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Interference of breast cancer treatment
on daily life activities
J. M. PEREIRA DE GODOY 1, S. H. DA SILVA2, M. DE FÁTIMA GUERREIRO GODOY 3
1Adjunct Professor of the Cardiology
and Cardiovascular Surgery Department
and professor of the post graduation course
of Medicine School
of São Jose do Rio Preto-FAMERP, Brazil
2Professor of the Further Education College
in Catanduva-Brazil
3Occupational therapist
professor of the post graduation course
on lymphedema rehabilitation
in Medicine School
of São Jose do Rio Preto-FAMERP, Brazil
Aim. The objective of this study was to evalua-
te the effect of breast cancer treatment on the
daily lives of women.
Methods. The domestic activities of patients
suffering from breast cancer were compared
before and after mastectomies. The inclusion
criterion was that the participants had been
submitted to the surgical treatment for breast
cancer with axillary lymphadenectomy. The
study period was from July to December 2005.
The variables analyzed were: Cleaning the hou-
se, washing and ironing clothes looking after
plants and animals, preparing meals, shop-
ping, going to the bank, driving, taking care of
children and using public transport. Additio-
nally, the necessity to adapt to limitations and
to accept help from other people was also eva-
luated. For statistical analysis percentages and
the Fisher exact test were utilized with an alpha
error of 0.05 being considered acceptable.
Results. A total of 89 women with a mean age
of 54.8 ± 11.7 years participated. Cleaning the
house, washing and ironing clothes, prepa-
ring meals, shopping, driving, taking care of
children, using public transport and the neces-
sity to adapt to new habits and receiving help
from other people were all significantly chan-
ged.
Conclusion. Some everyday activities were affec-
ted in the period following breast cancer sur-
gery causing limitations in the day-to-day life of
these women including physical handicaps
and social isolation.
Key words: Day-to-day activities - Breast cancer,
therapy - Evaluation.
Qualitative investigators, who study per-
spectives after serious diseases, describe
that individuals look for new meaning in their
lives and a desire to change their life style.1
Thus, an occupation may have significance
and be utilized as a form of rehabilitation.
However, this must be carefully assessed with
the aim of improving the quality of life of
the individual. Rehabilitation interventions
can use day-to-day activities as a means of
placing individuals back into a more normal
life, especially following a potentially lethal
disease such as breast cancer.
One current concern relates to the sequels
resulting from surgery and radiotherapy, due
Received on April 4, 2009.
Accepted for publication on December 15, 2009.
Corresponding author: M. de Fátima Guerreiro Godoy,
Rua Floriano Peixoto, 2950, São José do Rio Preto-SP, Zipe
code:15020-010. E-mail: godoyjmp@riopreto.com.br
Vol. 168, N. 6 GAZZETTA MEDICA ITALIANA - ARCHIVIO PER LE SCIENZE MEDICHE
369
GAZZ MED ITAL - ARCH SCI MED 2009;168:369-72
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PEREIRA DE GODOY INTERFERENCE OF BREAST CANCER TREATMENT ON DAILY LIFE ACTIVITIES
to the possible limitations to movements,
restricting domestic, social and employment
activities leading to an introspective outlook
that consequently causes isolation, depres-
sion and early death. Day-to-day activities
can be transformed into activities that stimu-
late the lymphovenous drainage system in
women with lymphedema after mastectomies
and may therefore be used as a therapeutic
resource in rehabilitation.2
Hence, it is important to treat diseases and
sequels that cause changes in the lives of
people causing them to be physically, emo-
tionally and socially dependent.
The objective of the current study was to
evaluate the affect of mastectomies on the
daily life activities of women.
Materials and methods
A three-year study to evaluate the effects of
the surgical treatment for breast cancer on
domestic tasks was performed. Patients were
selected from the patients’ records of the “Dr.
José Perri” government healthcare clinic and
the teaching clinic of the Physiotherapy
College in Catanduva, Brazil. After being
identified, the women were contacted by
telephone or home visits in order to explain
the purpose of the research and their partic-
ipation in the collection of data was request-
ed. The women who fulfilled the inclusion
criteria and who gave their informed con-
sent were enrolled in the study.
The inclusion criteria were that the partic-
ipants had been submitted to the surgical
treatment for breast cancer with axillary lym-
phadenectomy. The study period was from
July to December 2005. The variables ana-
lyzed were: Cleaning the house, washing and
ironing clothes, looking after plants and ani-
mals, preparing meals, shopping, going to
the bank, driving, taking care of children and
using public transport. Additionally the neces-
sity to adapt to limitations and to accept help
from other people were also evaluated. For
statistical analysis percentages and the Fisher
exact test were utilized with an alpha error of
0.05 being considered acceptable.
