Definition of rehabilitation treatment
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 restore their physiological functions, adjust their psychological state, and return to the society and rebuild their lives destroyed by the disease at the same time or after the regular treatment of breast cancer.
The content of rehabilitation treatment
1. Exercise of upper limb function on the affected side.
(1) Postoperative upper limb functional exercise
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, not arbitrarily in advance, so as not to affect the wound healing.
Step-by-step method: 1~2 d after surgery, practice fist clenching, finger extension and wrist flexion; 3~4 d after surgery, forearm extension and flexion exercise; 5~7 d after surgery, the hand on the affected side touches the contralateral shoulder and ipsilateral ear (the affected limb can be supported by the healthy limb); 8~10 d after surgery, practice shoulder elevation, extension and flexion to 90°; 10 d after surgery, shoulder joint climbing wall and apparatus exercise.
①The requirement for functional exercise was that the upper arm of the affected limb could 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.
(2) Shoulder joint abduction should be limited within 7 d after surgery.
③In case of severe flap necrosis, avoid large movements for 2 weeks after surgery.
④If subcutaneous fluid or drainage fluid exceeds 50 mL 1 week after surgery, reduce the number of exercises and the range of shoulder joint movement (limit abduction).
⑤ Shoulder exercises should be postponed 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, and >5 cm as severe edema.
①Prevent 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.
②Avoid 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.
③Avoid weight-bearing: avoid lifting, pulling or pushing overly heavy objects; avoid heavy physical labor or more strenuous sports activities.
④Other: restore arm function as soon as possible; wear elastic cuffs when traveling by airplane.
⑤ Self-care methods for lymphedema: ①Mild or moderate lymphedema: elevate the arm; bottom-up centripetal massage along the lymphatic direction; do arm function restoration training; wear an elastic cuff. ②Severe lymphedema: wear an elastic cuff; 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.Nutrition and exercise
The progress 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, so proper nutrition and a healthy lifestyle are especially important in the recovery period of breast cancer patients.
(1) Diet and nutrition
So far there is no evidence to prove that a certain type of food diet is related to the recurrence or metastasis of breast cancer.
①Foods that are easy to digest, high in protein, high in vitamins and low in fat can be used.
②Foods that need to be avoided are: placenta and its products; health products of unknown composition.
(2) Exercise
During the rehabilitation period, you should choose an aerobic exercise that is suitable for you and can be adhered to throughout your life. Exercises that can be recommended to patients include brisk walking, cycling, 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 Maintaining a normal body weight.
(②Adhering to daily exercise.
(③Reducing the intake of alcohol and not smoking.
④ Use health care products carefully.
3.Adjustment of psychological state
Psychological intervention of bad emotions
Adverse emotions of breast cancer patients mainly focus on self-esteem, physical impact, anxiety and depression. Health care workers 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 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 and face life positively as soon as possible.
①Provide adequate information to help patients accept the fact of illness rationally Healthcare professionals can participate in patients’ cognitive correction, help them to reflect appropriately, reduce false ideas and alleviate patients’ fears.
②Help patients find a positive purpose for survival and build confidence in life Healthcare professionals 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 patients’ sense of commitment and assist them to effectively control themselves by implementing a patient-centered medical care model that helps patients fully utilize their decision-making power and stimulates their sense of self-responsibility.
4. 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 androgen. About half of a woman’s androgens are produced by the adrenal glands, which are located above the kidneys, and the ovaries produce the other half of the androgens. Women need only a very 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 partner regarding sexuality.
② Try sensual massage.
③ Read a good book on sex to increase knowledge and skills about sex.
④Increase sexual fantasies.
⑤ Share your sexual fantasies with your partner.
⑥encourage your partner to be more active in sexual activities.
⑦Tell your partner to do it in the way you like.
5.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 must be fully considered when choosing whether and when to have children.
The impact on offspring and adequate communication with patients are also necessary.
(1) Patients with carcinoma in situ of the breast can be considered for childbirth after 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 carcinoma of the breast can consider having children after 5 years of surgery.
(4) Patients who need adjuvant endocrine therapy should stop endocrine therapy (e.g. norethindrone, triamcinolone or other SERMs) 3 months before conception until the end of breastfeeding after childbirth, and then continue endocrine therapy.
6. Postoperative follow-up guidance
(1) Patients with early-stage breast cancer should be followed up regularly after surgery to understand the survival status of patients, as well as their compliance with adjuvant therapy and adverse reactions.
(2) Follow-up time: once every 3 months in the 1st~2nd year after surgery (or after finishing adjuvant chemotherapy), once every 4~6 months in the 3rd~4th year, and once 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 (once a year), gynecological examination (once a year in triamcinolone therapy), bone density (in aromatase inhibitor therapy).
(5) Bone scan, CT or MRI may be used in symptomatic patients, but are not recommended routinely for asymptomatic patients.
Provide comprehensive social support to promote recovery of social mobility