Abstract
PurposeThe study aim was to develop a mobile application (app) supported by user preferences to optimise self-management of arm and shoulder exercises for upper-limb dysfunction (ULD) after breast cancer treatment.MethodsFocus groups with breast cancer patients were held to identify user needs and requirements. Behaviour change techniques were explored by researchers and discussed during the focus groups. Concepts for content were identified by thematic analysis. A rapid review was conducted to inform the exercise programme. Preliminary testing was carried out to obtain user feedback from breast cancer patients who used the app for 8 weeks post surgery.ResultsBreast cancer patients’ experiences with ULD and exercise advice and routines varied widely. They identified and prioritised several app features: tailored information, video demonstrations of the exercises, push notifications, and tracking and progress features. An evidence-based programme was developed with a physiotherapist with progressive exercises for passive and active mobilisation, stretching and strengthening. The exercise demonstration videos were filmed with a breast cancer patient. Early user testing demonstrated ease of use, and clear and motivating app content.ConclusionsbWell, a novel app for arm and shoulder exercises, was developed by breast cancer patients, health care professionals and academics. Further research is warranted to confirm its clinical effectiveness.Implications for cancer survivorsMobile health has great potential to provide patients with information specific to their needs. bWell is a promising way to support breast cancer patients with exercise routines after treatment and may improve future self-management of clinical care.
Highlights
Axillary treatment for breast cancer, which is surgical removal of the lymph nodes in the armpit or axillary radiotherapy, can contribute to upper limb dysfunction (ULD)
Study approvals were gained from the National Research Ethics Service (NRES) Committee London—Camberwell St Giles and Brighton, NRES Committee North West—Greater Manchester West and Sussex University Hospitals NHS Trust and Sussex University Hospitals NHS Trust
Nine women with early-stage breast cancer participated in the focus groups
Summary
Axillary treatment for breast cancer, which is surgical removal of the lymph nodes in the armpit (axilla) or axillary radiotherapy, can contribute to upper limb dysfunction (ULD). Symptoms of ULD include pain, numbness, decreased shoulder range of motion (ROM), reduced strength, joint restrictions, axillary web syndrome (lymphatic cording), and development of arm volume changes or lymphoedema due to interruption or damage to the axillary lymphatic system [1,2,3,4,5,6,7]. Severity of symptoms and prevalence vary considerably because of differences in diagnostic criteria, assessment methods and time points among studies. Research data show that half of patients report at least one moderate-to-severe symptom in the first 18 months post surgery [8, 9]. Symptoms decrease over time, but for some, they are more persistent or develop later [10,11,12,13,14].
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