Volume 8, Issue 8, August – 2023 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Awareness of Physical Therapy Rehabilitation among

Pre and Post Surgical Breast Cancer Patients –
A Survey
Gauri G. Kamer1 , Dr. Shweta P. Pachpute (MPT)2
LSFPEF’s College of Physiotherapy, Nigdi, Pune- 411044 Head Of Musculoskeletal Department,
Address: Sunrise, flat no 506, Film city road, Professor of Musculoskeletal-physiotherapy,
Goregoan-East,Mumbai-400063. LSFPEF’s College of Physiotherapy, Nigdi, Pune- 411044.

Abstract:- cancer patients as well as in post surgical breast cancer

patients. A below average of subjects (42.2%) were not
 Background: referred to physical therapy during breast cancer
Breast cancer is the most common cancer and also treatment, while the majority of subjects (74.3%) were
the primary cause of mortality due to cancer in females not aware about the pre surgical assessment and
all around the globe. There is a huge difference in breast intervention provided by a physical therapist.
cancer survival rates worldwide, with an estimated 5
year survival of 80% in developed countries and below  Conclusion :
40 % in developing countries. Physical therapy The pre and post surgical breast cancer patients
Rehabilitation is effective and safe in the management of both were less aware of the physical therapy
pre and post surgical breast cancer rehabilitation in breast cancer.They did knew about
patients.Physiotherapy intervention empower patients in physical therapy treatments but didn’t have enough
the management of their symptoms, side effects of knowledge about the physical therapy rehabilitation in
treatment or recovery from surgery. Pre Surgical breast cancer.
Physiotherapy Management is equally important that of
the Post Surgical Physiotherapy Management.With the Keywords:- Awareness, Physical Therapist, Physical
increasing number of females diagnosed with breast Therapy Rehabilitation, Pre Surgical Breast Cancer
cancer and surviving it, quality of life outcomes are Patients, Post Surgical Breast Cancer Patients.
increasing in importance with numerous studies
supporting physical activity and its positive impact. It is I. INTRODUCTION
important to aware patients about physical therapy
techniques and its effects to voluntary participate in The term “Breast Cancer” refers to a malignant tumor
rehabilitation, it creates lot of difference in the quality of that developed by proliferation of cells in the breast.(1) It
life of cancer patients. occurs more commonly in women with a family history of
breast cancer than in general population. (2) Less than 0.5%
 Aim : of patients with breast cancer are male.(2) Breast cancer is
To Study the Awareness of Physical Therapy mow the most common cancer in Indian women. (3) The latest
Rehabilitation among Pre and Post Surgical Breast WHO-GLOBOCAN data came out in October2020.In India,
Cancer Patients. approximately 1,78361 i.e 13.3% new cases of breast cancer
are detected per annum with 90,408 i.e. 10.6% deaths.
 Method : According to WHO-GLOBOCAN 2020, breast cancer ranks
The study involves 370 females diagnosed cases of first in india and world i.e. 25.8% of world population
Breast cancer which includes 185 pre and post surgical among all the other cancer and it is leading cause of cancer
breast patients respectively.They voluntarily deaths.(13) Types of breast cancer: Invasive and Non-invasive
participated in the study by answering a structured breast cancer.(4) The staging system most often used for
questionnaire. Approval were taken from the Oncologist breast cancer is American Joint Committee on Cancer
for collecting the patients data from their hospitals, in (AJCC).(5) The post surgical breast cancer complications
persons well as telephonically, these questionnaire was include: 1.Scar tissue adhesions. 2.Pain: shoulder, chest,
collected through google forms and Social media (Gmail back, neck or arm. 3. Restricted Rom. 4.Stiffness of the
and Whatsapp links) around Pune (India). shoulder, neck and spine. 5.Lymphedema. 6.Weakness and
fatigue. 7.Neuropathy. 8.Axillary Web syndrome (cording).
 Result : 9. Bowel and bladder changes. 10.Dyspareunia (Pain with
The result showed a vast majority of subjects (96%) intercourse). 11.Post mastectomy pain syndrome (PMPS). (11)
received physiotherapy treatment and got relief from
it.Hence, it is noted that awareness of physical therapy
rehabilitation is equally essential in pre surgical breast

