Breast cancer treatment issues may linger for years

More than 60% of breast cancer survivors report at least one treatment-related complication as long as six years after their diagnosis, according to a new study.

“Our work provides the first accounting of the true magnitude of the post-treatment problems suffered by breast cancer patients, and serves as a call to action for proper monitoring and rehabilitation services to care for them,” Kathryn Schmitz, PhD, MPH, Perelman School of Medicine, University of Pennsylvania, an associate professor of biostatistics and epidemiology who serves as a senior scientist on a committee overseeing creation of a surveillance model for breast cancer survivors, said in a news release.

“We can no longer pretend that the side effects of breast cancer treatment end after patients finish active treatment. The scope of these complications is shocking and upsetting, but a ready solution for many of them already exists in rehabilitative exercise.”

Schmitz, a member of Penn’s Abramson Cancer Center, said previous studies to determine the prevalence of post-treatment complications typically examined only one issue. The new findings provide a full snapshot of the complications women may experience following chemotherapy, surgery, radiation treatment and hormonal therapy.

The results revealed these problems rarely exist in isolation. For example, many women with lymphedema also may struggle with fatigue and bone-health challenges.

Schmitz collaborated with an Australian research team to follow 287 Australian women with invasive, unilateral breast cancer for a median of 6.6 years, prospectively assessing the women for treatment-related physical and functional complications at set points throughout the study. Areas of study included post-surgical complications, skin reactions to radiation therapy, upper-body symptoms and functional limitations, lymphedema, weight gain and fatigue.

At six years after diagnosis, 60% of the women continued to experience one of the problems, and 30% were struggling with at least two issues. Most of the problems appeared within the first year of assessment, with the prevalence of most impairments — except lymphedema and weight gain — decreasing over the course of the study.

Writing in the lead editorial of a special issue of the journal Cancer, Schmitz and her colleagues outlined the myriad barriers that lie in the way of properly monitoring breast cancer survivors for the problems uncovered in the new study. Patients may have fragmented care, receiving different prongs of their treatment at different hospitals; patients and providers may believe certain problems are “expected” and “normal” and not appropriate for treatment; and, unlike orthopedists and cardiologists who frequently send patients for physical rehabilitation to ensure their complete recovery, oncologists and surgeons are often poorly linked to physical therapy professionals, limiting the number of patients who are aware of or referred for these services.

In the face of these challenges, an expert panel laid out a model for prospectively surveying breast cancer survivors and formally incorporating rehabilitation and exercise experts into cancer survivorship programs. Research increasingly shows that post-treatment complications can be minimized or prevented altogether when caught early and addressed through various rehabilitation regimens.

The American College of Surgeons Commission on Cancer has published guidelines that will require all accredited cancer treatment centers to provide treatment summaries and survivorship health care plans to all patients by 2015. The proposed surveillance and rehabilitation model could serve as a framework for meeting those pending guidelines, the researchers said.

“In the meantime,” Schmitz said, “breast cancer survivors should be empowered to ask their doctor for a referral to physical therapy and exercise programs.”

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