Physical impairments and physical therapy services for minority and low-income breast cancer survivors.

Ann Marie Flores,William J Blot,Lee Sowles,Jason Nelson,Karen Bienenstock

doi:10.1186/s40064-016-2455-3

Abstract

PurposeWe describe impairments after breast cancer and its treatment for African American (AA), non-Hispanic white and low-income breast cancer survivors (BCS) and whether physical therapy (PT) was utilized to address these impairments.MethodsBCS from the Southern Community Cohort Study (SCCS) were surveyed about self-reported BC treatment-related impairments (shoulder impairment, muscle weakness, pain, fatigue, skin numbness, abnormal posture) and referral to PT for impairments. We compared impairments by race, income and PT utilization. We used a cross-sectional design.ResultsAmong 528 BCS interviewed (266 whites; 262 AA), mean age 64, those with low incomes were more likely to report muscle weakness, pain and postural abnormalities, and a greater total number of impairments than those with higher incomes. Racial differences were few. PT utilization tended to be low, with AAs more likely than whites to utilize PT if they had shoulder impairment or pain, whereas no monotonic trends across income levels were seen in PT utilization.ConclusionsLow-income level was associated with greater prevalence of BC-related physical impairments, but not higher PT utilization. There appears to be a possible under-utilization of PT, particularly for those with low incomes.

Highlights

Background and significanceSide effects such as physical impairments are persistent reminders of the breast cancer (BC) experience (Hewitt et al 2006)
We examine the associations between race and income with BC-related impairments and whether physical therapy (PT) is utilized to treat impairments
Sample size Of 1109 women reported having been diagnosed with BC prior to Southern Community Cohort Study (SCCS) enrollment and not previously known to have died, we completed 577 interviews

Summary

Introduction

Side effects such as physical impairments (impairments) are persistent reminders of the breast cancer (BC) experience (Hewitt et al 2006). The most common breast cancer (BC)—related impairments are lymphedema, pain and fatigue. These and less studied impairments such as upper extremity muscle weakness, loss of range of motion, altered skin sensation and integrity, and abnormal posture and shoulder movement (Hewitt et al 2006; Battaglini et al 2014; Binkley et al 2012) fall under the scope of physical therapy (PT) practice (American Physical Therapy Association 2001). Socioeconomic status and race have strong explanatory effects on cancer mortality (Tian et al 2012), but the relationship of impairment prevalence and PT utilization are less clear.

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Results

Discussion

Conclusion