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Volume 8, Issue 8, August – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Today the involvement of physiotherapist in the field II. METHODOLOGY AND MATERIALS
of oncology is diverse and includes specific roles which are
evidence based.(6)In physical therapy services, Study Duration: 6 months, Study set up : Pune, Study
“physiotherapists assess,plan and implement rehabilitative design: Cross section study, Sampling size: 370, Sampling
programs that improve or restore human motor functions, technique: Purposive sampling.
maximize movement ability, relieve pain syndromes, and
treat or prevent physical challenges associated with injuries, Smart phone, Google forms application, Internet
diseases and other impairments.(7) connection, whatsapp or Email account, Awareness of
physical therapy rehabilitation questionnaire among pre and
There are 4 stages of rehabilitation: post surgical breast cancer patients.

 Preventive-Rehabilitation:  Outcome Measure:

Intervention focused on improving the patient’s level The questionnaire was a close ended multiple choice
of function prior to the onset of the effects of cancer and its questionnaire with 15questions included overall.
treatment,patient’s education and the psychological support.
 Have you been taught how to do self breast Examination.
 Restorative-Rehabilitation: (a) Yes. (b) No.
Intervention meant to assist the cancer patient to a level
of function and addressing impairments, activity limitations  If answer is Yes, who taught you: i. Doctor ii. NGO
and participation restrictions. volunteer iii. Physical therapist iv. Nurse v. Others

 Palliative-Rehabilitation:  Do you have a Family history of Breast cancer. (a) Yes.

Intervention focused on minimizing complications (b) No.
such as pressure ulcers, contractures and muscle
deconditioning ensuring adequate pain control and  Are you regular with you follow up: (a) Yes. b) No
emotional support for the family.(12)So in all stages patients
involvement is very important so it is necessary for patients  Are you aware of the type of surgery you have
and also medical doctors be aware about how physical undergone/you are going to undergo:(a) Yes (b) No.
therapy plays ab important role in maintaining the functional
ability of an individual.(8)  Have your surgeon mentioned you about the post
surgical complication related to breast cancer surgery.(a)
Various studies show that there is a lack of knowledge Yes (b) No.
about physical therapy among medical professionals also.(9)
 Have you ever referred to a physical therapist during
 Need of study. your treatment. (a) Yes. b) No.
Physical therapy rehabilitation is effective and safe in
the management of pre and post surgical breast cancer
 Do you have enough knowledge about physiotherapy. (a)
patients. Physiotherapy intervention empower patients in the
Yes (b) No.
management of their symptoms, side effects of treatment or
recovery from surgery. Patient’s with breast cancer not only
have post surgical complications but also have pulmonary  What are your source of information about physical
and vascular complications. Some research have studied the therapy.
(a) Personal Contact:i.Family members/Friends
awareness have studied the awareness of physical therapy
treatment un medical professionals but there are very few ii.Through medical-
study which has analyzed awareness of physiotherapy in professionals/surgeon.Hospital/Healthcenter iv. NGO.
(b)Mass-Media: i.Books/Newspaper ii.Internet in. iii Radio/
patients and it is equally essential to find out whether these
breast cancer patients are aware about pre and post surgical TV. iv. Others.
physiotherapy treatment, As patient is the most important
member of rehabilitation team so that they voluntary  Are you aware about the Pre-operative Assessment and
participate in the rehabilitation and create a lot of difference Intervention provided by physical therapist. (a) Yes. (b)
in their quality of life. No

 Aim.  Are you aware about the Post-operative Assessment and

To study the awareness of physical therapy Intervention provided by a Physical Therapist. (a) Yes.
rehabilitation among pre and post surgical breast cancer (b) No
patients.
 Are you aware that a physical therapist provides you a
brief counseling about your condition and Advice
Regarding Exercises. (a) Yes (b) No

