Advancing breast cancer rehabilitation: a novel tool for assessing physical morbidity risk

Abstract

Purpose: This study presents the development process of the Arm Morbidity following Breast Cancer Treatments (ARM-BCT) tool.

Materials and methods: A historical prospective study was conducted across five medical centers from 2020 to 2023. Medical information and a questionnaire covering morbidities, lifestyle, emotional state, and functioning were collected. Regression models analyzed 22 risk factors for chronic pain, lymphedema, functional limitations, and decreased range of motion. Significant factors were included in the ARM-BCT tool.

Results: Seventeen significant risk factors were identified, including mastectomy (B = 2.073, CI, 7.403-5.366), axillary lymph node dissection (B = 0.194, CI, 0.988-1.036), breast reconstruction (B = 17.300, CI, 7.105-27.495), advanced stage (B = 0.498, CI, 1.044-2.594), chemotherapy (B = 1.326, CI, 0.870-3.673), BMI (B = 0.092, CI, 1.033-1.163), anxiety (B = 0.177, CI, 1.859-3.079), low physical activity levels (B = -0.059, CI, 0.190-0.001), specific comorbidities (B = -1.491, CI, 2.706-0.277), age (B = 0.035, OR = 1.036, CI, 1.002-1.071), and radiation therapy (B = 0.385, CI, 0.380-2.056), etc. The tool's development involved robust statistical modeling to determine the weight of each factor, evaluate model quality, and establish a clinically relevant cutoff point.

Conclusion: This article describes the development process of the ARM-BCT tool, designed to assess the risk of physical morbidity following breast cancer treatment. The tool incorporates 17 statistically significant risk and protective factors into a scoring scale ranging from 1 to 20. Risk is categorized as low (< 6) or high (> 7), enabling targeted recommendations for rehabilitation timing and necessity. While validation studies evaluating its clinical effectiveness are underway and will be presented in future publications, the ARM-BCT tool shows promise in enhancing recovery outcomes through early intervention.

Keywords: breast cancer; morbidity; physical impairments; physical therapy; rehabilitation; risk assessment; risk factors; tool development.

Figure 1.

Study flow chart consolidated standards of reporting trials (CONSORT) diagram.