to patients being referred for treatments for pain and mobility problems in their shoulder, chest, neck, underarm and arm (upper quadrant).
  This will be achieved through a survey of breast cancer patients and focus groups of breast cancer patients and members of the extended multi-professional team who care for patients with breast cancer.

  The outcome of this project is to develop an acceptable and evidence based pathway to help clinicians to identify patients with shoulder and arm problems, who could benefit from onward referral to physiotherapy or other mangement strategies.
  The specific aims of the project are:
  1) to explore the nature and impact of upper quadrant dysfunction in patients with breast cancer,
  2) to understand patients’ experiences of accessing treatment for upper quadrant dysfunction,
  3) examine clinicians’ experiences of identifying, managing and onward referral of breast cancer patients with upper quadrant dysfunction,
  The above findings will be used to underpin the development of interventions to enable the identification, referral and management of breast cancer patients with shoulder, chest and/or arm pain and dysfunction.

  Lay summary of study results
  Upper Limb Pain And Functional Morbidity Following Breast Cancer Treatment A Cross Sectional Survey Sixty percent of breast cancer patients develop persistent pain and weakness in their arm, shoulder, neck and/or chest, which affects their ability to use their arms and shoulders to engage in work and leisure activities. It is unclear how they manage these problems and what physiotherapy treatments, if any, they access.
  Methods
  A postal survey was sent to patients treated at a regional breast cancer unit (2018-2020). Data were collected on pain, shoulder function and quality-of-life, using questionnaires. Patients were invited to provide comments about their experiences of upper limb symptoms and management. All data were analysed using recognised methods.
  Results
  Of 517 patients surveyed, 162 (33%) questionnaires were returned. The average age of the participants was 62, and the average time since surgery for breast cancer was 2 years. 73% (119/162) reported pain. Whilst 53% recorded significant shoulder and arm pain and weakness that affected their daily life, only 28% reported accessing physiotherapy services that could help with their symptoms. Patients’ comments showed that many experienced ongoing symptoms, mixed attitudes towards exercise and varied access to physiotherapy and support.
  Conclusion
  Two years following surgery many patients still report significant upper limb symptoms which adversely impact on quality of life. However, only 28 % access beneficial treatments. There is a need to improve pathways of care.
  Funding: NIHR Imperial Biomedical Research Centre; Greater Manchester South Ethics Committee 21/NW/0032

  Abstracts have been submitted and published https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fu2790089.ct.sendgrid.net%2Fls%2Fclick%3Fupn%3Du001.QwnS5iG-2B4nwcunWxC03fkF5EpaqdEcQPaHSGjfLlw3bISyt0To9-2FPqNaZpQ0-2FbBsmFHH1-2FcVSCREGYMPJB-2Bfzs5Yb6Y5Mv-2B64NDg2V-2FJMzE-3DR4I2_a04dWCHmDh7gi4hRuvmsd-2FMEDkPNm6D0IRdq0o1v81deC73tvh-2FRVfLeiNL3yJSpBrxk-2BG3URocoJdsSMB-2FfyagciMNr9TE6K55yRNLTFPns45-2FI7vudYacDjzQSucQjTtX-2BNPEOtLY671oAiBZ1bejVm2RE5MLYrHZ9RyjHTBm6jSmGbkkgxhoFgDuQ5ianJFSJnPGTaAtT2kydJJvOzg-3D-3D&data=05%7C02%7Cgmsouth.rec%40hra.nhs.uk%7C2894a53a81c547c1e80e08dc48e0486e%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638465375318284262%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&sdata=B4DUIs%2BdR6uPvAN3yYrlj6LQXhD3piYZriUalZ3piHk%3D&reserved=0

• REC name

  North West - Greater Manchester South Research Ethics Committee

• REC reference

  21/NW/0032

• Date of REC Opinion

  15 Apr 2021

• REC opinion

  Further Information Favourable Opinion