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Volume 8, Issue 8, August – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
 Are you aware that a physical therapy rehabilitation Q4. Table 4, Out of 370 patients, (83.2%) 308 patients were
improves your Quality of life. (a) Yes. (b) No Regular with follow up where as (16.8%) 62 patients were
not Regular with their Follow up.
 What all Advantages does a physical therapy treatment
cause: i.Improves physical and mental function. ii. Q5. Table 5, Out of 370 patients, (84.6%) 313 patients were
Decreases pain and swelling. iii. Improves posture and aware of the surgery they are undergoing or have undergone
prevents deformity iv. None v. All of the above. where as (15.4%) 57 patients were not aware of the surgery
they have undergone or going to undergo.
 If Physical therapy received, got relieved from the same
(a)Yes. (b) No. Q6. Table 6, Out of 370 patients, (69.7%) 258 were
mentioned about the Post Surgical Complication related to
 Inclusion Criteria. Breast cancer by the surgeon where as (30.3%) 112 patients
Females, Age between 25-50years, Diagnosed C.A were not mentioned about the Post Surgical
breast cases, Stage1-Stage4, Recurrence cases. Complication related to Breast cancer by the surgeon.

 Exclusion Criteria. Q7. Table 7, Out of 370 patients (42.2%) 214 patients were
Males/Transgenders, undiagnosed cases, patients who not referred to physical therapy during their treatment where
are not technically equipped, patients with Ductal carcinoma as (57.8%) 156 patients were referred to physical
in situ (DCIS) – stage0, Paget disease of the nipple, Distant therapy during their treatment.
metastasis, Extensive Intraductal carcinoma (invasive ductal
carcinoma), Collagen disease: SLE (Lupus mastitis), Benign Q8. Table 8, Out of 370 patients (62.4%) 231 patients had
breast conditions, psychiatric diseases. enough knowledge about Physical Therapy where as
(37.6%) 139 patients didn’t had enough knowledge about
 Procedure. Physical Therapy.
Ethical approval was taken from the Ethical
committee. Subjects were chosen on the basis of inclusion Q9. The Source of Information about Physical Therapy for
and exclusion criteria. A self devised questionnaire was 370 patients were from (31.3%) 115 patients through
been prepared and distributed among 7 mpth physiotherapist Medical Professional / Surgeon, (15.7%) 58 patients by
and the face validity was been done. Different multi Medical Camp / Awareness Campaign, (13.5%) 50 patients
specialist cancer hospitals were approached. Approval were were from Internet, (12.7%) 47 patients were from Family
taken from the Oncologist for collecting the patients data members/Friends, (11.1%) 41 patients were from
from their hospitals, consent was taken from the approached Hospital/Health Care Center/Support Group, (5.9%)
patients participating in the study in person and as well as 22patients were from Others, (5%) 19 patients from
telephonically. The questionnaire were explained to patients Books/Newspaper and rest (5%) 18 patients from Radio/Tv.
in person as well as virtually through phone calls. The
Questionnaire were distributed to the patients by using Q10. Table 10, Out of 370 patients about (74.3%) 275 were
Google forms by a link share via social media not aware about the pre surgical assessment and
(whatsapp/Gmail) and in person. intervention provided by the physical therapist. Where as
(25.7%) 95 patients were aware about the pre surgical
III. RESULT AND DATA ANALYSIS assessment and intervention.

