For Healthcare Providers

TurningPoint Breast Cancer Rehabilitation 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. Geographic, financial, cultural and educational barriers should be minimized and ultimately removed. This specialized rehabilitation should be:

  1. Evidence-based
  2. Timely
  3. Accessible
  4. Compassionate
  5. Comprehensive

Healthcare Provider Education Opportunities:

In order to increase awareness and clinical knowledge about breast cancer survivorship issues among rehabilitation professionals, TurningPoint hosts annual fall healthcare provider education events. In addition, TurningPoint offers week-long onsite preceptorship training for physical therapists interested in gaining skills in the field. CEU credit is offered for the preceptorship program. Finally, TurningPoint staff speak nationally about breast cancer rehabilitation and exercise and lecture to many groups of physical therapy students.

General Inquiries About:

  • Onsite Clinical Preceptorship Opportunities for Physical Therapists
  • TurningPoint Speakers for Healthcare Provider Events and Student Physical Therapy Programs
  • Submit Your Questions/Inquiries

Healthcare Provider Events

2017 Breast Cancer Rehabilitation Course for Physical and Occupational Therapists

The Role of Rehabilitation and Exercise for Breast Cancer Patients

American Cancer Society Rehabilitation Project

In 2011, TurningPoint worked with the American Cancer Society on a project that included expert clinicians and researchers from around the world. Experts examined the role of rehabilitation and exercise for women with breast cancer and proposed a model of care that would make rehabilitation and exercise part of every survivor’s journey.  TurningPoint was a major contributor to the project.  For more information and the associated publication, click logo.

Evidence Supporting the Role of Rehabilitation and Exercise During and After Breast Cancer Treatment

New diagnostic techniques and treatments 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] Studies have shown that women with breast cancer may have long term impairment and functional morbidity after breast cancer treatment. [3] Many of these physical symptoms, including pain, limitation of shoulder mobility, lymphedema and axillary web syndrome (cording) have been shown to respond well to early physical and rehabilitation therapy. [4] Early physical therapy may reduce women’s risk of lymphedema. [5] 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. [6] Exercise plays a critical role for women with breast cancer. Exercise improves quality of life, reduces fatigue, is effective in the management of lymphedema and may even decrease the risk of breast cancer recurrence. [7] 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. [8] In women who receive rehabilitation services, fear and anxiety are decreased, pain is reduced, motion and function are 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. [9] 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 [10], and only a small percentage of women with breast cancer in the 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.[11]

References: (intended to be representative, rather than complete list for each topic)

1. Gerber, 2002; Leidenius, 2005; Gosselink, 2003; Reitman, 2003; Blomqvist, 2004; Barranger, 2005; Levangie, 2008; Schmitz, 2012, McNeeley, 2012; Hayes, 2012
2. Roth, 2007; Alderman, 2007; McCarthy, 2014
3. Schmitz, 2012; Yang, 2010
4. Locomba, 2010; Box, 2002; Na, 1999; Cinar, 2008; McNeeley, 2012, Stout 2012
5. Locomba, 2010
6. Stout Gergich, 2008; Springer, 2010; Stout 2012
7. Holmes, 2008; Schmitz, 2009, Courneya, 2010; Mishra, 2012; Speck 2010
8. Ganz et al, 1998, 2002; Valdivieso, 2012, Ridner, 2005
9. Cheville, 2007
10. Blanch-Hartigan, 2014
11. Binkley, 2012

Barriers to Rehabilitation Referral in the United States

Reasons for the lack of referral for rehabilitation services for women with breast cancer include lack of:

  • Comprehensive and accessible rehabilitation care
  • Awareness by breast cancer survivors and their healthcare providers of their survivorship needs
  • Established evidence-based clinical practice guidelines to identify and manage effects of breast cancer and breast cancer treatment
  • Clinical centers of excellence for breast cancer rehabilitation to demonstrate models of coordinated interdisciplinary survivorship care

Strategies to Change Standard of Care

A significant part of TurningPoint’s mission is 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 Breast Cancer Rehabilitation 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 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