Surveillance and rehabilitation for breast cancer-related upper-body issues

There is a growing population of breast cancer survivors world-wide due to an ageing population, improved early detection, treatment advances and longer survival. Breast cancer survivors experience persistent upper-body issues following surgery and adjuvant treatment. Physical rehabilitation is known to improve outcomes in upper-body functioning. Strategies to improve reach and access of physical rehabilitation interventions and early detection of upper-body issues are needed to prevent the development of chronic issues. This dissertation aims to develop and test new delivery approaches to surveillance and physical rehabilitation by employing a variety of research methodologies. The first study was a development and feasibility study of the Breast Cancer Online Rehabilitation (BRECOR) program, consisting of a clinical assessment tool, a pamphlet and website to inform and support 12-week self-managed upper-body rehabilitation. This program was found to be feasible for use in community-based centres with preliminary evidence of efficacy. The second study was cross-sectional and tested the reliability and validity of self-measured arm circumference, as well as attitudes towards self-managed surveillance for breast cancer-related lymphedema. The third study was prospective and tested the feasibility and reliability of self-managed surveillance for upper-body issues as part of a hospital-based program. The fourth study aimed to understand experiences and preferences for surveillance and rehabilitation services using qualitative research methods among breast cancer survivors, rehabilitation professionals and breast surgeons from across British Columbia. Participants reported that current services did not enable early detection and were in need of revamping to increase equity of care. Suggestions included providing multimodal self-management resources. In summary, these studies propose new delivery approaches to enable timely and support evidence-based upper-body rehabilitation. The studies lay the groundwork for future randomized controlled trials to determine the magnitude of the effect that self-managed surveillance and rehabilitation may have on the prevalence of chronic breast cancer-related upper-body issues.Medicine, Faculty ofGraduat