A total of 370 diagnosed breast cancer patients Q11. Table 11, Out of 370 patients (40.5%) 150 patients
participated in the study among them included (50%) 185 were not aware about the post surgical assessment and
pre surgical breast cancer patients and 185 (50%) post intervention provided by a physical therapist, where as
surgical breast cancer patients respectively. (59.5%) 220 patients were aware about the post surgical
assessment and intervention provided by a physical
Q1. Table1, Shows out of 370 Patients, (74.99%) 277 therapist.
patients were taught how to do Self Breast Examination
Where as (25.1%) 93 patients were not taught how to do Q12. Table 12, (22.2%) 82 patients were not aware by the
Self breast examination. brief counseling about the condition and advice provided
regrading exercises.where as (77.8%) 288 patients were
Q2. Table 2, Shows that Out if 277 patients, Self-Breast aware about the brief counseling about the condition and
Examination were taught to (32.2%) 77 patients was by advice provided regrading exercises.
Doctor, (21.5%) 62patients were taught by Physical
Therapist, (18.1%) 57 patients by Nurse, (16.4%) 45 by Ngo Q13. Table 13, (77.8%)288 patients agreed physical
Volunteer and (11.9%)36 patients were taught self breast therapy rehabilitation improves quality of life where as
examination by others. (22.2%) 88 patients were not aware that physical therapy
rehabilitation improves quality of life.
Q3. Table 3, Out of 370 patients, (55.7%)164 patients have a
family history of breast cancer where as (45.3%) 206
patients didn’t had family history of breast cancer.

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Volume 8, Issue 8, August – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Q14. Table 14, The advantages of physical therapy Q15. Table 15 (A) Out of 370 patients, (70.8%) 262
treatment cause was answered (35.7%) 132 patients stated patients received the physical therapy treatment where as
all of the above while (23.8%) 88 patients stated improves (29.2%) 108 patients didn’t received the treatment.
posture and prevents deformity, where as (22.2%) 82
patients stated it decreases pain and swelling, (14.3%) 53 Table 15 (B) Out of 262 patients, (96.2%) 252 patients got
patients stated it improves physical and mental health and relief after physiotherapy treatment where as (3.8%) 10
rest (4%) 15 patients stated none. patients didn’t get any relief after physiotherapy treatment.

Table 1 Self Breast Examination Description.

SELF BREAST EXAMINATION DIDN’T TAUGHT

277/370 93/370

Table 2 Self Breast Examination Taught by Description.

PATIENT WHO WERE TAUGHT SELF EXAMINATION.
SELF BREAST EXAMINATION TAUGHT BY:.
(277subjects)
DOCTOR 77
PHYSICAL THERAPIST 62
NURSE 57
NGO VOLUNTEER 45
OTHER 36

Table 3 Family History of Breast Cancer Description.

FAMILY HISTORY OF BREAST CANCER NO FAMILY HISTORY OF BREAST CANCER.
164 206

Table 4 Regular with Follow up Description.

REGULAR WITH FOLLOW UP NOT REGULAR WITH FOLLOW UP.
308 62

Table 5 Type of Surgery to Undergo/ Undergone Description.

AWARE OF THE TYPE OF SURGERY TO NOT AWARE OF THE TYPF OF SURGERY TO
UNDERGO/UNDERGONE. UNDERGO/UNDERWENT.
313 57

Table 6 Surgeon Mentioned About Post Surgical Breast Cancer Complication Description.
SURGEON MENTIONED ABOUT POST SURGICAL SURGEON DIDN’T MENTIONED ABOUT POST
BREAST CANCER COMPLICATION. SURGICAL BREAST CANCER COMPLICATION.
258 112

Table 7. Referred to Physical Therapy During Treatment Description.

Referred To Physical Therapy During Treatment. Not Referred To Physical Therapy During Treatment.
214 156

Table 8 Knowledge About Physical Therapy Description.

HAVE ENOUGH KNOWLEDGE ABOUT PHYSICAL DOESN’T HAVE ENOUGH KNOWLEDGE ABOUT
THERAPY PHYSICAL THERAPY
231 139

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Volume 8, Issue 8, August – 2023 International Journal of Innovative Science and Research Technology
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Table 9 (A) Source of Information About Physical Therapy Information Description.
SOURCE OF INFORMATION ABOUT PHYSICAL THERAPY SUB.
PERSONAL CONTACT.
1. Through medical professional/ Surgeon.
115

2. Medical camp/ Awareness campaign.

58

3. Family/Friends. 47
4. Hospital/Healthcare center/Support group.
41

Table 9 (B) Source of Information About Physical Therapy Information Description.

