PSM Study at Grady Finds Common Factors in Breast Cancer Patients Needing Postoperative Therapy
The Prospective Surveillance Model of care (PSM), originally developed by the American Cancer Society in conjunction with a panel of breast cancer experts and advocacy groups, practices early identification, treatment, and support of the physical impairments experienced by breast cancer survivors. This proactive approach to the morbidity of breast cancer treatment has been applied and evaluated since 2012 at Grady Memorial Hospital's Avon Comprehensive Breast Center, a program directed by Sheryl Gabram, MD, an Emory surgical oncologist and chief of the Division of Emory Surgery at Grady Memorial Hospital.
In a recent study published in the Annals of Surgical Oncology, a team of investigators that included Gabram as senior author and members of Turning Point Breast Cancer Rehabilitation, Emory University, and other national academic medical centers, began compiling data that would eventually allow physicians to identify breast cancer patients that were most likely to need rehabilitation intervention. The study was the first to undertake a 12-month-long observation of PSM in action with a focus on describing the incidence of impairments during the first postoperative year, and the differences between patients requiring rehabilitation intervention and those who did not.
A total of 120 patients were enrolled. Impairment measures of pain, range of motion, and self-reported measures of function using the Upper Extremity Functional Index (UEFI) and Quick Disability of the Arm, Shoulder and Hand (QuickDASH) questionnaires were performed at designated intervals during the postoperative year. All patients received exercise and education, and the 36 patients with identified impairments underwent individualized rehabilitation intervention. Clinical factors associated with need for intervention were determined using univariate analysis.
"There were no statistically significant differences between the intervention and non-intervention groups for BMI, breast surgery type, reconstruction type, or radiotherapy," Gabram says. "However, the intervention group had significantly lower levels of extremity function at the early postoperative evaluation, greater number of lymph nodes removed, greater extent of axillary surgery, were more likely to have undergone chemotherapy, had greater overall burden of disease, and were younger than the non-intervention group."
The study concluded that survivorship practitioners should have heightened awareness for rehabilitation intervention in patients whose treatment experience contains a number of these characteristics, and that future studies should focus on implementing a screening tool for early identification of patients in need of rehabilitation referral.
"Implementing the Prospective Surveillance Model (PSM) of Rehabilitation for Breast Cancer Patients with 1-Year Postoperative Follow-up, a Prospective, Observational Study." Lisa Lai MD, Jill Binkley MSc, PT, CLT, Veronica Jones MD, Stephanie Kirkpatrick PT, DPT, CLT, Cathy Furbish PT, Paul Stratford PT, MS, Winifred Thompson PhD, MSW, Amanjyot Sidhu MBBS, MPH, Clara Farley MD, Joel Okoli MD, MPH, Derrick Beech MD, Sheryl Gabram MD, MBA. Annals of Surgical Oncology. Published online June 22, 2016.