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Prevalence and Treatment Patterns of Physical Impairments in Patients With Metastatic Breast Cancer

Andrea L. Cheville, Andrea B. Troxel, Jeffrey R. Basford, Alice B. Kornblith

From the Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, MN; University of Pennsylvania, PA; and the Dana-Farber Cancer Institute, Boston, MA

Corresponding author: Andrea L. Cheville, MD, MSCE, Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: cheville.andrea{at}mayo.edu

Purpose Physical impairments cause profound functional declines in patients with cancer. Although common rehabilitation measures can address many impairments, the extent of their delivery is unknown. We studied these issues by quantifying physical impairments in patients with metastatic breast cancer and by assessing how they are addressed.

Patients and Methods A consecutive sample of 163 community-dwelling patients with metastatic breast cancer was stratified by Karnofsky performance score and administered the Medical Outcomes Study Physical Function Subscale and the Older Americans Resource Study Activities of Daily Living subscales. Cancer-related physical impairments were identified through a physical examination, the 6-Minute Walk Test, and the Functional Independence Measure Mobility Subscale. Patients were questioned regarding the nature, type, and setting of treatments for impairments. Physical rehabilitation needs were determined through a consensus process involving physiatrists and physical/occupational therapists specializing in cancer.

Results Ninety-two percent of patients (150 of 163) had at least one physical impairment. Among 530 identified impairments, 484 (92%) required a physical rehabilitation intervention and 469 (88%) required physical therapy (PT) and/or occupational therapy (OT). Only 30% of impairments requiring rehabilitation services and 21% of those requiring PT/OT received treatment. Impairments detected during hospitalization were overwhelmingly more likely to receive a rehabilitation intervention (odds ratio [OR] = 87.9; 95% CI, 28.5 to 271.4), and PT/OT (OR = 558.8; 95% CI, 187.0 to 1,669.6). Low socioeconomic and minority status were significantly associated with nontreatment.

Conclusion Remediable physical impairments were prevalent and poorly addressed among patients with metastatic breast cancer, drastically so in the outpatient setting. Undertreatment was particularly prominent among minority and socioeconomically disadvantaged groups.

Supported by a Langeloth Foundation grant, Department of Defense Grant No. DAMD17-03-1-0622, and National Institutes of Health Grant No. KL2 RR024151-01.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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