SOURCE OF INFORMATION ABOUT PHYSICAL THERAPY SUB.
MULTI-MEDIA.
1. Internet.
50

2. Others.
22

3. Books/Newspaper. 19
4. Radio/Tv.
18

Table 10 Aware About Pre Surgical Assessment and Intervention Provided by Physical Therapist Description.
NOT AWARE ABOUT PRE SURGICAL ASSESSMENT
AWARE ABOUT PRE SURGICAL ASSESSMENT AND
AND INTERVENTION
INTERVENTION PROVIDED BY PHYSICAL
PROVIDED BY
THERAPIST.
PHYSICAL THERAPIST
95 275

Table 11 Aware About Post Surgical Assessment and Intervention Provided by Physical Therapist Description.
AWARE ABOUT THE POST SURGICAL ASSESSMENT NOT AWARE ABOUT THE POST SURGICAL
AND INTERVENTION PROVIDED BY PHYSICAL ASSESSMENT AND INTERVENTION PROVIDED
THERAPIST. BY PHYSICAL THERAPIST.
220 150

Table 12 Brief Counseling About Your Condition and Advice Provided Regrading Exercises Description.
AWARE ABOUT BRIEF COUNSELING ABOUT YOUR NOT AWARE ABOUT BRIEF COUNSELING ABOUT
CONDITION AND ADVICE PROVIDED REGRADING YOUR CONDITION AND ADVICE PROVIDED
EXERCISES. REGRADING EXERCISES.
288 82

Table 13 Physical Therapy Rehabilitation Improves Quality of Life Description.

AWARE ABOUT PHYSICAL THERAPY NOT AWARE ABOUT PHYSICAL
REHABILITATION IMPROVES QUALITY OF LIFE. REHABILITATION IMPROVES QUALITY OF LIFE.
288 82

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Table 14 Advantages of Physical Therapy Rehabilitation Description.
ADVANTAGES OF PHYSICAL THERAPY
RESPONSES BY PATIENTS.
REHABILITATION.
IMPROVES PHYSICAL AND MENTAL FUNCTION. 53
DECREASES PAIN AND SWELLING. 82
IMPROVES POSTURE AND PREVENTS
88
DEFORMITIES.
NONE. 15
ALL OF THE ABOVE 132

Table 15 (A) Physical Therapy Received Description.

PHYSICAL THERAPY RECEIVED PHYSICAL THERAPY NOT RECEIVED.
262 108

Table15.B. Relief after Physical Therapy Treatment Description.

