Monitoring and caring for breast cancer patients with post-treatment problems: what can we do?

Abstract

253 ISSN 1758-1923 10.2217/BMT.12.45 © 2012 Future Medicine Ltd Breast Cancer Manage. (2012) 1(4), 253–256 Breast cancer patients that have completed prescribed therapies are often faced with post-treatment problems. Depending on the treatment, common sequelae include: lymphedema, postmastectomy pain syndrome, brachial plexopathy, pneumonitis, secondary malignancies, ovarian failure, myelosuppression, neuropathy, bone health issues, reduced functional status, thrombosis and cardiomyopathy, among others. These physical issues often arise in conjunction with far reaching psycho social, emotional, cognitive, spiritual and economic concerns for this population. Complications due to treatment are highly prevalent in all cancers with 98% of cancer survivors reporting at least one problem associated with their treatment [1]. Late effects of breast cancer treatment were recently investigated in a study that followed 287 breast cancer survivors for 6 years. In this follow-up study, which specifically assessed complications amenable to rehabilitation interventions (postsurgical complications, skin or tissue reaction to radiation therapy, upperbody symptoms, lymphedema, >10% weight gain, fatigue and upper-quadrant function), the proportion of breast cancer survivors who still reported facing at least one of these issues was greater than 50% at 6, 12, 18 and 24 months – and even at 6 years [2]. One challenge in meeting the unique and complex medical and non-medical needs of breast cancer survivors is co ordination of care. Many of these needs remain unmet in the current healthcare system, precisely because coordination of care for cancer survivors remains problematic [3,4]. The Institute of Medicine and National Research Council recognize prevention, surveillance, intervention and co ordination as key components to survivorship care. Breast cancer survivors also report a need for better coordination of survivorship care; Mao et al. surveyed 300 breast cancer survivors on their perception of care and only 28% believed their primary care physician (PCP) and oncologist communicated well [5]. With coordination lacking and a projected shortfall of oncologists, other relationships need to be established for breast cancer survivors to address their health problems [6,7]. What can we do to care for breast cancer patients with post-treatment problems? Given the litany of complications due to