A Qualitative Study of Rehabilitation Professionals' Practices to Define the Presence of Arm Morbidity After Breast Cancer Surgery

Abstract

Background: Rehabilitation professionals (RPs) play a major role in identifying, managing, and treating upper-body issues in individuals following breast cancer surgery. Varying definitions of postoperative arm morbidity in the literature have hampered development of standardized surveillance programs for people undergoing breast cancer surgery within clinical care. Our objective was to explore RPs' practices in defining the presence of arm morbidity after breast cancer surgery. Methods: This qualitative study used semistructured focus group interviews with 29 RPs from 5 health authorities in British Columbia, Canada. Transcripts were analyzed using content analysis. Results: Two categories captured RPs' overarching lack of consensus in defining the presence of postoperative arm morbidity: (1) Complex concerns, complex considerations; and (2) Many ways of measuring arm morbidity. Varying perspectives exist as to which upper-body issues and functional criteria constitute arm morbidity, as well as which characteristics to consider in identifying who is at risk of developing arm morbidity. In tandem, there is currently no gold standard outcome measure or standardized assessment to identify arm morbidity. Conclusion: Because of the complex interaction between different breast cancer treatments and various environmental and personal factors, there is currently a lack of consensus among RPs about how to define and assess arm morbidity. Our findings demonstrate the presence of arm morbidity is challenging to characterize, given its multifaceted presentation, inconsistent approaches to risk stratification across clinical settings and geographical regions the RPs worked, and numerous ways of measuring arm morbidity.