NOT RELIEF AFTER PHYSICAL THERAPY
RELIEF AFTER PHYSICAL THERAPY TREATMENT
TREATMENT
252 10

IV. DISCUSSION population: A social media survey stated that though

majority of health care professionals and general population
The purpose of the study is to find awareness about the are aware of physiotherapy, its role in the field of oncology
physical therapy rehabilitation among pre surgical and post is little known and remains under utilized. There is a felt
surgical breast cancer patients, awareness about the pre and need by both health care professionals and general
post surgical assessment and intervention provided by a population to create more specific understanding and
physical therapist among the pre and post surgical breast promote utilization of services to promote quality of life.
cancer patients and awareness about physical therapy
improves quality of life in pre and post surgical breast Hari Krishnan R,Kamalambal H. Awareness and
cancer patients. attitude towards physiotherapy among higher secondary
students: A pilot study stated that the student have moderate
To do, the study involves a self devised pre validated awareness about physical therapy. The awareness about the
awareness of physical therapy rehabilitation questionnaire. role of physiotherapy in specialities other than Orthopedics
is not satisfactory.
Cancer is physiological condition where affected cells
in a body part grow and reproduce uncontrollable growth. Davinder Kumar, Virender Kumar, Savarna. The role
The cancerous cells can assault and wipe out surrounding of physiotherapy for the management of breast cancer and
healthy tissues, including organs. enhancing lifestyle for breast cancer survivors through
physical activity and exercise stayed the physiotherapist
Mullai, Dhinakaran, Chanchal Gautam, Clarence understands the patients underlying pathological condition.
Samuel Awareness of physical therapy rehabilitation for Exercise can contribute to improved mood, reduced anxiety
breast cancer related lymphedema among medical oncology and depression suffering breast cancer treatment. Exercise
Team-A survey stated that early physical therapy treatment may prevent weight gain during cancer treatment and cause
improves the patient’s quality of life. Medical oncology reduction in fatigue. In our study we found that, a few
team members felt that physical therapist is an important subjects (25.1%) were not taught self breast examination.
team member for rehabilitation of breast cancer in both pre Self breast examination is used as an important self
as well as post operative phase, but few of them send their screening tool for early detection of breast cancer because it
patients to out patients physiotherapy department. The study is cheap, widely available and does not require complex
also stated that it is important that awareness of the physical technical training. It also enhances the sensitivity and alert
therapy and its effects to the medical professionals is on abnormal changes at earliest, so that women are aware of
necessary and also inclusion of physical therapist in the any breasts changes detected during self breast examination.
rehabilitation team. Additionally, by performing regular self breast examination,
it is able to empower women and encourage them to take
Devanshi Doshi, Mariya Jiandani, Rucha Gadgil, Neha responsibility for their own health. Thus, it is recommended
Shetty Physiotherapy awareness in medical and non medical for raising women's awareness for breast cancer.

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Volume 8, Issue 8, August – 2023 International Journal of Innovative Science and Research Technology
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A few subjects (16.8%) were not regular with the aware about the pre surgical assessment and intervention
follow up. The follow-up may include regular physical provided by the physiotherapist.
examinations, medical tests, or both. Doctors want to keep
track of your recovery in the months and years ahead. The Hence, our observational study statistically concluded
major goal of follow-up is to check for a recurrence, which that the pre and post surgical breast patients who received
means that the cancer has come back. cancer recurs because the physical therapy rehabilitation got relief from the
small areas of cancer cells that don't respond to treatment treatment and thus it is important to create awareness among
may remain undetected in the body. Over time, these cells both pre and post surgical breast cancer patients.
may increase in number until they show up on test results or
cause signs or symptoms.  Limitation of study.
The Response to the Questionnaire was Subjective.
Some survivors continue to see their oncologist, while
others transition back to the care of their primary care  No Special Exercises were asked in the Questionnaire.
doctor, another health care professional, or even a physical  The Participants were particularly from the urban and
therapist. A physiotherapist plays an important role in the developing cities, resulted into lack of diversity among
rehabilitation process as they emphasis patients by educating participants.
them about the condition, complication and the treatment  It did not capture the challenges the rural women
needed in brief. experience.

A below average of subjects (42.2%) were not referred  Future scope of the study.
to physical therapy during breast cancer treatment. Recommendations and scope of study.
Physiotherapy Treatment not only reduce the incidence of
post cancer musculoskeletal disorders but also reduce the  Survey can be done in different cities of india.
incidence of anxiety, depression and stress.  Comparative surveys can be done to evaluate the
awareness among the pre and post surgical breast cancer
A majority of subjects (74.3%) were not aware about patients.
the pre surgical assessment and intervention provided by a  Comparative surveys can be done to evaluate the
physical therapist, the pre-surgical assessment involves awareness among the breast cancer patients and the
physical and psychological assessments to identify patient’s medical oncology team.
baseline functional level and possible pre-existing
 Survey can be done to determine the Quality of Life in
comorbidities and the pre surgical interventions may include patients receiving/received physiotherapy treatment.
exercise, respiratory physiotherapy, nutritional support and
psychological counseling encompassing a multi-modal
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