Barriers to rehabilitation following surgery for primary breast cancer

Andrea L. Cheville, Julia Tchou

Research output: Contribution to journalReview article

141 Scopus citations

Abstract

Surgery is a mainstay of primary breast cancer therapy. Alterations in surgical technique have reduced normal tissue injury, yet pain and functional compromise continue to occur following treatment. A tenuous evidence base bolstered by considerable expert opinion suggests that early intervention with conventional rehabilitative modalities can reduce surgery-associated pain and dysfunction. Barriers to the timely rehabilitation of functionally morbid sequelae are discussed at length in this article. Barriers arise from a wide range of academic, human, logistic, and financial sources. Despite obstacles, expeditious and effective post-surgical rehabilitation is being regularly delivered to breast cancer patients at many institutions. This experience has given rise to anecdotal information on the management of common sequelae that may undermine function. The epidemiology, pathophysiology, and management of these sequelae are outlined in this article with an emphasis on the caliber of supporting evidence. Myofascial dysfunction, axillary web syndrome, frozen shoulder, lymphostasis, post-mastectomy syndrome, and donor site morbidity following breast reconstruction are addressed. A critical need for more definitive evidence to guide patient management characterizes the current treatment algorithms for surgical sequelae.

Original languageEnglish (US)
Pages (from-to)409-418
Number of pages10
JournalJournal of Surgical Oncology
Volume95
Issue number5
DOIs
StatePublished - Apr 1 2007

Keywords

  • Adhesive capsulitis
  • Axillary lymph node dissection
  • Axillary web syndrome
  • Breast cancer
  • Function
  • Lumpectomy
  • Lymphedema
  • Lymphostasis
  • Mastectomy
  • Myofascial pain
  • Post mastectomy syndrome
  • TRAM flap

ASJC Scopus subject areas

  • Surgery
  • Oncology

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