Marsili Cynthia, Wilson Christopher M, Gura Nathan
Physical Therapy, Beaumont Health, Sterling Heights, USA.
Physical Therapy, Oakland University, Rochester, USA.
Cureus. 2019 Jul 29;11(7):e5265. doi: 10.7759/cureus.5265.
Breast cancer and its treatments can cause detrimental effects to function and quality of life (QoL). These patients do not conventionally receive physical therapy services until impairments and functional limitations have become extensive. Emerging treatment models advocate for early rehabilitation screenings and proactive interventions, which are termed prospective surveillance. The purpose of this case report was to describe two prospective surveillance screenings at initial diagnosis and survivorship and subsequent physical therapy episodes of care for a patient with breast cancer. A 39-year-old female was diagnosed with invasive ductal carcinoma of the right breast. Approximately three months after the initial diagnosis, the patient had a right nipple-sparing mastectomy and immediate reconstruction with an expander. In addition, one lymph node was removed and underwent a biopsy, which was negative for metastases. The patient was screened by a physical therapist after her initial cancer diagnosis at the breast multidisciplinary clinic. This was after her mastectomy with an expander; the therapist recommended an episode of outpatient physical therapy due to impairments in pain, fatigue, loss of range of motion, weakness, and limitations in performance of her activities of daily living. The patient was seen initially for five visits. She underwent her final reconstructive surgery one month after discharge from physical therapy. Six months after her final reconstructive surgery, she was screened by the same physical therapist in the cancer survivorship clinic. Once again, therapy was recommended due to pain as well as deficits to her range of motion, strength, and functional status. The second episode of care lasted 14 visits and the patient showed improvements in pain, range of motion, shoulder strength and gains in the patient-specific functional scale and upper extremity functional index. This case reflects the importance of prospective surveillance screenings to overall patient outcomes. This patient may not have otherwise received physical therapy and its associated benefits without the prospective screenings by the physical therapist.
乳腺癌及其治疗方法会对身体功能和生活质量（QoL）产生不利影响。通常情况下，这些患者直到出现严重的损伤和功能受限才会接受物理治疗服务。新兴的治疗模式提倡早期康复筛查和积极干预，即前瞻性监测。本病例报告的目的是描述一名乳腺癌患者在初次诊断和生存期间进行的两次前瞻性监测筛查，以及随后的物理治疗过程。一名39岁女性被诊断为右乳浸润性导管癌。初次诊断后约三个月，患者接受了保留乳头的右乳乳房切除术，并立即使用扩张器进行了乳房重建。此外，切除了一个淋巴结并进行活检，结果显示无转移。患者在乳腺多学科诊所初次确诊癌症后，由一名物理治疗师进行了筛查。这是在她接受扩张器乳房切除术后；由于疼痛、疲劳、活动范围受限、虚弱以及日常生活活动能力受限等损伤，治疗师建议进行门诊物理治疗。患者最初接受了五次治疗。她在物理治疗出院后一个月接受了最后一次重建手术。最后一次重建手术后六个月，她在癌症生存诊所由同一名物理治疗师进行了筛查。由于疼痛以及活动范围、力量和功能状态方面的缺陷，再次建议进行治疗。第二次治疗持续了14次，患者在疼痛、活动范围、肩部力量方面有所改善，在患者特定功能量表和上肢功能指数方面也有所提高。本病例反映了前瞻性监测筛查对患者整体预后的重要性。如果没有物理治疗师的前瞻性筛查，该患者可能无法接受物理治疗及其相关益处。
