1.Definition of rehabilitation treatment
Rehabilitation includes recovery of physiological function, adjustment of psychological state and recovery of social activities. The rehabilitation treatment of breast cancer is to help patients recover their physiological functions and adjust their psychological state at the same time or after the regular treatment of breast cancer, and to enable them to return to society and rebuild their lives damaged by the disease.
2. Contents of rehabilitation treatment
2.1 Exercise of upper limb function on the affected side
2.1.1 Functional exercise of the upper limb after surgery
Functional exercise is essential to restore the function of the patient’s shoulder joint and eliminate edema, but the order of gradual progress must be strictly observed, and should not be advanced arbitrarily to avoid affecting the wound healing.
Step-by-step method.
1-2 days after surgery, practice fist clenching, finger extension, wrist flexion, etc.
3-4 days after surgery, forearm extension and flexion exercises.
5-7 days after surgery, the hand of the affected side touches the opposite shoulder and the ipsilateral ear (the affected limb can be supported by the healthy limb).
8-10 days after surgery, practice shoulder elevation, extension and flexion to 90 degrees.
After 10 days postoperatively, the shoulder joint was subjected to wall climbing and apparatus exercises.
(1) The requirement for functional exercise is that the upper arm of the affected limb can be straightened and raised around the top of the head to touch the opposite ear within 2 weeks. After achieving the standard, functional exercise should be continued.
(2) Restriction of shoulder abduction within 7 days after surgery.
(3) For severe flap necrosis, avoid substantial exercise for 2 weeks after surgery.
(4) If subcutaneous fluid accumulation or drainage exceeds 50 ml 1 week after surgery, reduce the number of exercises and the range of shoulder joint movement (limit abduction).
(5) Shoulder joint exercises should be postponed after skin grafting and breast reconstruction with latissimus dorsi flap.
2.1.2 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 contralateral upper limb as mild edema, 3-5 cm as moderate, and greater than 5 cm as severe edema.
(1) Prevention of 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; 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 an elastic cuff when traveling by airplane.
(5) Self-care methods for lymphedema: a. Mild or moderate lymphedema: elevate the arm; bottom-up centripetal massage along the lymphatic direction; do arm function restoration training; wear an elastic sleeve. b. Severe lymphedema: wear an elastic sleeve; physical therapy. If the arm becomes red or abnormally hard, or if the edema is severe, infection should be considered and anti-infection and symptomatic treatment should be given.
2.2 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, and proper nutrition and healthy lifestyle are especially important in the recovery period of breast cancer patients.
2.2.1 Diet and Nutrition
So far there is no evidence to prove that the diet of a certain type of food is related to the recurrence or metastasis of breast cancer.
(1) Foods that are medically digestible, high in protein, high in vitamins, and low in fat can be used.
(2) Foods that need to be contraindicated are: a. placenta and its products; b. health products of unknown composition.
2.2.2 Exercise
During the rehabilitation period, one should choose an aerobic exercise that is suitable for him/her and can be adhered to for life. 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 the symptoms of fatigue caused by having cancer and its treatment, and increase the body’s resistance to diseases.
2.2.3 Establish a healthy lifestyle
(1) Maintaining a normal body weight.
(2) Adhere to daily exercise.
(3) Reduce the intake of alcohol and do not smoke.
(4) Use health care products carefully/
2.3 Adjustment of psychological state
2.3.1 Psychological intervention of bad emotions
The adverse emotions of breast cancer patients mainly focus on self-esteem, physical impact, anxiety and depression.
Health care workers and family members need to understand the characteristics of patients’ psychological changes and the process of psychological state adjustment in order to provide necessary psychological interventions. Health care professionals and family members can enhance patients’ self-control in terms of cognition, decision-making, and coping skills, and guide and enlighten patients to use reasonable coping skills such as suggestion and catharsis to increase their tolerance for distress. Avoid being located in the patient’s excessive sympathy and pity, emphasize to the patient the importance of maintaining normality, and help the patient to 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. Health care workers and family members can participate in patients’ cognitive correction to help them reflect appropriately, reduce false ideas and alleviate patients’ fears.
