TurningPoint Women’s Healthcare believes that the standard of care for all women with breast cancer should include referral to evidence-based, specialized rehabilitation care to maximize quality of life. Geographical, financial, cultural and educational barriers should be minimized and ultimately removed.
This specialized rehabilitation should be:
- Evidence-based
- Timely
- Accessible
- Compassionate
- Comprehensive
Rationale and Evidence
New diagnostic techniques and treatments have have contributed to significant declines in breast-cancer related mortality. However, cancer treatments often have debilitating effects on a woman’s endurance, physical function, and quality of life. Almost all women who undergo breast surgery experience significant shoulder mobility problems in the weeks and months following surgery. Symptoms are more severe and more prolonged in women who require axillary dissection and or radiation. [1] Reconstructive surgery may contribute to a woman’s pain, strength and/or mobility issues. [2] Many of these physical symptoms, including pain, limitation of shoulder mobility, lymphedema and axillary web syndrome have been shown to respond well to early physical and rehabilitation therapy. [3] Early physical therapy has been shown to reduce women’s risk of lymphedema. [4] There is evidence that early prospective surveillance of women with breast cancer may improve patient outcomes by facilitating early intervention that decreases the long-term impact of impairments. [5] Exercise has a critical role for women with breast cancer. Evidence shows that exercise improves quality of life, is effective in the management of lymphedema and may even decrease the risk of breast cancer recurrence. [6] While every woman experiences breast cancer differently, emotional and psychosocial stresses are almost universal as women grapple with issues related to fear of death and prolonged illness, loss of control, altered sexuality and body image, and anxiety related to family and social relationships. [7] In women who receive rehabilitation services, fear and anxiety are decreased, pain is reduced, motion and function is restored, and women can return to their usual roles as wife, partner, mother, friend and coworker as quickly as possible.
In spite of extensive documentation of survivorship issues facing women with breast cancer and the existence of interventions shown to be effective, these survivorship issues are not adequately identified and addressed by the medical community. [8] The National Cancer Institute advocates comprehensive breast cancer survivorship plans that address treatment history and planned follow-up, as well as common physical and psychosocial issues following breast cancer treatment. The literature suggests that few women receive such a plan, and only a small percentage of women with breast cancer in United States will receive specialized rehabilitation to address these survivorship issues. Women often feel isolated and confused about how to deal with the physical and emotional impact of breast cancer and struggle alone in trying to return to their usual activities of daily living.
Barriers to Rehabilitation Referral in the United States
Reasons for the lack of referral for rehabilitation services for women with breast cancer include the following:
- lack of comprehensive and accessible rehabilitation care
- lack of awareness by breast cancer survivors and their healthcare providers of their survivorship needs
- lack of established evidence- based clinical practice guidelines to identify and manage effects of breast cancer and breast cancer treatment
- lack of clinical centers of excellence for breast cancer rehabilitation to demonstrate models of coordinated interdisciplinary survivorship care
Strategies to Change Standard of Care
Steps need to be pursued to increase recognition of cancer rehabilitation as an essential component of breast cancer survivors’ care and to improve access to evidence-based, timely, accessible, compassionate and comprehensive care.
TurningPoint Women’s Healthcare has identified the following strategies to make referral to rehabilitation the standard of care for women with breast cancer:
- Partnerships with national breast cancer organizations
- Healthcare provider education
- Education of the community at large about breast cancer survivorship issues
- Education of the community at large and women with breast cancer to raise awareness of survivorship issues in order to increase self-advocacy related to rehabilitation
- Increasing the number of rehabilitation professionals to meet the complex needs of a growing population of long-term breast cancer survivors
- Gerber, 2002; Leidenius, 2005; Gosselink, 2003; Reitman, 2003; Blomqvist, 2004; Barranger, 2005; Levangie, 2008
- Roth, 2007; Alderman, 2007
- Locomba, 2010; Box, 2002; Na, 1999; Cinar, 2008; Wingate, 1985; Schmitz, 2009
- Locomba, 2010
- Stout Gergich, 2008; Springer, 2010; Yang, 2010
- Locomba, 2010; Box, 2002; Na, 1999; Cinar, 2008; Wingate, 1985; Schmitz, 2009
- Holmes, 2008; Schmitz, 2009, Courneya, 1999; Dimeo, 1999; Schwartz, 2000; Paskett, 2007; Shaw, 2007.
- Ganz et al, 1998, 2002
- Cheville, 2007
