Examining Occupational and Physical Rehabilitation Referral Patterns Following Mastectomy for Individuals With Breast Cancer: A Retrospective Cohort Study

Background: Despite advances in oncological treatment for individuals diagnosed with breast cancer (BC), and increases in lifespan for those living with BC, many will experience decreases in function and the ability to participate in meaningful occupations. Several studies have demonstrated that rehabilitation is a necessary component of care for individuals’ surviving BC yet is underutilized. This study examined referral patterns and trends in occupational therapy (OT) and physical therapy (PT) for individuals diagnosed with BC who have undergone a mastectomy. Methods: A retrospective cohort study was conducted. Medical records of 164 individuals with BC were reviewed. Data collected included demographics; cancer stage; adjuvant treatment types; referral orders to OT and/or PT; referring health professional’s specialty; when along the continuum of care the referral was ordered; common comorbidities; and performance measure scores. Results: Data analysis revealed that only 48 individuals (29.3%) referred for rehabilitation; with 3 (1.8%) being referred to OT, 34 (20.7%) to PT, and 12 (7.3%) referred to a combination of both OT and PT. Most referrals were ordered during the adjuvant/survivorship phases, while only one was ordered during the pre-operative phase. A total of 245 instances of impairments were found where referrals were not ordered but may have been indicated. Conclusion: Results suggest that rehabilitation services continue to be severely underutilized. Recommendations are identified to assist health professionals with referral decision making.