Results
A total of 152 women fulfilled the inclusion
criteria but only 89 were included for data col-
lection as it was impossible to contact 20 and
43 did not want to take part in the study.
The mean age of the participants was
54.8±11.7 years and the followed-up was
over a period of 5.4 years. Table I demon-
strates that the domestic activities were
reduced by most of the interviewees and that
some performed activities even with pain.
The availability of help and special tools to
simplify day-to-day activities of the women
are necessary for reintegration.
Approximately half the women did not
have help from other people to do the tasks.
Following surgery, habits were adapted due
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TABLE I.—Activities in the day-to-day life before and after surgery and the symptoms felt.
Activities Before surgery %After surgery % p-value
(N.) (N.)
Cleaning the house 86 96.6 42 47.1 0.0001*
Washing clothes 79 88.7 32 35.9 0.0001*
Ironing clothes 75 84.2 41 46.0 0.0002*
Looking after plants 52 58.4 31 34.8 0.16
Looking after animals 41 49.3 24 26.9 0.25
Preparing meals 85 95.5 53 59.5 0.003*
Shopping 83 93.2 49 55.0 0.0001*
Going to the bank 60 67.4 47 52.8 0.11
Driving 42 47.1 33 37.0 0.0007*
Looking after children 18 20.2 9 10.1 0.014*
Public transport 45 50.6 33 37.0 0.015*
N=89. *P<0.05.
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INTERFERENCE OF BREAST CANCER TREATMENT ON DAILY LIFE ACTIVITIES PEREIRA DE GODOY
important to fill the time and reduce negative
thoughts. To feel useful and being capable of
doing everyday tasks can improve the self-
esteem, however due to deficient guidance or
even because of the lack of a specialized
team to assist the patient in the pre- and post-
operative periods, these women cease to per-
form day-to-day activities which may con-
tribute to the physical limitations and result
in social isolation.
In the current study, when the common
activities were evaluated in this group, a sig-
nificant reduction in the everyday activities
was detected. A total of 96.6% of the women
cleaned the house in the period before surgery
but in the post-operative period this percent-
age dropped to 47.1%; a reduction of approx-
imately half the women. This reduction is
understandable as cleaning the house is an
activity that requires force, may involve repet-
itive movements and is associated to a risk
of injuries. Additionally, the presence of pain,
edema and the insecurity are related to an
aggravation of the clinical condition. Avoiding
cleaning the house reduces the risk of edema,
however not performing activities can cause
muscle atrophy. Other activities that were
highlighted in this study were washing clothes,
initially performed by 88.7% of the women but
only by 35.9% following breast cancer treat-
ment and shopping; before treatment 93.0%
of the participants shopped but only 55.0%
after surgery. These reductions are attributed
to the fact that both activities require much
force; following surgery there are reductions
in the strength of muscles and amplitude of
movements, there is surgical scaring and
patients are warned about excessive use of the
arms. On the other hand, there is lack of
understanding of the biomechanical mecha-
nisms and specific guidance or evaluation.
Ironing was reduced from 84.2% of the
Vol. 168, N. 6 GAZZETTA MEDICA ITALIANA - ARCHIVIO PER LE SCIENZE MEDICHE
371
to the imposed limitations which significant-
ly increased the necessity of help and adapt-
ed tools.
Discussion
The current study made a comparison of
the daily life activities of women before and
after performing mastectomies.
In the electronic scientific library Pubmed,
few studies on the effect of mastectomies
were found, even though this type of oper-
ation is very common. The daily life experi-
ences of women suffering from lymphedema
after breast cancer treatment were evaluat-
ed showing alterations in the practical and
psychosocial activities. The most common
themes related to changes were: the attitudes
of people around in respect to their prob-
lem; the development of lymphedema; diffi-
culties to accept the chronic disease; the treat-
ment; the emotional difficulties in under-
standing and accepting the problem and the
difficulties to perform routine activities.3
The confirmation of these changes in the
participation of daily occupational activities,
as well as the alterations in the abilities of
women accompanied for a period of six to 12
months after mastectomy reinforce the neces-
sity to develop rehabilitation protocols for
these women.4
One of the alterations identified in the cur-
rent study was the pain felt by the majority of
women who restarted activities. This can be
attributed to the degree of post-treatment
dysfunction that leads to a reduction in the
movement of joints and the weight of the
limb, limiting the patients in their everyday
tasks, whether in the home, profession or
for leisure. This affects the lives of the women
and causes psychological disorders and phys-
ical dependence.
