Falls prevention in people with breast cancer: a survey of current physiotherapist practices.

PURPOSE: To examine the current falls prevention knowledge, beliefs and practices of physiotherapists providing clinical care to people with breast cancer. METHODS: A cross-sectional online survey of currently registered, practising Australian physiotherapists was conducted. The survey was developed and reported using the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) checklist, with data analysed descriptively or using bivariate tests. Free-text responses to open-ended questions were classified into key themes for analysis. RESULTS: Forty-two physiotherapists completed the survey, of which 55% (23/42) believed that people with breast cancer had a higher risk of falls compared to the general population. Whilst most respondents received prior training in assessing and managing falls risk factors (30/42; 71%), they reported only moderate confidence in assessing and delivering falls prevention care to people with breast cancer (median 6; IQR 4). Only half of respondents (20/38; 53%) routinely asked about falls history although 61% assessed standing balance (23/38) either through an overall functional assessment (16/38; 42%) or using specific balance measures (7/38; 18%). CONCLUSIONS: Further resources and training for physiotherapists may be required to optimise their skills and confidence, and to embed best-practice falls prevention strategies into the physiotherapy care of people with breast cancer.IMPLICATIONS FOR REHABILITATIONThere is an opportunity to better address falls in routine breast cancer care.Falls screening and prevention activities should be included in the care pathways for breast cancer.More resources are required for physiotherapists to optimise their skills and confidence to facilitate the uptake of best-practice falls prevention strategies.

COVID-19 Effects on Public Finance and SDG Priorities in Developing Countries: Comparative Evidence from Bangladesh and Sri Lanka.

The COVID-19 pandemic, an unprecedented global health crisis, rapidly transferred into a global economic and social crisis. The pandemic has threatened the world's commitment to achieve Sustainable Development Goals (SDGs) by 2030 as governments in developing countries have shifted their priorities from attaining SDGs, to providing urgent financial needs to save lives and prevent recession in hopes for a rapid economic recovery. The rerouting of public funding priorities has undermined the progress and achievement of SDGs. We employed a mixed-method and carried out a comparative study using pre- and post-public financial data of two developing countries in South Asia; Bangladesh and Sri Lanka. A threefold analysis was conducted to investigate the evolution of the COVID-19 pandemic in two countries, the impact of the pandemic on external and internal public finance and the effect of the pandemic in shifting the policy priorities from SDGs to economic survival. This study found that both countries are highly vulnerable to the COVID-19 pandemic and are suffering from the lack of financing from external sources through the private sector as well as an increasing foreign debt. There is mounting pressure on the fiscal balance in both countries. Supplementary Information: The online version contains supplementary material available at 10.1057/s41287-022-00558-6.

La pandémie de COVID-19, une crise sanitaire mondiale sans précédent, s'est rapidement transformée en une crise économique et sociale mondiale. La pandémie menace l'engagement mondial visant à atteindre les objectifs de développement durable (ODD) d'ici 2030, car les gouvernements des pays en développement ont changé leurs priorités, passant de la réalisation des ODD à la satisfaction des besoins financiers urgents pour sauver des vies et prévenir la récession, dans l'espoir d'une reprise économique rapide. Le changement de priorités et la réallocation des financements publics ont sapé les progrès et la réalisation des ODD. Nous avons utilisé une méthode mixte et réalisé une étude comparative à partir de données financières publiques pré et post dans deux pays en développement d'Asie du Sud, le Bangladesh et le Sri Lanka. Nous avons mené une analyse en trois volets pour étudier l'évolution de la pandémie de COVID-19 dans ces deux pays, l'impact de la pandémie sur les finances publiques externes et internes et l'effet de la pandémie sur le changement des priorités politiques, passant des ODD à la survie économique. Cette étude a révélé que les deux pays sont très vulnérables à la pandémie de COVID-19 et souffrent du manque de financements externes émanant du secteur privé ainsi que d'une dette extérieure croissante. La pression sur le solde budgétaire des deux pays est de plus en plus importante.

The feasibility of pelvic floor training to treat urinary incontinence in women with breast cancer: a telehealth intervention trial.

PURPOSE: To investigate the feasibility of recruiting into a pelvic floor muscle training (PFMT) program delivered via telehealth to treat urinary incontinence (UI) in women with breast cancer on aromatase inhibitors. METHODS: We conducted a pre-post single cohort clinical trial with 54 women with breast cancer. Participants underwent a 12-week PFMT program using an intra-vaginal pressure biofeedback device: femfit®. The intervention included eight supervised individual PFMT sessions over Zoom™ and a 12-week home exercise program. The primary outcome of this study was feasibility, specifically consent rate. Secondary outcomes which included prevalence and burden of UI measured using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), and pelvic floor muscle (PFM) strength measured as intravaginal squeeze pressure were compared using McNemar's and paired t tests. RESULTS: The mean age of participants was 50 years (SD ± 7.3). All women who were eligible to participate in this study consented (n = 55/55, 100%). All participants reported that the program was beneficial and tailored to their needs. The results showed a statistically significant decline in the prevalence (percentage difference 42%, 95% CI 28, 57%) and burden (ICIQ-UI SF score mean change 9.4, 95% CI 8.5, 10.4) of UI post intervention. A significant increase in PFM strength was observed post-intervention (mean change 4.8 mmHg, 95% CI 3.9, 5.5). CONCLUSION: This study indicated that PFMT delivered via telehealth may be feasible and potentially beneficial in treating stress UI in women with breast cancer. Further studies such as randomized controlled trials are required to confirm these results.

