Breast Cancer and Gynecological Cancer Rehabilitation

Adrian Cristian

• Publisher: Elsevier
• Year: 2020
• Print ISBN: 9780323721660
• eBook ISBN: 9780323721677
• Topic: Medizin
• Subtopic: Physiotherapie, Physikalische & Rehabilitative Medizin

Breast Cancer and Gynecological Cancer Rehabilitation, edited by Adrian Cristian, MD, MHCM, provides today's clinicians with a concise, accessible resource covering the holistic rehabilitation of breast cancer patients. Beginning with a review of epidemiology, genetics, and pathophysiology of breast cancer, it then covers clinical assessment and treatment options before providing comprehensive coverage of rehabilitation. Containing practical information, best practices, and the latest advances and research, this book is a valuable reference for physical medicine and rehabilitation physicians and residents, as well as occupational and physical therapists.- Provides a clear understanding of the current medical, surgical, and radiation treatments for breast cancer.- Covers the whole spectrum of breast cancer rehabilitation, including the role of physical and occupational therapy, treatment of anxiety and depression, pain syndromes, integrative care, nutritional rehabilitation, palliative care, and more.- Offers a timely and convenient resource written by leading experts in breast cancer and rehabilitation.

Section I

Outline

• Chapter 1 Cascade of Disability in Breast and Gynecologic Cancer
• Chapter 2 Practice Implementation, Clinical Assessment, and Outcomes Measurement
• Chapter 3 Exercise While Living With Breast and Gynecological Cancers
• Chapter 4 Cancer-Related Fatigue in Breast and Gynecologic Cancers
• Chapter 5 Nutritional Rehabilitation of Breast and Gynecologic Cancer Patients
• Chapter 6 A Comprehensive Approach to Psychosocial Distress and Anxiety in Breast and Gynecological Cancers
• Chapter 7 Prehabilitation in Breast and Gynecologic Oncology

Chapter 1

Cascade of Disability in Breast and Gynecologic Cancer

Adrian Cristian, MD, MHCM

Abstract

Earlier detection and improved treatments have been very beneficial to improving survivorship from breast and gynecologic cancers. However, the combination of a person’s precancer level of health, other medical illnesses, cancer characteristics, and cancer-related physical impairments can all contribute to loss of function. This cascade of disability can lead to a decreased quality of life. It is important for rehabilitation clinicians to be able to identify the various layers of disability in this cascade phenomenon early and introduce interventions that can minimize functional loss.

Keywords

Breast cancer; gynecologic cancer; impairments

Introduction

According to the American Cancer Society, as of January 1, 2019, there were 3,861,520 women living with breast cancer; 807,860 women living with uterine cancer; 283,120 women living with cervical cancer; and 249,320 women living with ovarian cancer. The 5-year survival rates are 91% for breast cancer, 65.8% for cervical cancer, 81.2% for uterine cancer, and 47.6% for ovarian cancer.^1–3 As women are surviving breast and gynecologic cancers longer, it is perhaps not surprising that the projection for people living with breast and gynecologic cancers is to see these numbers increase. The projection is that by 2030 there will be 4,957,960 living with breast cancer; 1,023,290 living with uterine cancer; 297,580 living with ovarian cancer; and 288,710 living with uterine cervix cancer. Women are also living substantially longer post diagnosis as well. For example, 19% of women are living 20+ years since diagnosed with breast cancer, 29% since diagnosed with ovarian cancer, 49% since diagnosed with cervical cancer, and 22% with uterine cancer. The number of women living with metastatic breast cancer is greater than 150,000. Women are also diagnosed with breast or gynecologic cancer more often later in life. For example, age at prevalence for women diagnosed with breast cancer in the 65–84 age-group was 51% for breast cancer, 47% for ovarian cancer, 39% for uterine cancer, and 56% for uterine corpus.

