Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Proposed Topic (Second preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Authors (including presenting author) :
Chan CS(1), Tsoi YKV(2), Chan CSA(2), Leung CH(1), Lee TY(1), Ching WK(1)
Affiliation :
(1)Occupational Therapy Department, North District Hospital
(2)Department of Surgery, North District Hospital
Introduction :
Breast cancer is the most prevalent cancer affecting women. Breast cancer related lymphedema (BCRL) and upper body dysfunction have tremendous negative impacts on daily functioning and quality of life. Risk of BCRL development is associated with exertions of upper-body in daily livings. An occupational therapy (OT) program featured with proactive self-management; lifestyles intervention; early detection and prevention of sub-clinical BCRL was implemented to prevent progression to chronicity.
Objectives :
To (1) augment self-management through knowledge translations by proactive education; (2) detect and prevent progression of sub-clinical BCRL by friendly technologies; (3) maximize activity participation with proactive preventive measures.
Methodology :
Patients had breast cancer surgery in NTEC were recruited to the Breast Cancer Survivor Empowerment Program. The program included structured pre-operation disease specific education and adaptive skills learning, screening of BCRL by Perometer and Lymphscanner; and tailored intervention for prevention of BCRL. Outcomes measures were (1) adherence to the program; (2) incidence of BRCL; (3) activity participation; and (4) disease specific quality of life.
Result & Outcome :
Total 1449 patients, aged 27 to 94, with mastectomy (86%) and axillary lymph node dissection (41%) from 2018 to 2022 were analyzed. The median follow-up was 10 months (70% adherence) over 5 postoperative visits to occupational therapy. 342 patients completed program at 22nd-month at the time of review. Exertion levels of upper-body in daily living were “Heavy” (16%) like cleansing jobs; “Medium” (75%) like household chore; and “Light” (9%) like basic self-care. Full upper-body function attained was 38% at 1st-month, 68% at 4th-month and 84% at 16th-month; with significant improvement at 4th-month (p<0.001), 10th-month (p<0.001) and 16th-month (p=0.001). Subclinical BCRL was detected in 50 patients and reversed with early treatment. BCRL persisted in 35 patients (10.2%) at 22nd-month. The self-reported distressing symptoms reduced at 1st-month (p<0.001) and 10th-month (p<0.001), reflecting increased symptoms recognition and coping ability among the patients. Health-related apprehensions (p<0.001) declined at 1st-month, suggesting improved efficacy in self-management and quality of life after program. This retrospective review affirmed promising outcome of the OT program in patient empowerment, preventing BCRL, and promoting early resumption of activity participation, which were imperative to quality of life of the breast cancer survivors. Smart application of non-invasive and comprehensible perometry and tissue dielectric constant measurement for BCRL further augment patients’ awareness and compliance to OT interventions.
