title: A prospective surveillance model for rehabilitation for women with breast cancer.
abstract: BACKGROUND
  The current model of care for individuals with breast cancer focuses on treatment of the disease, followed by ongoing surveillance to detect recurrence. This approach lacks attention to patients' physical and functional well-being. Breast cancer treatment sequelae can lead to physical impairments and functional limitations. Common impairments include pain, fatigue, upper-extremity dysfunction, lymphedema, weakness, joint arthralgia, neuropathy, weight gain, cardiovascular effects, and osteoporosis. Evidence supports prospective surveillance for early identification and treatment as a means to prevent or mitigate many of these concerns. This article proposes a prospective surveillance model for physical rehabilitation and exercise that can be integrated with disease treatment to create a more comprehensive approach to survivorship health care. The goals of the model are to promote surveillance for common physical impairments and functional limitations associated with breast cancer treatment; to provide education to facilitate early identification of impairments; to introduce rehabilitation and exercise intervention when physical impairments are identified; and to promote and support physical activity and exercise behaviors through the trajectory of disease treatment and survivorship.
  
  
  METHODS
  The model is the result of a multidisciplinary meeting of research and clinical experts in breast cancer survivorship and representatives of relevant professional and advocacy organizations.
  
  
  CONCLUSIONS
  The proposed model identifies time points during breast cancer care for assessment of and education about physical impairments. Ultimately, implementation of the model may influence incidence and severity of breast cancer treatment-related physical impairments. As such, the model seeks to optimize function during and after treatment and positively influence a growing survivorship community.
authors.affiliation: National Naval Medical Center, Bethesda, Maryland, USA. nicole.stout@med.navy.mil
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Stout
authors.forename: Jill M
authors.initials: JM
authors.lastname: Binkley
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Schmitz
authors.forename: Kimberly
authors.initials: K
authors.lastname: Andrews
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Hayes
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Campbell
authors.forename: Margaret L
authors.initials: ML
authors.lastname: McNeely
authors.forename: Peter W
authors.initials: PW
authors.lastname: Soballe
authors.forename: Ann M
authors.initials: AM
authors.lastname: Berger
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Cheville
authors.forename: Carol
authors.initials: C
authors.lastname: Fabian
authors.forename: Lynn H
authors.initials: LH
authors.lastname: Gerber
authors.forename: Susan R
authors.initials: SR
authors.lastname: Harris
authors.forename: Karin
authors.initials: K
authors.lastname: Johansson
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Pusic
authors.forename: Robert G
authors.initials: RG
authors.lastname: Prosnitz
authors.forename: Robert A
authors.initials: RA
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000570:American Cancer Society; D001943:Breast Neoplasms / Q000401:mortality / Q000534:rehabilitation* / Q000628:therapy; D003131:Combined Modality Therapy; D003226:Congresses as Topic; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D018572:Disease-Free Survival; D042241:Early Diagnosis; D015444:Exercise / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D017146:Models, Organizational; D020380:Needs Assessment; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000517:prevention & control*; D010353:Patient Education as Topic; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D011788:Quality of Life; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States