(2) Help patients find a positive purpose for survival and build confidence in life. Health care providers and family members must promptly and correctly assess the patient’s current expectations, including the relationship and degree of dependency between the patient and his or her relatives. 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) To stimulate the patient’s sense of commitment and assist him/her in controlling his/her self effectively. Implement a patient-centered medical care and family care model to help patients give full play to their decision-making power and stimulate their sense of self-responsibility.
2.4 Sexual rehabilitation guidance
(1) Learn all the information about the possible effects of breast cancer and its treatment on sexuality. They need to be informed that the sex hormone that causes women to have sex drive is androgen. About half of a woman’s androgens are produced by the adrenal glands located above the kidneys, while the ovaries produce the other half of the androgens. Women need only a small amount of androgens 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, and partners should help each other to reach orgasm through touch and caress.
(4) Communicate with your partner about sexual problems. Silence is the biggest enemy of sexual health, and if one is never afraid to ask for advice, then there will never be relief.
Related suggestions.
(1) Improve communication with your sexual partner about sexuality.
(2) Try sensual massage.
(3) Read a good book on sex to increase knowledge and skills about sex.
(4) Increase sexual fantasies.
(5) Share your sexual fantasies with your sexual partner.
(6) Encourage your partner to be more active during sex.
(7) Tell your partner to do it in the way you like.
2.5 Fertility Guidance
Although there is no evidence that childbearing affects the prognosis of breast cancer patients, the choice of whether and when to have children must be made with full consideration of the patient’s risk of disease recurrence and metastasis and the impact of treatment on offspring, and with adequate communication with the patient.
(1) Patients with carcinoma in situ of the breast can be considered for childbirth after the completion of surgery and radiation therapy.
(2) Patients with lymph node-negative invasive carcinoma of the breast can be considered for childbirth 2 years after surgery.
(3) Patients with lymph node-positive invasive breast cancer can be considered for childbirth 5 years after surgery
(4) Patients who need adjuvant endocrine therapy should stop endocrine therapy 3 months before conception until the end of breastfeeding after childbirth, and then continue endocrine therapy.
2.6 Postoperative follow-up guidance
(1) 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: every three months in the first two years after surgery (or after the end of adjuvant therapy), every four to six months in the third to fourth years, and every one year from the fifth year onwards.
(3) Follow-up examinations: physical examination by palpation, liver ultrasound, biochemical routine, tumor markers and routine blood test, lung X-ray examination.
(4) Other special examinations: ultrasound of chest wall and contralateral breast and related regional lymph nodes, mammogram of contralateral breast (once a year), gynecological examination for patients taking endocrine drugs (once every six months to a year), bone density test.
(5) Bone scan, CT, MRI or PET-CT can be used in symptomatic patients, but are not recommended for routine use in asymptomatic individuals.
2.7 Provide comprehensive social support to promote the recovery of social mobility
In 2000, Australia issued the first evidence-based guideline on supportive care for breast cancer patients, called “Psychosocial clinical practice guidelines: providing confidence, counseling and support for breast cancer patients”. confidence, counseling and support”. 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 is clear that professional support, family support and peer support should be covered in the social support network for breast cancer patients.
Elements of integrated social support.
(1) Professional support; to provide medical information and psychological support, professional lectures on rehabilitation courses, rehabilitation hotline, rehabilitation duty room, rehabilitation website, and publication of rehabilitation-related books can be offered.
(2) Family support: To encourage family members to participate in the diagnosis and treatment of patients and the rehabilitation process, family information and consultation windows can be set up, and communication platforms can be provided for family members.
(3) Patient support: The participation of rehabilitation patient volunteers is the main focus, which can take the form of ward visits or seminars for new patients, and is recommended to be carried out under the professional guidance and supervision of medical and nursing staff.