Cancer

The authors report on a February 2011 roundtable meeting and introduce a series of articles addressing a prospective evaluation approach for the physical rehabilitation of breast cancer survivors. They issue a call to action to include rehabilitation assessment, rehabilitation interventions, and exercise in survivorship care.

This article proposes a prospective surveillance model for physical rehabilitation and exercise for women diagnosed with breast cancer. The model seeks to optimize a woman's function during and after treatment and positively influence the impact of breast cancer on a growing survivorship community.

Models for health care and cancer survivorship care plans may help guide and streamline the complexities of meeting the health care needs of breast cancer survivors. Proponents of the prospective surveillance model (described elsewhere in this issue) need to collaborate with leaders in survivorship care models to integrate these complementary approaches. The shared goal is to develop the evidence base to support clinical practice guidelines to improve the medical and functional health of all breast cancer survivors.

Patients' perspectives about common impairments and functional limitations secondary to breast cancer treatment, including upper extremity motion restriction, lymphedema, fatigue, weight gain, pain, and chemotherapy-induced peripheral neuropathy, are addressed. The prospective surveillance model of rehabilitation will serve the needs of women with breast cancer by providing education and information about treatment side effects, reducing the incidence and burden of side effects through early identification and treatment, and enhancing access to timely rehabilitation.

Prospective follow-up of 287 breast cancer survivors over 6 years included measures of postsurgical issues, skin/tissue reaction to radiotherapy, upper-body symptoms and function, fatigue, lymphedema, and weight gain. The majority of breast cancer survivors reported at least 1 breast cancer treatment sequelae at 6, 12, and 18 months and 6 years after diagnosis, supporting the development of a multidisciplinary surveillance and treatment system for the purposes of managing and treating adverse effects and improving the lives of breast cancer survivors.

This article describes the incidence, prevalence, risk factors, and time course for early postoperative effects and the role of prospective surveillance as a rehabilitation strategy to prevent and mitigate them. The focus of this article is on acute postoperative effects occurring in the first 3 months following surgery.

Upper-body morbidity, including lymphedema, is common after breast cancer and may persist beyond the active treatment period. Integration of a prospective surveillance model into breast cancer care has the potential to optimize early diagnosis and treatment of upper-body morbidity, and in doing so will enhance women's ability to participate in daily activities and their quality of life.

The development of chemotherapy-induced peripheral neuropathy is anticipated for the majority of breast cancer patients who receive neurotoxic chemotherapy. A prospective surveillance model promotes a patient-centered multidisciplinary team approach to care that extends from pretreatment through survivorship and palliative care.

In this article, the authors discuss current knowledge regarding cancer-related fatigue (CRF) and its implications for cancer survivors, particularly for women with breast cancer. CRF topics include contributing factors, commonly associated problems, measurement issues, nonpharmacologic and pharmacologic interventions, implications for future research, and considerations for treatment in the context of a proposed surveillance model for the physical rehabilitation of women with breast cancer.

Adjuvant systemic breast cancer therapies may have adverse effects on the heart. A multidisciplinary prospective surveillance system, as proposed elsewhere in this supplement, would allow for earlier detection of cardiotoxic treatment effects and may allow for better adherence to existing guidelines monitoring of cardiovascular health of women.

Obesity is a risk factor for postmenopausal breast cancer, and many women diagnosed with breast cancer, irrespective of menopausal status, gain weight postdiagnosis. Weight management plays an important role in rehabilitation and recovery because obesity and/or weight gain may lead to poorer quality of life, overall health, and/or survival.

Treatment for breast cancer can result in accelerated bone loss and/or the development of arthralgias. Given the prevalence and consequences of these side effects, a prospective rehabilitation care model may provide a tool for surveillance and management that can reduce the impact of these musculoskeletal problems on the health and well-being of breast cancer survivors.

Treatment for breast cancer can result in a reduction in physical function that impacts quality of life and participation in life roles. The prevalence of functional limitations in breast cancer survivors illustrates the need for prospective measurement of function to better quantify limitations and for the development of effective rehabilitation interventions.

Based on recent research, updated clinical practice guidelines are urgently needed on assessment and treatment of breast cancer–related upper extremity impairments and lymphedema. The standards proposed in the 2011 Institute of Medicine report on development of practice guidelines could assist greatly in ensuring that new or updated guidelines are truly evidence-based.

The prospective surveillance model (PSM) may reduce the incidence breast cancer-related physical impairments, but its accompanying costs and resource requirements remain unclear and may be substantial. Examination of PSM costs should consider differential benefit across treatment-defined subgroups, diverse implementation strategies, and the burden to key stakeholders.

Stakeholder comments are presented on a proposed prospective surveillance model for rehabilitation aimed at patients with breast cancer. Perceived benefits, risks, barriers, and opportunities for dissemination are summarized.