I. Definition of breast cancer rehabilitation treatment
Rehabilitation includes restoration of physiological function, 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 society and rebuild their lives damaged by the disease at the same time or after the regular treatment of breast cancer.
Content of rehabilitation treatment
1. Rehabilitation of the affected limb function
2.Progressive functional exercise of the affected upper limb
Functional exercise is essential to restore the function of the shoulder joint and eliminate edema, but the order of gradual progress must be strictly observed, and should not be advanced at will, so as not to affect the wound healing.
III. Progressive method.
1.1-2d postoperatively, practice fist clenching, finger extension and wrist flexion.
2.3-4d postoperatively, forearm extension and flexion exercises.
3.5-7d after surgery, the hand on the affected side should touch the opposite shoulder and the ipsilateral ear (the affected limb can be supported by the healthy limb).
4.8-10d postoperatively, practice shoulder elevation, extension and flexion to 90°.
5. 10d after surgery, shoulder joint climbing and apparatus exercise.
4. The requirements for functional exercises to reach the standard are
Within 2 weeks, the upper arm of the affected side can be straightened and raised around the top of the head to touch the opposite ear. Functional exercise should be continued after the standard is achieved. Shoulder abduction is restricted for 7 d after surgery. For severe flap necrosis, avoid substantial exercise for 2 weeks after surgery. If the subcutaneous fluid accumulation or drainage fluid exceeds 50mL 1 week after surgery, the number of exercises and shoulder joint movement should be reduced (restrict abduction). Shoulder exercises should be postponed after skin grafting and breast reconstruction with latissimus dorsi flap.
V. Prevention or reduction of upper limb edema
The circumference of the affected upper limb is generally considered to be less than 3 cm longer than the circumference of the opposite upper limb as mild edema, 3-5 cm as moderate edema, and more than 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 to avoid prolonged contact with irritating washing solutions; avoid mosquito bites; dress and wear jewelry or watches must be loose.
2.Avoid high temperature environment: avoid burns; do not apply hot compresses to the affected arm, do not overheat the water temperature when bathing; avoid bright light exposure and high temperature environment.
3.Avoid weight bearing: avoid lifting, pulling and pushing overweight objects; avoid heavy physical labor or more strenuous sports activities.
4.Other: restore arm function as soon as possible; wear elastic cuffs when flying.
5. Self-care methods for lymphedema.
(1) Mild or moderate lymphedema: elevate the arm; bottom-up centripetal massage along the lymphatic direction; do arm function recovery training; wear an elastic cuff.
(2) Severe lymphedema: wear an elastic cuff; physical therapy. If there are symptoms such as redness or abnormal hardness in the arm, or if the edema is severe, infection should be considered and anti-infection and symptomatic treatment should be given.
Nutrition and exercise
The progression of breast cancer disease or adverse effects during treatment may lead to malnutrition, and overweight due to over-eating is 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 and increase the probability of disease-free survival.
1. Diet and nutrition
There is no evidence to prove that a certain type of food diet is associated with breast cancer recurrence or metastasis.
(1) The main recommendation of the American Cancer Society is to follow a diet rich in fruits, vegetables, coarse grains and soy products. The American College of Public Health recommends that adults drink at least 2.0-3.0 cups of vegetable juice and 1.5-2.0 cups of fruit juice per day. In some observational studies, high vegetable and coarse grain intake in breast cancer survivors was associated with a 43% reduction in overall mortality. Dietary supplements (e.g. multivitamins) are not recommended at this time.
(2) Placenta and its products and health supplements of unknown composition need to be contraindicated.
2.Exercise
During the rehabilitation 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 150min 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.Build 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.
VII. Adjustment of psychological status
The adverse emotions of breast cancer patients mainly focus on self-esteem, physical impact, anxiety and depression.
Health care personnel need to understand the characteristics of psychological changes and the process of psychological state adjustment of patients in order to provide necessary psychological interventions. Health care professionals can enhance patients’ self-control in cognition, decision-making, and coping skills, and instruct patients to reasonably use coping skills such as suggestion and catharsis in order to increase their endurance for difficult situations. Avoid giving patients too much sympathy and pity, and emphasize to patients the importance of maintaining normality to help them get rid of the patient role as soon as possible and face life positively.
