A prospective model of care for breast cancer rehabilitation: Function

Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Cancer (Impact Factor: 4.89). 04/2012; 118(8 Suppl):2300-11. DOI: 10.1002/cncr.27464
Source: PubMed


A significant proportion of adult breast cancer survivors experience deficits in function and restriction in participation in life roles that may remain many years after diagnosis. Function is a complex construct that takes into account the interactions between an individual, their health condition, and the social and personal context in which they live. Research to date on limitations in activities of daily living, upper extremity function, and functional capacity in breast cancer survivors illustrates the need for prospective measurement of function using measures that are sensitive to the unique issues of breast cancer survivors and the need for the development of effective rehabilitation interventions to improve function. Limitations in function have a significant impact on quality of life, but less is known about the implications on return to work and survival, as well as the impact of other comorbidities and aging on the function limitations in breast cancer survivors. This review provides a rationale for the integration of measures of function into breast cancer care to more fully appreciate the functional limitations associated with breast cancer diagnosis and treatment and to aid in the development of better rehabilitation care for breast cancer survivors.

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Available from: Kenneth J Harwood, Nov 18, 2015
    • "In many cases, cancer treatments lack specificity and can damage healthy tissues. Cancer and its subsequent treatment can have profound negative side effects on bodily structures and function including but not limited to reductions in cardiac function (Curigliano et al, 2010; Prosnitz and Marks, 2005); muscle mass and muscle performance (Alibhai et al, 2010; Christensen et al, 2014; Schmitz et al, 2010); skeletal structure and function (Winters-Stone et al, 2012); range of motion (Harrington et al, 2011); sensorium (Stubblefield, McNeely, Alfano, and Mayer, 2012); ability to perform functional activities (Campbell et al, 2012); balance (Stubblefield, McNeely, Alfano, and Mayer, 2012); and QoL (Jansen et al, 2011); increases in pain (Stubblefield, McNeely, Alfano, and Mayer, 2012); and cancerrelated fatigue (Berger, Gerber, and Mayer, 2012). Cancer treatment successes have decreased cancer mortality to the point where cancer is often a chronic disease (Rajotte et al, 2012). "
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    ABSTRACT: Abstract The purpose of this single-arm pilot study was to examine the effects of a community-based multimodal exercise program on: physical function (Timed-Up-and-Go [TUG], 6-min walk test [6MWT], leg and chest press strength, and functional reach [FR]); and quality of life, QoL [FACT-G]), in cancer survivors. Fifty-nine cancer survivors (91.5% female; mean age 59 ± 12 years) completed supervised exercise training for 90 min twice weekly for 12 weeks. Exercise training consisted of 30 min of each of the following: (1) aerobic conditioning; (2) resistance training; and (3) balance and flexibility training. Pre-post-outcome measures were compared for statistically significant differences (p < 0.01) and were related to the International Classification of Functioning, Disability and Health Model. Effect sizes (ES), minimal clinically important differences, and minimal detectable change at 90% confidence intervals were calculated. Participants decreased TUG time by 21.1% and walked 15.5% farther during 6-MWT (p < 0.001). Leg and chest press strength increased by 34.5% and 32.7%, respectively (p < 0.001). FR increased by 15.1% (p < 0.001). Significant improvements for physical well-being (13.9%), emotional well-being (6.7%), functional well-being (13.0%), and total well-being (9.6%) were found (p < 0.01). Improvements in physical function and QoL showed "moderate to large" ESs indicating improvements in physical function and QoL are clinically meaningful.
    Physiotherapy Theory and Practice 01/2015; 31(5):1-10. DOI:10.3109/09593985.2015.1004390
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    • "With recent therapeutic advances, survival rates of persons with cancers have improved [10] [11] [12]. However, recovery and treatment options after BC or BT can be challenging, and many survivors experience transient and/or persistent physical, functional, and psychosocial morbidities impacting everyday activities, participation (work, social activities), and quality of life (QoL) [12] [13] [14]. In the community, various issues may surface during transition: adjustment (self-worth, selfimage ), coping with new demands associated with increased care needs, inability to return to driving and work, financial constraints, marital stress, and restriction in participation. "
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    ABSTRACT: Objective. To assess and identify patient-reported supportive care needs following definitive treatment in persons with breast cancer (BC) and primary brain tumours (gliomas) (BT) in an Australian community cohort and to assess the commonalities and/or discrepancies of the reported needs in these oncological populations. Methods. A prospective cross-sectional survey of persons with BC () and BT () using questionnaires for supportive care needs, psychological morbidity, and quality of life. Results. BT participants were younger than BC patients (mean ages 51 and 57 years). The median time since diagnosis for both groups was over 2 years. The level of psychological morbidity, mainly depression, was high in both groups: BC (22%) and BT (20%). Participants in both groups reported at least one need (“met” or “unmet”). The BC patients reported higher numbers of “needs” and “unmet” needs compared with BT patients (mean 13.7 versus 11.6 needs; “unmet” needs mean 6.0 versus 4.1). The common “met” and “unmet” needs highlighted by both groups were comparable; the domain for most “met” needs included comprehensive cancer care, while “unmet” needs related to existential survivorship issues. Conclusion. Despite successful treatment many cancer survivors experience unmet supportive care needs in longer term. Understanding the impact of these beyond the acute phase is important as care shifts to community settings. More research in existential survivorship issues is needed.
    01/2014; 2014:1-10. DOI:10.1155/2014/945472
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    • "Decongestive lymphatic therapy, which is a complex form of physical therapy that includes the redirection of lymph flow through intact cutaneous lymph nodes, the use of compressive wrappings, and comprehensive skin care [47], may help to decrease limb volume [47] [48]. It is even possible that patients may experience physical deficits related to cancer treatments many years later [25] and as such these survivors may benefit from physical therapy and other rehabilitation services many years after their original diagnosis [42]. Physical therapists also work with individuals to develop general fitness/wellness programs that support healthier and more active lifestyles during the survivorship period and may help prevent loss of mobility [46] as well as secondary and long-term side effects of treatment . "
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    ABSTRACT: Cancer and its treatment may cause physical impairments and psychological distress in survivors. Rehabilitation is a critical component of quality cancer care, returning survivors to their highest functional potential. This overview focuses on the benefits of multidisciplinary cancer rehabilitation - including improving physical function, reducing psychological distress, promoting return to work and, therefore, decreasing the economic burden of cancer and its treatment on individuals and society in general. Relevant literature was identified through a search of the PubMed database and reviewed for its relevance to cancer rehabilitation and the topic of this article. Search terms included, but were not limited to, cancer rehabilitation, cancer prehabilitation, disability, return to work, employment, and unemployment. Cancer survivors are less likely to be employed and take more sick leave than workers without a history of cancer. Pain, musculoskeletal issues, deconditioning, fatigue, balance, psychosocial issues, and lymphedema are most amenable to rehabilitation. Overall health and the need for work accommodations must be addressed in order to improve return to work and subsequent productivity in cancer survivors. Survivors are usually best served by a multidisciplinary care team comprising members who can address the myriad impairments affecting survivor function.
    Work 10/2013; 46(4). DOI:10.3233/WOR-131755 · 0.52 Impact Factor
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