Occurrence and impact of pelvic floor dysfunction in women with and without breast cancer: a cross-sectional study.

BACKGROUND: One of the sequalae of breast cancer treatments may be pelvic floor (PF) dysfunction such as urinary incontinence (UI), faecal incontinence (FI), and pelvic organ prolapse (POP). OBJECTIVE: The aim of this study was to compare the occurrence and related distress and impact of PF dysfunction between women with and without breast cancer. METHODS: Women with and without breast cancer participated in this cross-sectional study. The Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire were used to quantify the prevalence and related distress, and impact of PF dysfunction. Factors associated with PF outcomes were examined using logistic and linear regressions while controlling for known risk factors for PF dysfunction (age, body mass index, and parity). RESULTS: 120 women with breast cancer, and 170 women without breast cancer responded. The occurrence of any type of UI was higher in women with breast cancer than women without breast cancer (percentage difference=17%; 95% CI: 7, 29). Women with breast cancer experienced higher impact of urinary symptoms (mean difference=18.2; 95% CI: 8.9, 27.7) compared to those without. Multivariable analysis indicated that having breast cancer (ß 0.33; 95%CI: 0.08, 0.51) was the strongest predictor of greater impact of urinary symptoms. CONCLUSION: Women with breast cancer reported a higher occurrence and impact of urinary symptoms than women without breast cancer. While further studies are required to confirm our findings, routine screening and offering treatment for urinary symptoms may be indicated for women with breast cancer.

Experiences of pelvic floor dysfunction and treatment in women with breast cancer: a qualitative study.

PURPOSE: To explore the experiences of women with breast cancer and pelvic floor (PF) dysfunction and the perceived enablers and barriers to uptake of treatment for PF dysfunction during their recovery. METHOD: Purposive sampling was used to recruit 30 women with a past diagnosis of breast cancer and PF dysfunction. Semi-structured interviews were conducted, and data were analysed inductively to identify new concepts in the experiences of PF dysfunction in women with breast cancer and deductively according to the capability, opportunity, motivation and behaviour (COM-B) framework to identify the enablers and barriers to the uptake of treatment for PF dysfunction in women with breast cancer. RESULTS: Participants were aged between 31 and 88 years, diagnosed with stages I-IV breast cancer and experienced either urinary incontinence (n = 24/30, 80%), faecal incontinence (n = 6/30, 20%) or sexual dysfunction (n = 20/30, 67%). They were either resigned to or bothered by their PF dysfunction; bother was exacerbated by embarrassment from experiencing PF symptoms in public. Barriers to accessing treatment for PF dysfunction included a lack of awareness about PF dysfunction following breast cancer treatments and health care professionals not focussing on the management of PF symptoms during cancer treatment. An enabler was their motivation to resume their normal pre-cancer lives. CONCLUSION: Participants in this study reported that there needs to be more awareness about PF dysfunction in women undergoing treatment for breast cancer. They would like to receive information about PF dysfunction prior to starting cancer treatment, be screened for PF dysfunction during cancer treatment and be offered therapies for their PF dysfunction after primary cancer treatment. Therefore, a greater focus on managing PF symptoms by clinicians may be warranted in women with breast cancer.

Prevalence and impact of bladder and bowel disorders in women with breast cancer: A systematic review with meta-analysis.

BACKGROUND: One of the consequences of breast cancer treatments may be the onset of new, or aggravation of preexisting bladder and bowel disorders. However, the presence and impact of these disorders in women with breast cancer are poorly documented. The aim of this systematic review was to assess the prevalence, incidence and impact of bladder and bowel disorders in women undergoing breast cancer treatment. METHODS: A systematic search of six databases was conducted. Pooled prevalence rates and impact of bladder and bowel disorders were calculated using random-effects models. RESULTS: A total of 32 studies met the inclusion criteria, and 17 studies were included in the meta-analyses. The pooled estimate of women who experienced bladder disorders following sensitivity analysis, which removed one study reporting a result that deviated from the pooled estimate, was 38% (95% confidence interval [CI]: 32%-44%; I2 = 98%; n = 4584). The impact of bladder and bowel disorders on women's daily lives was relatively low (bladder [scale: 0-4]: mean: 0.8; 95% CI: 0.4-1.1; I2 = 99%; n = 4908; bowel [scale: 0-100]: mean 14.2; 95% CI: 9.4-19; I2 = 95%; n = 1024). CONCLUSION: This is the first study to comprehensively document the magnitude of bladder and bowel disorders in the breast cancer population. This meta-analysis found that women with breast cancer had a higher prevalence of urinary incontinence (38%) compared to women without breast cancer (21%). Given the extent and impact of our findings, screening and management of bladder and bowel disorders may be indicated in women with breast cancer to improve their health-related quality of life.