Risk Reduction Recommendations for Upper Quadrant Side Effects after Breast Cancer Surgery and Treatments: A Delphi Survey to Evaluate Consensus among Expert Physical Therapists and Alignment with Current Evidence

Survivors of breast cancer (BC) face various upper quadrant side effects (UQSEs) after surgery and treatments. This study aims to develop consensus for recommendations for side effect (SE) risk reduction. A team of physical therapists certified in lymphedema treatment (PTCLTs) conducted a narrative literature review and developed a questionnaire (topics included post-BC UQSE risk reduction instruction), which was then used in a Delphi survey to understand perceptions of a representative sample of Israeli PTCLTs (study participants). Thirty studies on post-BC upper quadrant (UQ) and other SE risk reduction recommendations and 29 studies on protocols for risk reduction instruction provision were identified. The levels of evidence of the studies varied widely. A 2-round Delphi questionnaire was completed by 130 and 101 study participants, respectively. The main general recommendations were: (1) instruction provision and referral to PTCLTs for all women after BC surgery; (2) information provision about individual risk for SEs and controversies; and (3) stress avoidance. Lymphedema and other UQ risk reduction recommendations were infection prevention, early shoulder mobility, physical activity, and normal body mass index. Instruction should be provided: pre-surgery, before hospital discharge, a few weeks after discharge, and during prospective surveillance. Instruction content would depend on timing and individual need. Although the literature review was comprehensive, it was not systematic. The study population excluded other health care staff. These recommendations may assist health care providers to give individually tailored instructions for patients after BC surgery and treatments.