Abstract
BackgroundBreast cancer (BC) and related treatment are associated with the risk of developing a wide range of persistent disabling impairments. Despite extensive research in the field and an enhanced focus on BC rehabilitation, up to 34–43% of these patients are at risk of developing chronic distress. In addition, it is known that these patients repeatedly report unmet needs, which are strongly associated with reduced quality of life. However, despite knowledge that patients’ needs for support during BC rehabilitation varies greatly, individualized rehabilitation is often lacking. Therefore, this study aimed to explore health care professionals’ (HCPs) experiences of current rehabilitation practice and describe current barriers and facilitators for individualized rehabilitation for patients following BC treatment.MethodsA total of 19 HCPs were included, representing various professions in BC care/rehabilitation within surgical, oncological and specialized cancer rehabilitation units at a university hospital in Sweden. Five semi structured focus group interviews were conducted and inductively analysed using conventional qualitative content analysis.ResultsThree categories were captured: (1) varying attitudes towards rehabilitation; (2) incongruence in how to identify and meet rehabilitation needs and (3) suboptimal collaboration during cancer treatment. The results showed a lack of consensus in how to optimize individualized rehabilitation. It also illuminated facilitators for individualized rehabilitation in terms of extensive competence related to long-term experience of working with patients with BC care/rehabilitation. Further, the analysis exposed barriers such as a great complexity in promoting individualized rehabilitation in a medically and treatment-driven health care system, which lacked structure and knowledge, and overarching collaboration for rehabilitation.ConclusionThis study suggests that the cancer trajectory is medically and treatment-driven and that rehabilitation plays a marginal role in today’s BC trajectory. It also reveals that structures for systematic screening for needs, evidence-based guidelines for individualized rehabilitation interventions and structures for referring patients for advanced rehabilitation are lacking. To enable optimal and individualized recovery for BC patients’, rehabilitation needs to be an integrated part of the cancer trajectory and run in parallel with diagnostics and treatment.
Highlights
Breast cancer (BC) and related treatment are associated with the risk of developing a wide range of persistent disabling impairments
This study suggests that the cancer trajectory is medically and treatment-driven and that rehabilitation plays a marginal role in today’s BC trajectory
It reveals that structures for systematic screening for needs, evidencebased guidelines for individualized rehabilitation interventions and structures for referring patients for advanced rehabilitation are lacking
Summary
Breast cancer (BC) and related treatment are associated with the risk of developing a wide range of persistent disabling impairments. Despite a favourable prognosis and extensive evidence of the positive effects of cancer rehabilitation, patients with breast cancer (BC) still suffer from unmet rehabilitation needs [1]. This may increase the risk of prolonged or inhibited recovery, emphasizing the need for extended knowledge about barriers and facilitators for individualized rehabilitation. BC and associated treatment comes with the risk of developing a wide range of persistent disabling complications. As BC tends to be diagnosed at younger ages compared with other common cancer types [4] the long-term impact affects work ability, with approximately 30–60% remaining on sickness absence 1 year after treatment [10, 11]
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