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).
Am J Phys Med Rehabil. 2019 Feb;98(2):154-164. doi: 10.1097/PHM.0000000000001017.
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.
乳腺癌治疗的身体和心理副作用会对患者的身体和社会功能产生重大影响。大约有超过 300 万的美国乳腺癌幸存者报告称，他们的肿瘤治疗带来了负面的、降低功能的后遗症。为了及时提供康复服务，已经提出了一些护理交付模式，但这些模式的验证或实施都很有限。这些模式包括前瞻性监测模型、与治疗相关的转介、生存护理计划和风险分层。患者在癌症治疗期间和康复期间参与康复过程的能力会发生变化。围手术期的注意力通常集中在管理发病前的损伤和恢复肩部功能上。相比之下，在化疗和放疗期间，控制症状、积极应对和保持角色可能变得更加重要。通过预测模型和分析，针对特定损伤的风险分层、个体化筛查和预防活动变得越来越可行。已经证实，一些损伤的严重程度和不良影响是可以减轻的，例如淋巴水肿、肩部功能障碍、化疗引起的周围神经病、认知功能障碍、疲劳和性功能障碍。一些综合性康复项目通常在美国以外的国家提供，这些项目通常在癌症治疗结束后启动，为幸存者提供重要的职业和业余生活导向服务。
