title: Physical impairments and physical therapy services for minority and low-income breast cancer survivors.
abstract: OBJECTIVE
  We describe impairments after breast cancer and its treatment for African American (AA), non-Hispanic white and low-income breast cancer survivors (BCS) and whether physical therapy (PT) was utilized to address these impairments.
  
  
  METHODS
  BCS from the Southern Community Cohort Study (SCCS) were surveyed about self-reported BC treatment-related impairments (shoulder impairment, muscle weakness, pain, fatigue, skin numbness, abnormal posture) and referral to PT for impairments. We compared impairments by race, income and PT utilization. We used a cross-sectional design.
  
  
  RESULTS
  Among 528 BCS interviewed (266 whites; 262 AA), mean age 64, those with low incomes were more likely to report muscle weakness, pain and postural abnormalities, and a greater total number of impairments than those with higher incomes. Racial differences were few. PT utilization tended to be low, with AAs more likely than whites to utilize PT if they had shoulder impairment or pain, whereas no monotonic trends across income levels were seen in PT utilization.
  
  
  CONCLUSIONS
  Low-income level was associated with greater prevalence of BC-related physical impairments, but not higher PT utilization. There appears to be a possible under-utilization of PT, particularly for those with low incomes.
authors.affiliation: Department of Physical Therapy, Movement and Rehabilitation Sciences, Center for Cancer Survivorship Studies (CCSL), Northeastern University, Boston, MA USA.
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Flores
authors.affiliation: Biostatistics Research Center, Institute for Clinical Research and Health Policy Studies, Tufts University Medical Center, Boston, MA USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Nelson
authors.affiliation: Office of Health Equity, Maine Center for Disease Control and Prevention, Augusta, ME USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Sowles
authors.affiliation: Department of Physical Therapy, Movement and Rehabilitation Sciences, Center for Cancer Survivorship Studies (CCSL), Northeastern University, Boston, MA USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Bienenstock
authors.affiliation: International Epidemiology Institute, Rockville, MD USA ; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Blot
keywords: Breast cancer; Impairments; Income; Physical therapy; Race