The Underutilization of Rehabilitation to Treat Physical Impairments in Breast Cancer Survivors

Abstract

Breast cancer survivors can experience multiple neuromuscular, musculoskeletal, pain, and functional disorders as a result of their cancer and its treatment. Common disorders include shoulder dysfunction, postmastectomy syndrome, chemotherapy-induced peripheral neuropathy, axillary cording, lymphedema, and a host of others. Cancer rehabilitation is a process that helps breast cancer and other survivors to obtain and maintain the highest possible physical, social, psychological, and vocational functioning within the limits created by cancer and its treatments. There are good data supporting the safety and efficacy of cancer rehabilitation in the treatment of many breast cancer-related impairments, including shoulder dysfunction and lymphedema, among others. Despite the goals and efficacy of cancer rehabilitation, there is a marked underuse of services. The reasons for this phenomenon are many, but broadly result from a lack of knowledge about cancer rehabilitation on the part of patients and referring clinicians, limited access to services, and suboptimal adherence. This article explores underutilization of cancer rehabilitation in breast cancer survivors and provides an opportunity to consider ways to improve this gap in care.

Physical Activity, Exercise and Breast Cancer - What Is the Evidence for Rehabilitation, Aftercare, and Survival A Review

“…Stubblefield et al [56] noted that there is incomplete knowledge about cancer rehabilitation in patients and referring clinicians. It is also interesting that treatment rates for remediable physical impairments in cancer rehabilitation are lower than 2% [57].…”

Follow the trail: Using insights from the growth of palliative care to propose a roadmap for cancer rehabilitation

“…Moreover, CAPC, in conjunction with the National Palliative Care Research Center and data from other organizations, produces the CAPC Report Card, which is a state‐by‐state report card on access to palliative care services in US hospitals. These results are published in the scientific literature and in a joint CAPC/National Palliative Care Research Center report with policy implications …”

“…Historically, there have been low rates of referral to and uptake of rehabilitation services in oncology. 11,12 For example, Pergolotti et al observed that only 9% of older adults with cancer used physical or occupational therapy, despite having a potentially modifiable functional limitation detected by comprehensive geriatric assessment. 2 Cheville et al likewise reported that less than 30% of outpatients with cancer and women with advanced cancer who had functional limitations used rehabilitation services.…”

“…2 Cheville et al likewise reported that less than 30% of outpatients with cancer and women with advanced cancer who had functional limitations used rehabilitation services. 13 The reasons for low utilization include a workforce shortage of rehabilitation physicians and therapists trained in oncology 11,14 and a low familiarity and recognition on behalf of patients and referring providers as to the need, value, and function of cancer rehabilitation. 11,15 Research has indicated that individual treatments delivered by rehabilitation professionals can reduce impairments or functional limitations of cancer survivors.…”

“…13 The reasons for low utilization include a workforce shortage of rehabilitation physicians and therapists trained in oncology 11,14 and a low familiarity and recognition on behalf of patients and referring providers as to the need, value, and function of cancer rehabilitation. 11,15 Research has indicated that individual treatments delivered by rehabilitation professionals can reduce impairments or functional limitations of cancer survivors. 16,17 For example, meta-analyses or systematic reviews support the use of exercise to reduce fatigue 18 and to improve physical fitness, physical and emotional function, and quality of life 19 ; education to manage pain 20 and fatigue 21,22 ; nonpharmacological interventions 23 or neuropsychological interventions 24 to improve cognitive functioning; groupbased self-management programs to improve physical functioning 25 ; massage therapy to improve pain, fatigue, and anxiety 26 ; and manual lymphatic drainage to manage lymphedema.…”