According to a report in the prestigious British medical journal The Lancet, 1.6 million people are diagnosed with cancer and 1.2 million die of cancer in China each year. As in many other countries, breast cancer is the most common cancer among Chinese women, accounting for 12.2 percent of new breast cancer diagnoses and 9.6 percent of breast cancer deaths worldwide.
Statistics show that 21.6 out of every 100,000 Chinese women are “favored” by breast cancer. According to the Chinese National Tumor Registry, breast cancer is the most common cancer among urban women and the fourth most common cancer among rural women. The incidence rate in urban areas is twice as high as in rural areas. In China, the average age of diagnosis of breast cancer is 45 to 55 years old, earlier than in Western women. And data from both Shanghai and Beijing show that the two peak age groups for incidence are 45 to 55 years old and 70 to 74 years old, respectively.
For breast cancer, the preferred treatment is radical surgical excision, supplemented by a combination of radiotherapy, chemotherapy, endocrine, molecular targeting, and traditional Chinese medicine depending on the patient’s condition. However, it is not enough to rely on the efforts of doctors alone to overcome breast cancer. Patients and their family members should also learn rehabilitation care to win this war with cancer together with doctors.
In the following, we will introduce how to implement rehabilitation care reasonably and effectively from 3 aspects, namely post-operative, radiotherapy and chemotherapy, in order to get the best curative effect.
I. Prevention of post-surgical complications
Radical surgery, as the first choice of treatment for breast cancer, has an irreplaceable status, so what are the possible complications after surgery and how should we prevent them?
(A) Subcutaneous hematoma
Subcutaneous hematoma usually occurs within 24 hours after surgery and is usually associated with inappropriate movement of the affected limb. Therefore, the family must provide good care and observation during these 24 hours after surgery. The patient should be placed in a flat position for 6 hours after surgery and the shoulder joint should be braked for 24 hours. If the patient shows symptoms such as nausea, vomiting, pain, agitation, etc., the doctor should be notified promptly to give symptomatic treatment to avoid bleeding due to excessive activity and traction, which may affect the healing of the flap. At the same time, attention should be paid to observe whether the drainage tube is patent and whether the amount, color and nature of the drainage fluid are abnormal. Under normal circumstances, the amount of drainage fluid within 24 hours after surgery should be less than 150 ml, with a thin, dark red color. If the color and nature of the drainage fluid change, it should be reported to the doctor immediately for treatment.
(II) Subcutaneous effusion
Subcutaneous fluid accumulation is also one of the complications that tend to occur after surgery. Patients and their families should pay attention to the fact that the affected shoulder joint should be braked for 1 week after surgery. Also pay attention to the patient’s underlying disease, communicate with the doctor in a timely manner, control blood pressure and blood sugar, and improve nutritional status.
(C) Infection
Infection is a common problem that affects wound healing and postoperative recovery. After surgery, try to keep the wound area dry. If family members or patients find excessive blood or ooze from the wound, they should notify the doctor in time to prevent wound infection. After surgery, too many visits from friends and relatives should be avoided to ensure that the patient has sufficient rest and sleep, and also to avoid cross-infection brought about by a large number of people. Attention should also be paid to observe whether the position of the drainage bag is lower than the drainage opening to avoid infection caused by backflow. In addition, the nutritional intake of the patient after surgery should be enhanced to strengthen the immune system and promote wound healing. Also closely observe the patient’s vital signs, especially the change of body temperature. If the body temperature is elevated and the wound is painful, it indicates wound infection and should be reported to the doctor immediately for treatment.
(iv) Skin flap necrosis
Whether the flap graft is successful is especially important for the patient, and attention should be paid to the appropriate tightness of the chest strap wrapping to avoid over-tightening. At the same time, the condition of the affected limb should be closely observed, and if the affected limb appears cold and purple in color, it should be reported to the doctor for timely treatment.
(E) Shoulder joint dysfunction
After breast cancer surgery, the upper limb on the affected side often has different degrees of dysfunction due to the influence of scarring and so on. This dysfunction can usually be reduced or avoided by appropriate exercises. However, it is worth noting that upper limb functional exercise should avoid overexertion and should be done gradually and according to the ability. For patients with special conditions, the exercise time should be reduced or delayed as appropriate, but try not to stop the exercise.
Functional exercise steps (demonstrated with the left side as the affected side).
1~3 days after surgery (bedside phase): practice finger extension, fist clenching and wrist flexion exercises.
3~5 days after surgery: practice sitting elbow flexion movement.
5~8 days after surgery: practice touching the contralateral shoulder and ipsilateral ear with your hand.
9~13 days postoperative: practice straightening, elevation, inversion and flexion of the upper limb on the affected side, and shoulder joint elevation to 90° to reach the level of flat shoulder.
14 days after surgery: practice shoulder joint, put the hand behind the neck, practice from low head position to head up position, further practice hand over the top of the head to touch the contralateral ear; you can start to practice finger climbing wall exercise, etc. Patients can also strengthen their exercises by wiping objects and tying skirts and other movements in daily life after discharge.
(F) Edema of the affected limb
Edema of the affected upper extremity is a major problem for patients, which is mostly difficult to relieve and affects their daily life. So what should be done to prevent and relieve this annoying problem?
