The good or bad post-operative rehabilitation effect of breast cancer patients directly affects patients’ emotion and confidence in curing the disease. Therefore, a correct understanding of the possible complications, patient and serious rehabilitation exercises, and a good attitude to cooperate with postoperative chemotherapy and radiotherapy are all necessary conditions to ensure a good treatment effect. We hope that patients will read this article carefully, pay attention to some recovery details, take good care of their body and mind, establish firm confidence, and adopt a positive attitude of doing one’s best and listening to God’s fate, and they will definitely achieve good results!
After receiving surgery, breast cancer patients will enter the post-operative recovery stage and face various adjuvant treatments. The following will focus on the problems and solutions that patients may encounter in the process of recovery for their reference.
I. Rehabilitation problems arising from surgery
1. Delayed wound healing
Delayed wound healing after mastectomy in breast cancer patients is mainly manifested by flap necrosis and subcutaneous fluid accumulation. Many factors, including advanced age, diabetes mellitus, post-local radiotherapy, electrodebrider burns, and individual differences, are all factors that lead to delayed wound healing. Postoperative wound compression dressing, drainage tube maintenance usually, high protein and vitamin nutrition intake, and control of diabetes are very important preventive measures. Once necrosis or fluid accumulation of the flap occurs, the patient should not be nervous and should actively cooperate with the surgeon for treatment. If the area of necrosis is small, it can be cleaned and changed, and it can heal on its own in about two months on average; if the area of necrosis is large, the necrotic skin can be excised and the skin can be implanted in the second stage. When fluid accumulation occurs, incision and drainage and local pressure bandage can be given, and regular drug changes can generally be cured. If there is no fever during the treatment period, the patient may not need to apply antibiotics systemically.
2. Upper limb edema and dysfunction
After radical breast cancer surgery, due to the removal of axillary lymph, there will be different degrees of edema of the affected upper limbs and shoulder joint dysfunction. Therefore, it is recommended to carry out functional exercise of upper limbs as soon as possible after surgery, but it must be done gradually, otherwise it will affect the wound healing. Within one week after surgery, fist clenching, wrist bending and elbow bending are the main exercises, and after about one week, shoulder lifting exercises are appropriate according to the wound healing condition. After the wound is healed, exercises such as touching the height, pulling the ring and rotating the shoulder can be performed. Patients should adhere to functional exercises for more than 1 year after discharge from the hospital. In addition, care must be taken to avoid heavy lifting and prolonged dropping of the affected limb, to prevent mosquito bites, and to avoid intravenous injections in the affected limb. Symptomatic measures such as elevation of the upper limb and oral diuretics can be taken when severe upper limb edema occurs.
3.Loss of breast
At present, most of the breast cancer surgeries in China still adopt the surgery of mastectomy, including radical surgery and modified radical surgery. The absence of breast directly affects the aesthetic appearance of women, which can cause great pressure on their psychology. Therefore, after surgery, patients can wear suitable prosthesis while the wound is healing, avoid wearing low-neck and tight clothes, and choose soft, loose, cotton underwear to reduce the stimulation of the skin on the affected side. At present, many hospitals across the country are carrying out breast reconstruction after breast cancer surgery, using autologous tissue or prosthesis implants for breast reconstruction to return women’s beautiful posture. In terms of the results of plastic surgery and patient satisfaction, stage I breast reconstruction immediately after breast cancer surgery is the best choice.
II. Rehabilitation problems arising from radiotherapy
Radiotherapy after breast cancer surgery is usually given to the whole breast or the whole chest wall, the inner breast area and the supraclavicular area. The upper extremity abduction and supination are required during radiotherapy, so the functional exercise of the affected upper extremity before and after radiotherapy is very important. The most common side effect of breast cancer radiotherapy is skin reaction. There are two types of skin reactions: dry reactions and wet reactions. Dry reactions are erythema, burning sensation, tingling sensation, hyperpigmentation and non-exudative peeling of the skin, while wet reactions are eczema, blisters, and in severe cases, erosion and infection. Patients should not handle the above reactions by themselves if they occur, otherwise the symptoms may be aggravated. The correct practice is to choose wide and soft cotton or silk underwear during the whole radiotherapy period, to expose and ventilate the skin in sweaty folds properly, to avoid rubbing the skin with rough towels and jewelry in the radiotherapy field, not to scratch the skin with fingers, and not to apply skin care products or paste ointment. Some local medications can be used appropriately under the guidance of doctors. The distant reactions of radiotherapy may include myocardial damage, lung damage, upper limb edema, etc. Therefore, regular follow-ups must be conducted after radiotherapy.
