A study of the effect of Osteopathy on Breast Cancer Survivors.
Breast cancer is the second most common type of cancer in world, with an estimated 12.8% of women diagnosed, more than 246,000 new cases of breast cancer diagnosed each year, and more than 3.5 million survivors currently living in the United States alone. Due to improvements in early detection and in the effectiveness of oncological treatment, the population of breast cancer survivors is growing.
The improved survival rate of BCS can be attributed to the current patient-specific treatment options, which typically involve surgery followed by chemotherapy, radiation therapy, or hormonal therapy. Although such advancements have curtailed the mortality rate of this life-threatening disease, they also have brought forth new obstacles in the form of chronic illness, providing the medical community with new challenges to consider in the management of the long-term survivors. Few reliable studies exist which provide evidence for improvements in the comorbidities associated with breast cancer remission. The scarcity of research for clinical guidelines in the area of upper extremity impairment for future breast cancer rehabilitation requires urgent focus.
This study was designed to test the hypothesis that a series of four global osteopathic treatments will have a statistically significant effect on the range of motion, grip strength, and subjective disabilities of the arm, shoulder, and hand in patients who underwent breast cancer treatment (p<.05). The effect of manual osteopathic treatment was studied clinically, using quantitative, pre-post time series measurements and a controlled, within-subjects design. The control and experimental groups consisted of the same participants, evaluated over four measurement occasions, thus providing internal homogeneity of the groups with no need for sham or placebo treatments. The present intrasubject study aims to provide evidence-based research to support the role of osteopathic manual therapy as a valid option to reduce post-remission physical comorbidities and to improve their upper extremity function. The study also seeks to highlight the need for greater understanding of the pathogenesis and comorbidities after breast cancer, as well as for improved assessment standards, resources, and quality of life for survivors of breast cancer.
This quantitative study evaluated the effects of osteopathic treatment interventions in 30 breast cancer survivors, between the ages of 30 to 70, with upper extremity dysfunction. The study population consisted of women who had received curative treatments for breast cancer, and participants were recruited from local physicians, manual therapists, and support groups. The within-subject design protocol occurred from August - November 2018. There were three notable phases: weeks 1-4 (control phase with no osteopathic treatment); weeks 5-8 (experimental phase, with intervention); weeks 9-12 (assessment phase, with no additional osteopathic treatments). Intervention consisted of four 60-minute global osteopathic treatments, specific to each subject based on her history and assessment. Changes in upper extremity function were evaluated on four measurement occasions, at weeks 1, 4, 8, and 12. Three measurement tools were used to measure changes: digital inclinometer, hand dynamometer, and Disabilities of the Arm, Shoulder, and Hand questionnaire.
Analysis of data revealed statistically significant improvement in all three measurements after global osteopathic treatment (p<.05). These results supported the hypothesis of the study, that global osteopathic treatments would have a statistically significant effect on upper extremity function in subjects who had undergone medical treatment for breast cancer. The results are as follows;
1. Findings of the Disability of the Arm Shoulder and Hand Questionnaire
Changes in DASH scores for breast cancer survivors over four time periods.
There was a statistically significant decrease in DASH scores (i.e., improvement in ability) from pre-treatment to post-treatment (p<.001). The DASH scale ranged from 30 (no difficulty with any tasks) to 150 (unable to perform any activities). FirstPre=before treatment, week 1; SecondPre=before treatment, week 4; FirstPost=after treatment, week 8; SecondPost=after treatment, week 12.
2. Findings of the Digital Inclinometer – Shoulder Internal Rotation
Changes in mean shoulder internal rotation range of motion (degrees) of the unaffected and affected sides of subjects over the course of the four measurement times.
There was a statistically significant effect of time (p<.01) but no statistically significant difference between the unaffected and affected arms (p=.09). FirstPre=before treatment, week 1; SecondPre=before treatment, week 4; FirstPost=after treatment, week 8; SecondPost=after treatment, week 12.
3. Findings of Grip Strength
Changes in mean grip strength (in kg) of the unaffected (no) and affected sides (yes) of breast cancer survivors over four time periods.
FirstPre=before treatment, week 1; SecondPre=before treatment, week 4; FirstPost=after treatment, week 8; SecondPost=after treatment, week 12. Statistically significant effects on mean grip strength were found by the fourth measurement (p<.05).
In the present study, the author evaluated the intended results of oncological treatments for women with breast cancer, the proposed mechanisms of these treatments, and the common adverse effects manifested as UE symptoms in BCS. This study provides an evidence-based protocol for the treatment and prevention of upper extremity dysfunction following conventional cancer treatment. It is the hope of the author that the data will give osteopathic manual practitioners greater insight into the implications of cancer treatment and somatic dysfunction. Recommendations for future follow-up research are offered.
This study was a small step in the direction toward making osteopathic manual therapy a recognized treatment option in the recovery of women after breast cancer. Furthermore, it shines a light on the lack of postsurgical care and physical recovery after breast cancer interventions. This study provided evidence that surgery, chemotherapy, radiotherapy, and endocrine treatments can have lasting and distant effects on the bilateral UE function of BCS. These effects can be subjectively and objectively measured through the use of goniometry, hand-held dynamometry, and DASH questionnaires.
The results of this study supported the hypothesis that global osteopathic treatment would have a statistically significant effect on the UE function of BCS (p<.05). This study also brought forth important and unexpected findings that should be considered in future research. The bilateral and visceral osteopathic findings imply that there is a widespread effect of breast cancer interventions, which should be assessed, quantified, and treated to improve the recovery of the survivors. Other symptoms that may be associated with global treatments include those that affect the spine and lower extremities, cardiopulmonary and digestive function.
This study was effective, safe, and it provides a groundwork for future studies to evaluate safe and effective treatment options for breast cancer survivors. The findings of this study could serve as a basis for new treatment protocols and techniques to be tested to improve functional outcomes for survivors. Moreover, it is hoped that this study ignites opportunities to learn the potency of osteopathy and challenges therapists to move the research in this field forward. The many benefits gained by the researcher from this study and thesis experience were invaluable.