Abstract P5-15-14: The effect of introducing an enhanced recovery programme on improving compliance with arm exercises post breast cancer surgery and reducing morbidity

Abstract

Abstract Introduction The introduction of an enhanced recovery programme for breast cancer surgery in our institution has provided an opportunity to redesign the service and the way in which patients receive pre-operative information. We have encouraged pre-operative consultations with physiotherapists to demonstrate post-operative arm exercises to see if this can improve compliance with exercises and reduce morbidity. Aim To audit patient reported upper limb symptoms after breast cancer surgery both before and after the introduction of an enhanced recovery programme with more detailed patient information and input from physiotherapy. Methods An enhanced recovery programme was first introduced in our institution in Sep 2012. Between December 2012 and December 2013, 80 patients having breast cancer surgery in Wishaw were sent a detailed questionnaire asking them about all aspects of their treatment. Two patients were excluded from the questionnaire one because of learning difficulties and the other because of acute psychiatric illness. There was an 89% response rate with 71 responses having been received to date. A previous similar questionnaire was sent to patients at 2 and 4 weeks post surgery between November 2011 and April 2012 before the introduction of the enhanced recovery programme. On this occasion there was a 73% response rate with 63 responses having been received from 86 sent. The two groups were compared. 94% of patients reported having received advice about physiotherapy and those who had a session with a physiotherapist increased from 16 to 39% with the introduction of the enhanced recovery programme. 80% of patients received a photographic exercise leaflet in addition to verbal and DVD information on arm exercises. Postoperatively in the enhanced recovery group, 39% of patients reported some numbness in their ipsilateral upper arm (57% in the group who had undergone axillary node clearance compared with 28% in the sentinel node group). 11% of patients reported persistent ongoing pain after surgery and 9% felt that discomfort affected their daily activities. This contrasts with the previous cohort where 43% of patients reported reduced arm function and almost all of these patients (93%) felt that this impacted on their daily activities. As expected performance across a range of arm and shoulder functions was worse in for axillary node clearance than sentinel node biopsy for both groups. ConclusionIntroducing an enhanced recovery programme changed the way in which information was provided to patients about post-operative arm exercises and reduced self reported arm morbidity. Citation Format: Alistair RM Macey, Jayne I McGivern, Juliette Murray, Alison K Lannigan. The effect of introducing an enhanced recovery programme on improving compliance with arm exercises post breast cancer surgery and reducing morbidity [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-15-14.