III. Rehabilitation problems due to systemic treatment
Although chemotherapy has more side effects, it is an indispensable part of modern breast cancer treatment. It is now advocated that postoperative adjuvant chemotherapy should be started as early as possible, usually about one week after surgery. Common chemotherapy side effects include bone marrow suppression, nausea and vomiting, poor appetite, hair loss, oral mucositis, chemical phlebitis, etc.
1, bone marrow suppression: During chemotherapy, the blood image should be reviewed regularly according to medical advice. Patients with low leukocytes should suspend or delay chemotherapy and apply leuke-raising drugs in a timely manner. During chemotherapy, you should go out less and avoid eating raw food. Keep personal hygiene, cut nails and wash hands regularly to avoid skin damage.
2. Gastrointestinal reaction: On the day of chemotherapy, patients can have breakfast early and eat digestible food. Do not eat within four hours after chemotherapy to reduce the reaction of the digestive tract. Apply antiemetic and sedative before chemotherapy according to the chemotherapy reaction. Try to distract and maintain a good environment during chemotherapy to avoid malignant stimulation. Severe vomiting requires timely supplementation of fluids and nutrients.
3, oral mucosal reactions: chemotherapy can often cause gastrointestinal mucositis or ulcers, chemotherapy with ice water in the mouth can reduce the occurrence of ulcers. Keep your mouth clean after meals, rinse your mouth with mouthwash, and brush your teeth with a soft-haired toothbrush as much as possible. After the occurrence of oral ulcers, you should eat nutritious liquid or semi-liquid, lower the temperature of food and avoid irritating food. The ulcers can be used as tin type dispersion or mouth ulcer compound.
4, hair loss: hair loss during chemotherapy is almost always reversible, and the hair will grow back on its own after the end of chemotherapy. Therefore, there is no need to be depressed because of the loss of hair. Young patients can cut their hair short before chemotherapy to reduce the psychological pressure. During chemotherapy, you can temporarily wear a wig.
5.Protection of upper limb vein: postoperative adjuvant chemotherapy should be administered in the upper arm vein of the healthy side (patients with bilateral breast cancer can choose the upper limb of the smaller surgical area as the vein route. Patients should prepare well before chemotherapy: the upper limbs should be lowered as much as possible, and hot water can be applied externally when it is cold, so that the veins can be fully filled and the success rate of venipuncture can be improved. When chemotherapy is in progress, pay attention to whether there is local tingling, swelling, timely reflection, timely detection of drug extravasation, timely treatment can avoid tissue necrosis.
6, chemotherapy diet: chemotherapy diet during chemotherapy should depend on the patient’s response to chemotherapy. Generally speaking, on the day of chemotherapy to light, easy to digest and absorb food is appropriate. Eat less and more meals, in principle 4-6 meals/day. Acidic foods help control nausea. A small amount of cold drinks can ease stomach discomfort. Chew carefully and swallow slowly to avoid gas-producing foods. Encourage drinking more water, and encourage the choice of high nutrition, high calorie and low fat diet.
IV. Psychological rehabilitation
In addition to various physical adverse reactions, most breast cancer patients have mental health problems after surgery. For example, anxiety, fear and insomnia due to the fear of tumor recurrence; loneliness and depression due to the loss of breast; loss of libido due to treatment; guilt towards spouse or children due to medical expenses, etc.
In conclusion, postoperative rehabilitation and health care is an important part of modern breast cancer treatment and is receiving increasing attention.