What is Rehabilitation for Breast Oncology?


The purpose of rehabilitation for breast cancer patients is to screen for impairments associated with treatment and provide early intervention in order for the survivor to maintain and even supersede physical function prior to diagnosis.

The goal of rehabilitation is to prevent impairments which may limit optimal quality of life after treatment and serve as a reminder of the hardships associated with cancer treatment.

Common treatable side effects of medical intervention may include:

  • restricted shoulder range of motion due to lymphatic cording
  • lymphedema
  • brachial plexopathy (decreased sensation or weakness) secondary to surgery
  • post-mastectomy pain syndrome
  • muscle weakness and/or pain status-post breast reconstruction
  • skin adhesions and joint contracture status-post radiation
  • chemotherapy induced peripheral neuropathy
  • cardiotoxicity
  • osteoporosis
  • dyspareunia or pain with intercourse
  • weight gain
  • joint pain and arthralgias due to hormone therapy
  • cancer-related fatigue
Undoubtedly, cancer treatment is necessary; curing the body of disease should be the most important goal of medicine. Every day science is making great strides to limit the invasiveness of medical interventions while improving their effectiveness, however, treatable side effects of breast cancer interventions are too often perceived as a normal outcome of treatment. Rehabilitation providers are not yet a mainstay of the oncology team, however, the goal of this website is to educate patients and providers about what therapy can do to alleviate the side effects of cancer treatment. Furthermore, “Rehabilitation for the Breast Oncology Patient” is a continuing education course designed to empower rehab providers to serve as advocates for cancer patients.  Therapists can help patients maintain and even improve their physical function prior to diagnosis in order to live beyond their breast cancer diagnosis. 
 

How common are side effects of breast cancer treatment?

In 2002 researchers in Australia tracked the adverse side effects of breast cancer in 287 survivors for 6 years. These women were assessed for post-surgical complications, adverse skin reactions related to radiation therapy, arm dysfunction, lymphedema, weight gain, fatigue and general physical dysfunction. Outcomes of the study were enlightening: 60% of the subjects experienced at least one symptom that would be amenable to rehabilitation. This did not even take into consideration other side effects of treatment such as cardiotoxicity, bone health, arthralgias or chemotherapy-induced peripheral neuropathy (1).

 

Furthermore, recent research estimates the following incidence rates for breast cancer related impairments: (2) 

Lymphedema 6-70%
Upper quadrant dysfunction 20-44%
Chemotherapy-induced peripheral neuropathy (taxanes) 83%
Arthralgia and joint pain (aromatase inhibitors) 36%
Fatigue 94%
Vertebral fractures 5x more likely

 

What is the Prospective Surveillance Model?

The Prospective Surveillance Model is a model of health care designed to prevent and detect potential side effects of breast cancer medical intervention early in the episode of care. Furthermore, therapeutic interventions may also impact cancer outcomes! Studies show that regular exercise and maintaining a healthy body weight (BMI) can decrease the risk of recurrence. Models such as this may become more favorable in the United States (and potentially even mandated) as we shift from a ‘fee for service’ to a ‘pay for outcomes’ reimbursement method. Regardless of payment, however, physicians, therapists and survivors alike are witnessing and experiencing the benefits of the prospective surveillance model; the outcomes are even life changing. 

 

  1. Schmitz, K., Speck, R., Rye, S., DiSpio, T., Hayes, S., Prevalence of breast cancer treatment sequelae over 6 years of follow-up. Cancer, 2012; 118 (8) 2217-2225.
  2. Schmitz, K., Stout, N., Andrews, K., Binkley, J., Smith, R., Prospective evaluation of physical rehabilitation needs in breast cancer survivors. Cancer, 2012; 118 (8) 2187-2190.