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Integrated Rehabilitation for Breast Cancer Survivors

Cheville, Andrea L., MD, MSCE; McLaughlin, Sarah A., MD; Haddad, Tufia C., MD; Lyons, Kathleen D., OTR/L, ScD; Newman, Robin, OTR/L, OTD; Ruddy, Kathryn J., MD, MPH

American Journal of Physical Medicine & Rehabilitation: February 2019 - Volume 98 - Issue 2 - p 154–164
doi: 10.1097/PHM.0000000000001017
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The physical and psychological side effects of breast cancer therapies can have substantial impact on survivors' physical and social functioning. Roughly half of the more than 3 million Americans alive with a history of breast cancer report adverse, function-degrading sequelae related to their oncologic treatments. Care delivery models for the timely delivery of rehabilitation services have been proposed yet limitedly vetted or implemented. These include the prospective surveillance model, procedure-linked referrals, survivorship care plans, and risk stratification. Patients' capacity to engage in the rehabilitative process varies during cancer therapy and into survivorship. Perioperative attention generally focuses on managing premorbid impairments and normalizing shoulder function. In contrast, during chemotherapy and radiation therapy, symptom control, constructive coping, and role preservation may become more salient. Risk-stratified, individualized screening and prevention activities for specific impairments have become increasingly feasible through predictive models and analytics. Impairments' severity deleterious impact can be mitigated, as has been established for lymphedema, shoulder dysfunction, chemotherapy-induced peripheral neuropathy, cognitive dysfunction, fatigue, and sexual side effects. Integrated rehabilitative programs, often initiated after the completion of cancer treatment, are available in some countries outside of the United States and may offer survivors vital vocation- and avocation-directed services.

From the Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota (ALC); Department of Surgery, Mayo Clinic, Jacksonville, Florida (SAM); Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota (TCH, KJR); Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (KDL); and Department of Occupational Therapy, Boston University, Boston, Massachusetts (RN).

All correspondence should be addressed to: Andrea L. Cheville, MD, MSCE, Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First St, SW, Rochester, MN 55905.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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