Rehabilitation includes restoration of physiological functions, adjustment of psychological state and restoration of social activities. The rehabilitation treatment of breast cancer is to help patients recover their physiological functions, adjust their psychological state, and return to the society and rebuild their lives damaged by the disease at the same time or after the regular treatment of breast cancer.
I. Rehabilitation of the affected limb function
1.Progressive functional exercise of the affected upper limb
Functional exercise is essential for restoring the function of the shoulder joint and eliminating arm edema, but the order of gradual progress must be strictly observed, not arbitrarily in advance, so as not to affect the wound healing.
Step-by-step method.
①1~2 days after surgery, practice fist clenching, finger extension and wrist flexion.
② 3~4 days after surgery, forearm extension and flexion exercises.
③5~7 days after surgery, the hand of the affected side touches the contralateral shoulder and the ipsilateral ear (the affected limb can be supported by the healthy limb).
④8~10 days after surgery, practice shoulder elevation, extension and flexion to 90°.
⑤ After 10 days postoperatively, shoulder joint climbing wall and apparatus exercise.
The requirement for functional exercise is that the upper arm on the affected side can be straightened and raised around the top of the head to touch the opposite ear within 2 weeks. The functional exercise should be continued after the standard is achieved. Shoulder abduction is restricted for 7 days after surgery. For severe flap necrosis, avoid substantial exercise for 2 weeks after surgery. In case of subcutaneous fluid accumulation or drainage over 50 mL 1 week after surgery, you should
Reduce the number of exercises and shoulder joint movement (limit abduction). Shoulder exercises should be delayed after skin grafting and breast reconstruction with latissimus dorsi flap.
2. Prevention or reduction of upper limb edema
The circumference of the affected upper limb is generally considered to be <3 cm longer than the circumference of the contralateral upper limb as mild edema, 3-5 cm as moderate edema, and >5 cm as severe edema.
Specific methods.
(1) Prevent infection: keep the skin on the affected side clean; do not perform invasive operations on the affected arm, such as blood draws and infusions; wear loose gloves when washing and avoid prolonged contact with irritating washing solutions; avoid mosquito bites; always dress and wear jewelry or watches loosely.
(2) Avoid high temperature environment: avoid burns; do not apply hot compresses to the affected arm and do not overheat the water when bathing; avoid bright light exposure and high temperature environment.
(3) Avoid weight-bearing: avoid lifting, pulling or pushing overly heavy objects; avoid heavy physical labor or more strenuous sports activities.
(4) Other: restore arm function as soon as possible; wear elastic cuffs when traveling by airplane.
(5) Self-care methods for lymphedema: elevate the arm for mild or moderate lymphedema, massage from bottom to top along the lymphatic direction, do arm function restoration training and wear an elastic cuff; for severe lymphedema, wear an elastic cuff or undergo physical therapy. If the arm becomes red or abnormally hard, or if the edema is serious, infection should be considered and anti-infection and symptomatic treatment should be provided.
Nutrition and exercise
The progression of breast cancer disease or the adverse effects during treatment may lead to malnutrition, and overweight due to over-eating is also one of the problems faced by breast cancer patients during recovery. Cancer patients are also at high risk for second primary cancer, cardiovascular disease, diabetes and osteoporosis. Proper nutrition and a healthy lifestyle are especially important during the recovery period of breast cancer patients. Maintaining a healthy weight, adequate physical activity and a healthy diet can reduce the risk of disease recurrence.
1. Diet and nutrition
There is no evidence that a particular type of food and diet is associated with the recurrence or metastasis of breast cancer.
1 The main recommendation of the American Cancer Society is to follow a diet rich in fruits, vegetables, coarse grains and soy products. Public health in the United States recommends that adults drink at least 2 to 3 glasses of vegetable juice and 1 to 2 glasses of fruit juice daily. In some observational studies, high intake of vegetables and coarse grains in breast cancer survivors was associated with a 43% reduction in overall mortality. Dietary supplements (such as multivitamins) are not recommended at this time.
2 . Exercise
During the recovery period, you should choose an aerobic exercise that is suitable for you and can be maintained throughout your life. Regular exercise is recommended, with at least 150 minutes of moderate intensity exercise per week and strength training twice a week. Exercises that can be recommended to patients include brisk walking, bicycling, swimming, tai chi, and aerobic dance.
Balanced diet and aerobic exercise can strengthen the immune system, effectively reduce mental stress, improve sleep, relieve fatigue caused by cancer and its treatment, and increase the body’s resistance to disease.
3 . Establish a healthy lifestyle
(1) Maintain a normal weight.
(2) Adhere to daily exercise.
(3) Reduce the intake of alcohol and do not smoke.
(4) Use health care products carefully.
IV. Fertility guidance
Although there is no evidence that childbirth affects the prognosis of breast cancer patients, the risk of disease recurrence and the impact of treatment on offspring must be fully considered when choosing whether and when to have children. Childbearing may be considered in the following situations.
1. After surgery and radiation therapy for patients with carcinoma in situ of the breast.
2. 2 years after surgery for lymph node-negative invasive carcinoma of the breast.
3. 5 years after surgery for lymph node-positive invasive carcinoma of the breast.
4. Patients who need adjuvant endocrine therapy should stop endocrine therapy (e.g. Norelide, triamcinolone acetonide) 3 months before conception, until the end of breastfeeding after childbirth, and then continue endocrine therapy.
V. Postoperative follow-up guidance
1. Meaning of follow-up: Patients with early-stage breast cancer should be followed up regularly after surgery in order to understand their survival status, as well as their compliance with adjuvant therapy and adverse reactions.
2. Follow-up time: once every 3 months in the 1st~2nd year, once every 4~6 months in the 3rd~4th year, and once or twice a year in the 5th year after surgery (or after adjuvant chemotherapy).