①Adhere to the functional exercise of the affected upper limb. Such as making wall climbing movements and strengthening the activities of the affected limb, especially the activities of the fingers, to improve the circulation, which can help reduce edema.
②Manipulation to promote lymphatic reflux: If you feel a sense of swelling in the limb, massage from the distal end of the affected limb (palm end) to the proximal end (shoulder end) with the palm of the healthy side or family members, 2~3 times a day, 20 minutes each time.
③Pay attention to the protection of the affected upper limb: prohibit blood pressure measurement and any venipuncture (blood draw, chemotherapy, intravenous infusion) in the affected upper limb; avoid using the affected upper limb for weight bearing; pay attention to skin care, prohibit contact with too cold or too hot water and strong detergents; avoid breakage and infection or mosquito bites in the affected upper limb; avoid wearing jewelry in the affected upper limb as much as possible.
④ Closely observe the edema of the affected upper limb and frequently ask the patient about the sensation, such as whether the affected upper limb feels swollen. Early identification of mild edema can help avoid the occurrence of moderate to severe edema.
⑤ Diet therapy: controlling salt intake can reduce the degree of edema.
II. Care during radiotherapy
Radiotherapy, as one of the treatment methods for breast cancer, is also widely used. So, what should we pay attention to during radiotherapy?
(A) Dietary care
Some patients may have gastrointestinal reactions during radiotherapy, such as nausea and loss of appetite. Therefore, we should adjust the diet reasonably and keep a balanced nutrition. Avoid cold, hot, greasy, spicy and other stimulating foods.
(B) Oral care
Pay attention to keep the oral hygiene, remove residual food in the mouth, rinse the mouth after meals, and brush the teeth 2~3 times a day. If oral ulcers appear, you should gargle with light salt water or anti-inflammatory mouthwash every day.
(C) Skin care
Usually, the skin of radiotherapy site is thin, and coupled with the poor skin elasticity of postoperative patients, it is easy to produce skin reactions. Therefore, personal cleanliness and hygiene should be done, and soft and loose clothing should be worn. Keep the bed clean, dry, soft and comfortable. Avoid rubbing and pressure on the skin in the radiotherapy area, avoid using irritating shower gel, and do not bathe with overly hot water. If skin reactions occur, such as redness, swelling, itching, pain and other symptoms, be sure not to scratch, and seek medical advice in a timely manner and follow medical prescriptions for medication, in order to effectively control skin reactions and reduce the patient’s pain and mental burden.
(D) Regularly review the blood routine
The change of white blood cell should be closely observed during radiotherapy. If it is found that the white blood cell decreases, it means that the immunity of the organism decreases and there is a risk of infection, so radiotherapy should be suspended. At the same time, in addition to giving drug treatment, the patient’s ward should be ventilated and disinfected to keep the air fresh and pay attention to rest.
Third, care during chemotherapy
Chemotherapy, as an important treatment method other than surgery, is applicable to almost all breast cancer patients. Therefore, good chemotherapy-related nursing is crucial to improve the tolerance of chemotherapy and thus the efficacy of chemotherapy.
(I) Bone marrow suppression
Regular blood tests should be performed during chemotherapy. Patients with decreased white blood cells should suspend or delay chemotherapy and apply leukopoietic drugs in a timely manner.
(B) Gastrointestinal reactions
During chemotherapy, patients should eat in moderation, eat easily digestible food and have a light taste. If the reaction is serious, the medication should be used as prescribed by the doctor to increase the tolerance of chemotherapy.
(C) Oral mucosal reactions
Pay attention to keep the oral cavity clean, rinse the mouth with mouthwash and brush the teeth with a soft-haired toothbrush. If oral ulcers occur, you can use oral ulcer compound appropriately.
(IV) Hair loss
Hair loss caused by chemotherapy is mostly reversible, and the hair will grow on its own after the chemotherapy is finished, so patients do not need to have fear.
IV. Other precautions
Estrogen deficiency is a relatively common problem that will plague patients for a long time after chemotherapy and endocrine therapy. Patients often feel panic, fatigue, excessive sweating, abnormal sleep, vaginal dryness or itching, and other uncomfortable symptoms similar to menopausal syndrome. These symptoms can sometimes be so severe that it is difficult for patients to tolerate them for a long time.
However, we also know that estrogen has a stimulating effect on the development and progression of breast cancer, so reducing or counteracting estrogen stimulation is exactly what is needed to treat and prevent breast cancer. If we give up the ongoing endocrine treatment or apply estrogenic drugs to relieve these symptoms, it is likely to affect the effectiveness of the treatment. Therefore, we should relax and face it correctly.
In addition, there may be osteoporosis problem after chemotherapy and endocrine therapy, which can be alleviated to some extent by increasing physical activity and supplementing calcium and vitamin D appropriately. Certain bisphosphonates also have definite value in the prevention and treatment of osteoporosis. The above four aspects are the most important issues that family members and patients themselves should pay attention to during the treatment of breast cancer patients. If the various problems that arise during treatment can be dealt with in a timely and correct manner, it will be very beneficial to improve the efficacy and quality of survival.