This document discusses the physical impairments and functional limitations that can result from breast cancer treatments such as surgery, chemotherapy, radiation therapy, and endocrine therapy. It presents a prospective surveillance model for rehabilitation to promote early detection and intervention of treatment-related issues. The model involves preoperative evaluation and education, early postoperative reassessment and exercise programming, and ongoing surveillance. The goal is to improve outcomes and quality of life for breast cancer survivors.

1. Presented by: Erin Murphy, PT, DPT, CLT-UE | Certified Lymphedema Therapist

2. Treatments for breast cancer typically include surgery,
chemotherapy, radiation therapy and endocrine therapy which
cause a variety of physiologic effects known to adversely impact
body structure and function.1,2

3. 
Pain 1, 5, 6, 7

Neuropathy 1, 8

Fatigue 1, 9

Osteoporosis 1, 12

Lymphedema 1, 5, 7

Decrease in physical function 1, 5, 6, 7

Weakness 1, 5, 6, 7

Changes in body weight 1, 11

Restricted range of motion 1, 5, 6


Joint arthralgia 1, 12
Adverse affects on cardiovascular
health 1, 10

4. “A
proactive approach to periodically examining
patients and providing ongoing assessment during
and after disease treatment often in the absence of
impairment, in an effort to enable early detection of
an intervention for physical impairments known to be
associated with breast cancer treatment” 2

5. 
Promote surveillance for common physical impairments and
functional limitations

Provide education to reduce risk or prevent adverse effects and
facilitate early identification of impairments

Provide rehab and exercise interventions when impairments
identified

Promote and support physical activity, exercise, and weight
management behaviors through the trajectory of disease
treatment and survivorship. 2, 3, 15

6. Preoperative
Rehabilitation:
Early post- operative
Rehabilitation:
evaluation &
education
reassessment &
exercise program
Ongoing
Surveillance

7. 





8. 
–
–
–
–

9. 
Should take place within the first month after surgery

Repeats baseline tests and measures

Patient education on prevention and early detection of common
treatment related impairments

Education about exercise and health promoting behaviors

If functional limitations are detected, rehabilitation intervention
may be initiated 2, 14

10. 


–


11. 


12. 1. Stout, N. L., Binkley, J. M., Schmitz, K. H., Andrews, K., Hayes, S. C., Campbell, K. L., McNeely, M. L., Soballe, P. W., Berger, A.
M., Cheville, A. L., Fabian, C., Gerber, L. H., Harris, S. R., Johansson, K., Pusic, A. L., Prosnitz, R. G. and Smith, R. A. (2012), A
prospective surveillance model for rehabilitation for women with breast cancer. Cancer, 118: 2191–2200. doi:
10.1002/cncr.27476
2. Schmitz, K. H., Stout, N. L., Andrews, K., Binkley, J. M. and Smith, R. A. (2012), Prospective evaluation of physical
rehabilitation needs in breast cancer survivors. Cancer, 118: 2187–2190. doi: 10.1002/cncr.27471
3. Gerber, L. H., Stout, N. L., Schmitz, K. H. and Stricker, C. T. (2012), Integrating a prospective surveillance model for
rehabilitation into breast cancer survivorship care. Cancer, 118: 2201–2206. doi: 10.1002/cncr.27472
4. Binkley, J. M., Harris, S. R., Levangie, P. K., Pearl, M., Guglielmino, J., Kraus, V. and Rowden, D. (2012), Patient perspectives
on breast cancer treatment side effects and the prospective surveillance model for physical rehabilitation for women with
breast cancer. Cancer, 118: 2207–2216. doi: 10.1002/cncr.27469
5. Schmitz, K. H., Speck, R. M., Rye, S. A., DiSipio, T. and Hayes, S. C. (2012), Prevalence of breast cancer treatment sequelae
over 6 years of follow-up. Cancer, 118: 2217–2225. doi: 10.1002/cncr.27474
6. McNeely, M. L., Binkley, J. M., Pusic, A. L., Campbell, K. L., Gabram, S. and Soballe, P. W. (2012), A prospective model of care
for breast cancer rehabilitation: Postoperative and postreconstructive issues. Cancer, 118: 2226–2236. doi:
10.1002/cncr.27468
7. Hayes, S. C., Johansson, K., Stout, N. L., Prosnitz, R., Armer, J. M., Gabram, S. and Schmitz, K. H. (2012), Upper-body
morbidity after breast cancer. Cancer, 118: 2237–2249. doi: 10.1002/cncr.27467

13. 8. Stubblefield, M. D., McNeely, M. L., Alfano, C. M. and Mayer, D. K. (2012), A prospective surveillance model for physical
rehabilitation of women with breast cancer. Cancer, 118: 2250–2260. doi: 10.1002/cncr.27463
9. Berger, A. M., Gerber, L. H. and Mayer, D. K. (2012), Cancer-related fatigue. Cancer, 118: 2261–2269. doi: 10.1002/cncr.27475
10. Schmitz, K. H., Prosnitz, R. G., Schwartz, A. L. and Carver, J. R. (2012), Prospective surveillance and management of cardiac
toxicity and health in breast cancer survivors. Cancer, 118: 2270–2276. doi: 10.1002/cncr.27462
11. Demark-Wahnefried, W., Campbell, K. L. and Hayes, S. C. (2012), Weight management and its role in breast cancer
rehabilitation. Cancer, 118: 2277–2287. doi: 10.1002/cncr.27466
12. Winters-Stone, K. M., Schwartz, A. L., Hayes, S. C., Fabian, C. J. and Campbell, K. L. (2012), A prospective model of care for
breast cancer rehabilitation: Bone health and arthralgias. Cancer, 118: 2288–2299. doi: 10.1002/cncr.27465
13. Campbell, K. L., Pusic, A. L., Zucker, D. S., McNeely, M. L., Binkley, J. M., Cheville, A. L. and Harwood, K. J. (2012), A
prospective model of care for breast cancer rehabilitation: Function. Cancer, 118: 2300–2311. doi: 10.1002/cncr.27464
14. Harris, S. R., Schmitz, K. H., Campbell, K. L. and McNeely, M. L. (2012), Clinical practice guidelines for breast cancer
rehabilitation. Cancer, 118: 2312–2324. doi: 10.1002/cncr.27461
15. Stout, N. L., Andrews, K., Binkley, J. M., Schmitz, K. H. and Smith, R. A. (2012), Stakeholder perspectives on dissemination
and implementation of a prospective surveillance model of rehabilitation for breast cancer treatment. Cancer, 118: 2331–2334.
doi: 10.1002/cncr.27470