Human beings have an occupational
nature, characterizing them as active in the
construction and transformation of their
world. And thus, any change or situation that
harms man can be considered as an absence
of activities related to work, daily life, prac-
tical life and leisure.5
Hence the occupation of these patients is
TABLE II.—Help doing domestic chores.
Domestic chore Before After P-value
surgery surgery
Help from others 46 69 0.005*
Adaptation of habits 66 78 0.03*0
N=86. *P<0.05.
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PEREIRA DE GODOY INTERFERENCE OF BREAST CANCER TREATMENT ON DAILY LIFE ACTIVITIES
women before surgery to 46.0% in the post-
treatment period; a significant number for
such a common activity among the women.
In general the results demonstrated a
reduction in the post-treatment period of all
the routine activities previously performed
by this group of women. One fact that calls
the attention is related to the post-surgical
rehabilitation process, mainly in respect to
the motor function, where the movements
are very important and the daily activities
may stimulate these functions and maintain
patients within their normal routines.
The daily activities are mechanisms that
can be used in rehabilitation as a form of
exercise with specific objectives; however, it
is necessary to understand the biomechanism
of each movement required in the exercise,
specific evaluation, individual training and
frequent reevaluations. It is possible to return
patients back to their daily activities and uti-
lizes these for post-operative rehabilitation;
however a specialized multidisciplinary team
is recommended in both the pre- and post-
operative periods of breast cancer surgeries.
Conclusions
Some routine activities may be affected
following surgery for breast cancer such as
cleaning the house, washing and ironing
clothes and shopping causing limitations in
the daily life of these women possibly lead-
ing to physical handicap and social isolation.
Riassunto
Influenza del trattamento contro il carcinoma della
mammella nelle attività quotidiane
Obiettivo. L’obiettivo di questo studio era di valu-
tare l’effetto del trattamento del carcinoma della mam-
mella sulla vita di tutti i giorni delle donne affette da
questa patologia.
Metodi. Le attività domestiche delle pazienti affet-
te da carcinoma della mammella sono state confron-
tate prima e dopo l’intervento chirurgico di mastec-
tomia. Le partecipanti, come criterio di inclusione
allo studio, sono state sottoposte ad intervento chi-
rurgico per carcinoma della mammella con linfade-
nectomia ascellare. Il periodo dello studio era com-
preso tra Luglio e Dicembre 2005. Le variabili ana-
lizzate sono state: le pulizie di casa, lavare e stirare i
vestiti, aver cura di piante e di animali, preparare i
pasti, fare shopping, andare in banca, guidare, pren-
dersi cura dei bambini e prendere i mezzi pubblici di
trasporto. Inoltre, è stata valutata la necessità di adat-
tamento alle limitazioni e di accettazione dell’aiuto da
parte di altre persone. Dal punto di vista dell’analisi
statistica, le percentuali e il test esatto di Fisher sono
stati utilizzati considerando accettabile un errore alfa
di 0,05.
Risultati. Complessivamente, 89 donne con un’età
media di 54,8±11,7 anni hanno partecipato allo stu-
dio. Le pulizie di casa, lavare e stirare i vestiti, pre-
parare i pasti, lo shopping, guidare, prendersi cura dei
bambini, prendere i mezzi pubblici di trasporto e la
necessità di adattamento alle nuove abitudini, oltre a
ricevere aiuto da altre persone sono tutte variabili
che sono cambiate significativamente dopo l’inter-
vento chirurgico.
Conclusioni. Alcune attività quotidiane erano alte-
rate nel periodo successivo all’intervento chirurgico
per carcinoma della mammella, causando limitazio-
ni nella vita quotidiana di queste donne, con impor-
tanti menomazioni fisiche ed isolamento sociale.
Parole chiave: Attività quotidiane - Carcinoma della
mammella, trattamento - Valutazione.
References
1. Hammell KW. Dimensions of meaning in the occupa-
tions of daily life Can Occup Ther 2004;7:296-305.
2. Godoy MFG, Godoy JMP, Braile DM. Pilot study with
Myolymphokinetic activities in the treatment of lym-
phedema after breast cancer. Indian Journal of
Physiotherapy and Occupational Therapy 2008;2:17-9.
3. Johansson K, Holmstrom H, Nilsson I, Ingvar C,
Albertsson M, Ekdahl C. Breast cancer patients’ expe-
riences of lymphoedema. Scandinavian Journal of
Caring Sciences 2003;17:35-42.
4. Karki A, Simonsen R, Malkia E, Selfe J. Impairments,
activity limitations and participation restrictions 6 and
12 months after breast cancer operation Journal
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