Showing papers by "Andrea L. Cheville published in 2007"

Barriers to rehabilitation following surgery for primary breast cancer.

Abstract: Surgery is a mainstay of primary breast cancer therapy. Alterations in surgical technique have reduced normal tissue injury, yet pain and functional compromise continue to occur following treatment. A tenuous evidence base bolstered by considerable expert opinion suggests that early intervention with conventional rehabilitative modalities can reduce surgery-associated pain and dysfunction. Barriers to the timely rehabilitation of functionally morbid sequelae are discussed at length in this article. Barriers arise from a wide range of academic, human, logistic, and financial sources. Despite obstacles, expeditious and effective post-surgical rehabilitation is being regularly delivered to breast cancer patients at many institutions. This experience has given rise to anecdotal information on the management of common sequelae that may undermine function. The epidemiology, pathophysiology, and management of these sequelae are outlined in this article with an emphasis on the caliber of supporting evidence. Myofascial dysfunction, axillary web syndrome, frozen shoulder, lymphostasis, post-mastectomy syndrome, and donor site morbidity following breast reconstruction are addressed. A critical need for more definitive evidence to guide patient management characterizes the current treatment algorithms for surgical sequelae.

The role of cancer rehabilitation in the maintenance of functional integrity and quality of life

Abstract: Rehabilitation too often remains clinically marginalized in the care of cancer patients. The perception that only patients capable of full community and vocational pursuits with unrestricted life spans stand to benefit from rehabilitation is inaccurate. Although physical medicine and rehabilitation, or physiatry, was initially dedicated to transitioning individuals with anatomically devastating injuries back to productive lives, the field has broadened considerably. This increased scope is a response to medical advances that have radically altered the prognoses of many formerly fatal diseases. Integration of rehabilitation services in the care of patients with far-advanced pulmonary and cardiac disease is standard. Comparable services are rarely offered to cancer patients, even in the early stages of disease. The purpose of rehabilitation as outlined in this chapter is to improve the quality of life irrespective of etiology or anticipated survival. The number and severity of functional impairments correlate with disability among cancer patients (Cheville, 2002). As disease progresses, impairments become increasingly common. Most patients develop multiple deficits in the advanced stages of cancer. For example, patients with advanced breast cancer develop conjointly chemotherapy-induced peripheral neuropathies, lymphedema and steroid myopathies, referring to injury to peripheral nerves, edema or swelling secondary to injury in lymphatic channels, and muscle injury associated with use of steroids, respectively. Also plexopathies, or injury to the nerve plexus or network of nerve fibers that pass from one peripheral nerve to