How can occupational therapists support patient implementation of lymphoedema treatment recommendations? A retrospective cohort study

Introduction: Patient implementation of breast cancer-related lymphoedema treatment recommendations is often considered suboptimal. This study explored patient implementation of occupational therapy breast cancer-related lymphoedema treatment recommendations and identified barriers and enablers. Method: An observational retrospective cohort study was conducted using clinical data from a tertiary hospital’s prospective surveillance model of care for early breast cancer-related lymphoedema detection and intervention. Patients who received occupational therapy were included, and implementation levels were compared above and below a 70% threshold. Results: Among 63 patients (median age = 60 years, interquartile range 47.0–70.0), 73% ( n = 46) implemented over 70% of recommendations and 29% achieved full implementation. Pain (54%, n = 34) was the main barrier, while strong support networks (63.5%, n = 40) were the leading enabler. Lower implementation was associated with receipt of taxane chemotherapy ( p = 0.030), fewer therapy interventions provided ( p < 0.001), type of tumour ( p = 0.014), lymphoedema management not seen as a patient priority ( p = 0.001) and receiving nicotine treatment ( p = 0.038). Sentinel node biopsy ( p = 0.024) and understanding the risks of poor lymphoedema management ( p = 0.019) were associated with increased patient implementation. Conclusion: Most patients implemented >70% of breast cancer-related lymphoedema treatment recommendations; however, understanding and addressing clinical and psychosocial factors could optimise implementation and improve outcomes.