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BACKGROUND: The current model of care for individuals with breast cancer focuses on treatment of the disease, followed by ongoing surveillance to detect recurrence. This approach lacks attention to patients' physical and functional well-being. Breast cancer treatment sequelae can lead to physical impairments and functional limitations. Common impairments include pain, fatigue, upper-extremity dysfunction, lymphedema, weakness, joint arthralgia, neuropathy, weight gain, cardiovascular effects, and osteoporosis. Evidence supports prospective surveillance for early identification and treatment as a means to prevent or mitigate many of these concerns. This article proposes a prospective surveillance model for physical rehabilitation and exercise that can be integrated with disease treatment to create a more comprehensive approach to survivorship health care. The goals of the model are to promote surveillance for common physical impairments and functional limitations associated with breast cancer treatment; to provide education to facilitate early identification of impairments; to introduce rehabilitation and exercise intervention when physical impairments are identified; and to promote and support physical activity and exercise behaviors through the trajectory of disease treatment and survivorship. METHODS: The model is the result of a multidisciplinary meeting of research and clinical experts in breast cancer survivorship and representatives of relevant professional and advocacy organizations. RESULTS/CONCLUSIONS: The proposed model identifies time points during breast cancer care for assessment of and education about physical impairments. Ultimately, implementation of the model may influence incidence and severity of breast cancer treatment-related physical impairments. As such, the model seeks to optimize function during and after treatment and positively influence a growing survivorship community.

The purpose of this paper is to review the incidence of upper‐body morbidity (arm and breast symptoms, impairments, and lymphedema), methods for diagnosis, and prevention and treatment strategies. It was also the purpose to highlight the evidence base for integration of prospective surveillance for upper‐body morbidity within standard clinical care of women with breast cancer. Between 10% and 64% of women report upper‐body symptoms between 6 months and 3 years after breast cancer, and approximately 20% develop lymphedema. Symptoms remain common into longer‐term survivorship, and although lymphedema may be transient for some, those who present with mild lymphedema are at increased risk of developing moderate to severe lymphedema. The etiology of morbidity seems to be multifactorial, with the most consistent risk factors being those associated with extent of treatment. However, known risk factors cannot reliably distinguish between those who will and will not develop upper‐body morbidity. Upper‐body morbidity may be treatable with physical therapy. There is also evidence in support of integrating regular surveillance for upper‐body morbidity into the routine care provided to women with breast cancer, with early diagnosis potentially contributing to more effective management and prevention of progression of these conditions. Cancer 2012;118(8 suppl). © 2012 American Cancer Society.

Breast cancer is commonly diagnosed in postmenopausal women, the majority of whom express 1 or more cardiovascular disease risk factors. Cardiovascular disease poses a significant competing risk for morbidity and mortality among nonmetastatic breast cancer survivors. Adjuvant systemic therapies may result in late-cardiac toxicity decades after treatment completion. The cumulative incidence of treatment-related cardiotoxic outcomes may be as high as 33% after some adjuvant breast cancer therapies. Breast cancer treatment-induced cardiotoxicity may manifest as cardiomyopathy, coronary ischemia, thromboembolism, arrhythmias and conduction abnormalities, and valvular and pericardial disease. Evidence indicates that preexisting cardiovascular conditions such as hypertension or left ventricular dysfunction may compound the adverse effects of cardiotoxic treatments. There are currently no published clinical practice guidelines that address ongoing cardiac surveillance for cardiotoxicity after breast cancer, and existing guidelines for monitoring and promoting cardiovascular health in older women are often not followed. The multidisciplinary prospective surveillance system proposed elsewhere in this supplement would allow for earlier detection of cardiotoxicity from treatment and may improve monitoring of cardiovascular health in the growing population of breast cancer survivors. Advances in diagnosis and treatment of breast cancer have led to improved outcomes and an ever-expanding population of long-term breast cancer survivors currently estimated at 2.5 million in the United States alone.1,2 Approximately 90% of the nearly 200,000 newly diagnosed patients in 2011 will be expected to live for 5 or more years.1,2 Adjuvant therapies can potentially cause a wide range of acute and late cardiac complications. 3,4 In addition, diagnoses of breast cancer happen most commonly among postmenopausal women, 5 the majority of whom have 1 or more cardiovascular disease (CVD) risk factors.6 Furthermore, there are published guidelines for monitoring cardiovascular health in women. 7 The combined issues of common preexisting risk and the potential for adverse effects of treatment on the cardiovascular system implies that there may be merit to the establishment of multidisciplinary collaborative efforts to address potential adverse effects and improve cardiovascular health in breast cancer survivors.The proposed prospective surveillance model, presented elsewhere in this issue of Cancer, 8 promotes this type of multidisciplinary approach to managing cardiac toxicities and health in breast cancer survivors. The goal of this review is to understand the relative merits of such a model with a particular focus on early detection and management of cardiovascular outcomes in this population. Preexisting Cardiovascular Risk in Breast Cancer SurvivorsCardiovascular disease and cancer share multiple risk factors, such as obesity, inactivity, and substance abuse (alcohol and cigarettes), and the incidence of both diseases increases as the popula...

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The model proposed by Cohen and collaborators is used to describe the process of diffusion through polymeric membranes subjected to externally applied extensions. This continuum mechanics approach is compared with a model developed via a mesoscopic theory. Experimental data on a variety of polymer/solvent systems are successfully described by the model. It was found that the flux‐versus‐time curves for deformations up to 80% elongation could be reduced to a master curve. © 2005 Wiley Periodicals, Inc. J Appl Polym Sci, 2006

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