1. Provide adequate information to help patients accept the fact of illness rationally. Medical and nursing staff can participate in patients’ cognitive correction, help them to make appropriate reflections, reduce wrong ideas and alleviate patients’ fears.
2. Help patients find a positive purpose for survival and build confidence in life. Medical and nursing staff must promptly and correctly assess the patient’s current expectations, including the dependency relationship between the patient and his or her family. Help patients realize their own value and importance to other members of the family in order to increase their confidence in fighting the disease.
3. Stimulate the patient’s sense of commitment and assist him/her in controlling his/her self effectively. Implement a patient-centered medical care model to help patients give full play to their decision-making power and stimulate their sense of self-responsibility.
Sexual rehabilitation guidance
1. Learn all the information about the possible effects of breast cancer and its treatment on sexual life. What they need to be told is that the sex hormone that causes women to have sex drive is estrogen. About half of a woman’s estrogen is produced by the adrenal glands, which are located above the kidneys, and the ovaries produce the other half of estrogen. Women only need a very small amount of estrogen to maintain the normal levels needed for sexual desire.
2. Regardless of the treatment that will be used, the ability to obtain pleasure through caresses will not change.
3, try to enjoy other ways of feeling sexual pleasure, partners should help each other to reach orgasm through touch and caress.
4, communicate with your partner about sexual issues. Silence is the biggest enemy of sexual health, and if you are never afraid to ask for advice, then you will never be relieved.
Related suggestions.
1.Improve communication with your partner about your sex life.
2, try sensual massage.
3, read a good book on sex to increase knowledge and skills about sex.
4.Increase sexual fantasy.
5.Share your sexual fantasies with your partner.
6.Encourage your partner to be more active in sexual activities.
7.Tell your partner to do it in the way you like.
Nine, fertility guidance
Although there is no evidence that childbirth affects the prognosis of breast cancer patients, the risk of recurrence of the patient’s disease and the impact of treatment on the offspring must be fully considered when choosing whether and when to have children, and there must be adequate communication with the patient. Childbirth can be considered in the following cases.
1.After the end of surgery and radiotherapy for patients with carcinoma in situ of the breast.
2.2 years after surgery for patients with 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 [such as norethindrone, triamcinolone or other estrogen receptor modulators] 3 months before conception, until the end of breastfeeding after childbirth, and then continue endocrine therapy.
X. Postoperative follow-up guidance
Meaning of follow-up: Patients with early-stage breast cancer should be followed up regularly after surgery 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 first 1-2 years after surgery (or after finishing adjuvant chemotherapy), once every 4-6 months in the 3rd-4th years, and once or twice a year from the 5th year.
3.Follow-up examinations: physical examination by palpation, liver ultrasound, blood biochemistry and blood routine.
4.Other special examinations: mammogram (1 time per year), gynecological examination (1-2 times per year in triamcinolone therapy), bone density (in aromatase inhibitor therapy).
5. Bone scan, CT or MRI can be used in symptomatic patients, but are not recommended for routine application in asymptomatic patients.
XI. Provide comprehensive social support and restore social mobility
In 2000, Australia issued the first evidence-based guideline on supportive care for breast cancer patients, called “Psychosocial Clinical Practice Guidelines: Information, Counseling and Support for Breast Cancer Patients. “. The guidelines specifically recommend that all women should have access to emotional and social support from their treatment team, as well as information and support from peer support groups. From this, it can be seen that professional support, family support and peer support should be covered in the social support network for breast cancer patients.
1.Professional support: mainly providing medical information and psychological support, rehabilitation courses and professional lectures can be offered, rehabilitation hotlines, rehabilitation duty rooms, rehabilitation websites, and publishing rehabilitation-related books, etc.
2.Family support: To encourage family members to participate in the patient’s diagnosis and treatment and rehabilitation process, we can open a consultation window for family information and provide a communication platform for family members.
3.Peer support: The participation of rehabilitation patient volunteers is the main focus. It can take the form of ward visits or symposiums for new patients, which is recommended to be conducted under the professional guidance and supervision of medical and nursing staff.