These statistics illustrate that there are a significant number of women diagnosed with breast and gynecologic cancers, often later in life and living longer post treatments for their cancer. The most common treatments for these types of cancers include a combination of surgery, radiation therapy, chemotherapy, and antihormonal therapy. Whereas these treatments can be very successful in treating the cancer, they can also have an adverse impact on healthy tissues such as muscle, nerve, and connective. The adverse impact on healthy tissues can at times be very close to the onset of the treatment; however, these adverse effects often develop slowly over time leading to a gradual loss of function that can be imperceptible to both the individual and the treatment team. Often the loss of function cannot be directly linked to any one treatment, but rather to a combined effect of several treatments as well the patient’s own precancer state of health, nutritional status, and preexisting diseases such as diabetes mellitus.

Rehabilitation medicine should be an integral part of the care of the person with breast or gynecologic cancer from time of diagnosis, through active treatment and in the survivorship period. Following diagnosis and precancer treatment, physiatrists can assess the patient for any preexisting physical impairments of key body structures that would be subjected to the effects of multimodality cancer treatment. For the person with newly diagnosed breast cancer, this can include shoulder dysfunction, assessment of preexisting peripheral neuropathy, preexisting painful joint conditions affecting the hands, knees, and lower back, and lymphedema. For the person with newly diagnosed gynecologic cancer, this can include assessment of preexisting peripheral neuropathy, preexisting lymphedema of leg, impaired balance, decreased fine motor skills and strength in hands, and history of pelvic floor dysfunction. In addition, an assessment of nutritional status, preexisting cognitive impairment, depression, and anxiety is also very important.

Physiatrists can also provide useful and timely information to medical, surgical, and radiation oncologists with respect to potential impact of cancer treatment on loss of function, which can then in turn be useful in the planning of the cancer treatment. This is based on their knowledge of functional anatomy of the musculoskeletal and nervous systems as well as assessment of functional loss. This information would ideally be discussed at multidisciplinary tumor boards. Another role that physiatrists can have in the planning of cancer treatment is to assess the patient for frailty since frailty can have an adverse impact on a person’s ability to tolerate cancer treatments.

Once these preexisting impairments are identified, a coordinated effort of various team members such as physical therapy, occupational therapy, psychology, and nutrition to minimize them is critical. At times, it is not realistic to address all of these impairments prior to start of treatment since the patient’s focus as well as that of the cancer treatment team is on initiating treatment as soon as possible, therefore prioritization is key. For example, a patient with a preexisting reduction in range of motion of the shoulder would need this limitation to be addressed to help her undergo radiation therapy. Rehabilitative interventions can be continued during active cancer treatment; however, this depends on the patient’s ability to tolerate both cancer treatment and rehabilitative interventions concurrently. Periodic surveillance for subjective and objective evidence of loss of physical function becomes important at times during active treatment as well as during survivorship.

Assessment of Breast and Gynecologic Cancer Patient with a Focus on Physical Impairments and Loss of Function

The physiatrist should approach the assessment of the person with breast or gynecologic cancer by having a good working knowledge of the common physical, cognitive, and psychologic impairments affecting the breast and gynecologic cancer patients and utilizing appropriate clinical assessment tools.

A review of pertinent past medical history and past surgical history can help identify the areas of potential loss of function. For example, preexisting peripheral neuropathy from diabetes may worsen once the patient is treated with chemotherapy, thereby adversely affecting hand function and balance. Another example is a patient with a history of limited shoulder function due to adhesive capsulitis that could potentially lead to a worsening of the condition following treatment of breast cancer with surgery and radiation therapy.

Review of prior imaging studies such as PET/CT scans, bone scans, MRIs, and plain X-rays can help identify the areas with metastatic disease. Results of echocardiograms and pulmonary function studies, if available, can provide information about heart and lung function, respectively. That knowledge can then be used in setting precautions during rehabilitation to minimize the risk of harm for the patient. Review of laboratory studies such as hemoglobin, platelet, and white blood cell counts can yield importa...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Dedication
• List of Contributors
• Preface
• Section I
• Section II
• Section III
• Section IV
• Index