Breast Cancer Rehabilitation - Prospective Surveillance Model (PSM)

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Physical Therapy is an integral part of breast cancer rehabilitation. Those undergoing treatments for breast cancer often face surgery. Physical therapists can work with women to alleviate symptoms caused by surgical intervention or medical treatment for cancer. The Prospective Surveillance Model, or PSM, is a proactive approach to periodically examining patients and providing continued assessment during and after disease treatment, often in the absence of impairment.

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Breast Cancer Rehabilitation - Prospective Surveillance Model (PSM)

  1. 1. Presented by: Erin Murphy, PT, DPT, CLT-UE | Certified Lymphedema Therapist
  2. 2. Treatments for breast cancer typically include surgery, chemotherapy, radiation therapy and endocrine therapy which cause a variety of physiologic effects known to adversely impact body structure and function.1,2
  3. 3.  Pain 1, 5, 6, 7  Neuropathy 1, 8  Fatigue 1, 9  Osteoporosis 1, 12  Lymphedema 1, 5, 7  Decrease in physical function 1, 5, 6, 7  Weakness 1, 5, 6, 7  Changes in body weight 1, 11  Restricted range of motion 1, 5, 6   Joint arthralgia 1, 12 Adverse affects on cardiovascular health 1, 10
  4. 4. “A proactive approach to periodically examining patients and providing ongoing assessment during and after disease treatment often in the absence of impairment, in an effort to enable early detection of an intervention for physical impairments known to be associated with breast cancer treatment” 2
  5. 5.  Promote surveillance for common physical impairments and functional limitations  Provide education to reduce risk or prevent adverse effects and facilitate early identification of impairments  Provide rehab and exercise interventions when impairments identified  Promote and support physical activity, exercise, and weight management behaviors through the trajectory of disease treatment and survivorship. 2, 3, 15
  6. 6. Preoperative Rehabilitation: Early post- operative Rehabilitation: evaluation & education reassessment & exercise program Ongoing Surveillance
  7. 7.     
  8. 8.  – – – –
  9. 9.  Should take place within the first month after surgery  Repeats baseline tests and measures  Patient education on prevention and early detection of common treatment related impairments  Education about exercise and health promoting behaviors  If functional limitations are detected, rehabilitation intervention may be initiated 2, 14
  10. 10.    – 
  11. 11.  
  12. 12. 1. Stout, N. L., Binkley, J. M., Schmitz, K. H., Andrews, K., Hayes, S. C., Campbell, K. L., McNeely, M. L., Soballe, P. W., Berger, A. M., Cheville, A. L., Fabian, C., Gerber, L. H., Harris, S. R., Johansson, K., Pusic, A. L., Prosnitz, R. G. and Smith, R. A. (2012), A prospective surveillance model for rehabilitation for women with breast cancer. Cancer, 118: 2191–2200. doi: 10.1002/cncr.27476 2. Schmitz, K. H., Stout, N. L., Andrews, K., Binkley, J. M. and Smith, R. A. (2012), Prospective evaluation of physical rehabilitation needs in breast cancer survivors. Cancer, 118: 2187–2190. doi: 10.1002/cncr.27471 3. Gerber, L. H., Stout, N. L., Schmitz, K. H. and Stricker, C. T. (2012), Integrating a prospective surveillance model for rehabilitation into breast cancer survivorship care. Cancer, 118: 2201–2206. doi: 10.1002/cncr.27472 4. Binkley, J. M., Harris, S. R., Levangie, P. K., Pearl, M., Guglielmino, J., Kraus, V. and Rowden, D. (2012), Patient perspectives on breast cancer treatment side effects and the prospective surveillance model for physical rehabilitation for women with breast cancer. Cancer, 118: 2207–2216. doi: 10.1002/cncr.27469 5. Schmitz, K. H., Speck, R. M., Rye, S. A., DiSipio, T. and Hayes, S. C. (2012), Prevalence of breast cancer treatment sequelae over 6 years of follow-up. Cancer, 118: 2217–2225. doi: 10.1002/cncr.27474 6. McNeely, M. L., Binkley, J. M., Pusic, A. L., Campbell, K. L., Gabram, S. and Soballe, P. W. (2012), A prospective model of care for breast cancer rehabilitation: Postoperative and postreconstructive issues. Cancer, 118: 2226–2236. doi: 10.1002/cncr.27468 7. Hayes, S. C., Johansson, K., Stout, N. L., Prosnitz, R., Armer, J. M., Gabram, S. and Schmitz, K. H. (2012), Upper-body morbidity after breast cancer. Cancer, 118: 2237–2249. doi: 10.1002/cncr.27467
  13. 13. 8. Stubblefield, M. D., McNeely, M. L., Alfano, C. M. and Mayer, D. K. (2012), A prospective surveillance model for physical rehabilitation of women with breast cancer. Cancer, 118: 2250–2260. doi: 10.1002/cncr.27463 9. Berger, A. M., Gerber, L. H. and Mayer, D. K. (2012), Cancer-related fatigue. Cancer, 118: 2261–2269. doi: 10.1002/cncr.27475 10. Schmitz, K. H., Prosnitz, R. G., Schwartz, A. L. and Carver, J. R. (2012), Prospective surveillance and management of cardiac toxicity and health in breast cancer survivors. Cancer, 118: 2270–2276. doi: 10.1002/cncr.27462 11. Demark-Wahnefried, W., Campbell, K. L. and Hayes, S. C. (2012), Weight management and its role in breast cancer rehabilitation. Cancer, 118: 2277–2287. doi: 10.1002/cncr.27466 12. Winters-Stone, K. M., Schwartz, A. L., Hayes, S. C., Fabian, C. J. and Campbell, K. L. (2012), A prospective model of care for breast cancer rehabilitation: Bone health and arthralgias. Cancer, 118: 2288–2299. doi: 10.1002/cncr.27465 13. Campbell, K. L., Pusic, A. L., Zucker, D. S., McNeely, M. L., Binkley, J. M., Cheville, A. L. and Harwood, K. J. (2012), A prospective model of care for breast cancer rehabilitation: Function. Cancer, 118: 2300–2311. doi: 10.1002/cncr.27464 14. Harris, S. R., Schmitz, K. H., Campbell, K. L. and McNeely, M. L. (2012), Clinical practice guidelines for breast cancer rehabilitation. Cancer, 118: 2312–2324. doi: 10.1002/cncr.27461 15. Stout, N. L., Andrews, K., Binkley, J. M., Schmitz, K. H. and Smith, R. A. (2012), Stakeholder perspectives on dissemination and implementation of a prospective surveillance model of rehabilitation for breast cancer treatment. Cancer, 118: 2331–2334. doi: 10.1002/cncr.27470

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