The Breast Axilla Postoperative Support (BAPS) App

Donna Egbeare, Consultant Breast Surgeon

Cardiff and Vale University Health Board

This project designed an app to guide patients though exercises following breast or axillary surgery, to maintain shoulder function and enable them to get into position for radiotherapy if needed.

Background

Amongst the Health Boards that refer patients for oncological treatment at Velindre Cancer Centre (VCC) in Cardiff, there was disparity in the information given to patients, who gave the information and at what point. This increased the number of patients who were unable to maintain correct position for radiotherapy planning and required urgent and intensive physiotherapy input to achieve this.

Economically this has an impact on planned cancer care – CT scanner time is wasted, appointments must be rearranged, intensive physiotherapy sessions are needed, but most importantly; delayed adjuvant treatment has a psychologically negative impact on the patient.

The problem was initially highlighted by a patient who became an important member of the team in the design, development and testing of the App.

Aims

The BAPS App was designed following patient feedback, to guide patients who have had breast or axillary surgery for breast cancer through exercises aiming to maintain shoulder function and allow them to get into position for radiotherapy.

The aim was to standardise the information given to patients in a more interactive fashion, empowering patients with an understanding of why the exercises are important, motivating them to achieve their goals and optimising the patient care pathway from surgery to radiotherapy.

Woman using radiotherapy equipment

App Design

The multidisciplinary team worked together with an industry partner to film and develop the App and then identified key stakeholders to engage before launching the App.

The App has evolved in a pro-active way and now includes a section on deep inspirational breath holds, which is used for some patients with left sided breast cancer requiring radiotherapy, but also as a relaxation technique within the App.

Outcomes

The App was launched in February 2019. In six months it has achieved:

Next Steps

Questionnaires for patient feedback and healthcare professional feedback are underway and data collection is ongoing. The aim is to roll out use of BAPS App across Wales as an integrated component of the breast cancer care pathway.

The App is sustainable as the information is unlikely to change and is sufficiently generic for all cancer centres to use. It is transferable and indeed has been downloaded in many international locations, not just within Wales. It is available in Welsh and English language, thus no Welsh first language patient is disadvantaged. Health economists will help evaluate the App in terms of financial impact once longer term data is available.

“The VCC physiotherapy department have noticed a downward trend in urgent referrals.”

Part of cohort Bevan Exemplar Projects 2018-19