Introduction
Breast cancer is a tumor that affects lobules and milk ducts, which form part of the breast tissue. Depending on the site of occurrence, breast cancer can form ductal carcinomas and lobular carcinomas if they occur in the ducts and lobules of the breast, respectively. Breast cancer is prevalent among women, and it is the major cause of death in the United States. The prevalence rates and epidemiology of breast cancer indicate that it is a challenging disease, which the health care systems across the world are struggling to diagnose, treat, manage, and prevent. According to Lin and Pan (2012), “breast cancer is the most common malignancy in women, with approximately 1.38 million new patients, and 459,000 deaths per year worldwide,” (p. 1). The malignancy and treatment of breast cancer disable patients, as it causes great pain, shoulder dysfunction, lymphedema, hormone disorder, neuropathy, and psychological disorders. To enhance understanding of breast cancer, this paper assesses a literature review to determine treatment and rehabilitation options, performs a functional assessment, and establishes residual functional capacity of patients.
Literature Review
Breast cancer is dominant cancer among women, and it contributes to the high mortality rates. The health care system utilizes chemotherapy, radiotherapy, and surgery in the treatment of breast cancer. Since breast cancer has disabling effects, it requires effective treatment and rehabilitative interventions. According to Silver (2007), pain-relieving, fatigue reduction, physical exercise, and psychotherapy are some of the rehabilitation methods applicable to the management of cancer. However, a few numbers of patients usually undergo the process of rehabilitation; hence, increasing their risk of disabling effects of cancer (Lin, & Pan, 2012). Therefore, many women are grappling with the impacts of breast cancer and the adverse effects of therapies.
Breast cancer and treatment methods have significant effects on the health of patients. Studies show that breast cancer and its treatment methods cause motor, sensory, cognitive, emotional/behavioral, and adaptive dysfunctions (Perry, Kowalski, & Chang, 2007). Motor and sensory dysfunctions occur due to chronic pain that has a paralyzing effect. Chemotherapy and radiotherapy cause fatigue and increase physical disability among patients with breast cancer. In the emotional/behavioral aspect, breast cancer and its treatment reduce libido, thus causing sexual dysfunction (Melisko, Goldman, & Rugo, 2010). Functional analysis shows that breast cancer and its treatment methods have significant disabling effects that require effective treatment and rehabilitative interventions.
Treatment and Rehabilitation Options
Depending on the nature and stage of breast cancer, surgery, chemotherapy, and radiotherapy are available treatment options. Surgery involves the excision of the benign or malignant cells that are present in the breast. If surgery entails the excision of benign cells, the patient experience minimal disability. However, cases of malignancy always lead to mastectomy, which involves complete removal of the whole breast. Usually, patients who undergo mastectomy require breast reconstruction to replace their breasts. The use of chemotherapy and reconstruction procedure determines the disabling nature of mastectomy. Chemotherapy is an effective treatment that therapists apply in both long-term and short-term treatment of breast cancer.
It entails the destruction of cancerous cells using drugs, hormones, and antibodies (Silver, 2007). Chemotherapy is applicable in reducing the growth of cancer and preventing breast cancer cells from metastasizing into other tissues in the body. Radiotherapy is also an effective therapy that aids in the destruction of cancerous cells after surgery. A combination of surgery, chemotherapy, and radiotherapy provides enhanced treatment of breast cancer.
Breast cancer malignancy and treatment cause great disability, which influences the ability of patients to perform their daily activities. One of the rehabilitation options for people with breast cancer is physical therapy. Physiotherapy enhances the treatment of breast cancer because it promotes the normal functioning of the physiological processes in the body. “Physical and occupational therapy can help increase shoulder range of motion, promote upper extremity strengths, decrease pain, and reduce swelling” (Silver, 2007, p. 529). Hence, physical therapy has cascading effects that aid in the treatment and management of disabilities associated with breast cancer. Relieving pain is another method of rehabilitating patients with breast cancer. The malignancy and adverse effects of treatment cause great pain, which has disabling effects on the patients. Silver (2007) states that acupuncture, massage, analgesics, and occupational therapy are some of the ways that patients can use in relieving pain. With reduced pain, patients are able to perform their duties without undue interference by breast cancer.
Reducing fatigue is a rehabilitation option that people with breast cancer can use in overcoming disabling effects of breast cancer. “Studies examining the prevalence of fatigue among breast cancer patients have found that up 99% experience some level of fatigue during the course of radiation and/or chemotherapy” (Bower, Ganz, Desmond, Rowland, Meyetrowitz, & Belin, 2011, p. 743). Moreover, patients experience higher fatigue than healthy individuals do. This means that breast cancer and treatment method determine the extent of fatigue that individual experiences. Since fatigue occurs due to physical or emotional impacts of breast cancer, exercise, pain-relieving, and psychotherapy can help in reducing its impact.
Functional Assessment
Breast cancer and treatment have some disabling effects on patients. The functional assessment indicates that breast cancer affects motor functions, sensory functions, emotional/behavioral functions, cognitive functions, and adaptive functions of patients. Breast cancer and its treatment have significant impacts on the ability of patients to function effectively because they cause chronic pain, shoulder dysfunction, hormone disorder, psychological problems, and neuropathy (Lin, & Pan, 2012, p. 1). Each of these impacts has disabling effects on patients. Pain associated with breast cancer is chronic and emanates from the malignancy of cancer and adverse impacts of therapies such as chemotherapy, radiotherapy, and surgery.
According to Silver (2007), pain causes musculoskeletal disorders such as arthritis, cellulitis, edema, neuroma, brachial plexopathy, deep vein thrombosis, epicondylitis, and tendinitis, amongst other complications that contribute to physical disability. Additionally, breast cancer causes shoulder dysfunction, which prevents patients from lifting objects or performing heavy tasks using their hands. Thus, chronic pain and shoulder dysfunctions comprise a motor and sensory dysfunctions that patients of breast cancer exhibit.
Breast cancer also causes hormonal imbalance among patients and leads to serious emotional/behavioral dysfunctions. A combination of radiotherapy, surgery, and chemotherapy causes hormonal imbalance and consequent sexual dysfunction. “Sexual issues identified in breast cancer survivors include changes in body image associated with the loss of a breast or weight gain, decreased libido, vaginal dryness, and dyspareunia, difficulty with arousal and orgasm, and concern over fertility” (Melisko, Goldman, & Rugo, 2010, p. 248). Thus, sexual dysfunction is an emotional/behavioral dysfunction, which contributes to sexual disorders that patients with breast cancer are struggling to overcome.
In the aspect of cognitive function, breast cancer causes depression. According to Perry, Kowalski, and Chang (2007), breast cancer causes psychosocial distress, which affects cognitive functions and results in depression. Breast cancer threatens patients and causes a lot of anxiety because it leads to loss of breast and eventually death in some instances. However, despite enduring numerous disabling effects of breast cancer, patients exhibit adaptive functions such as adhering to therapeutic and rehabilitative interventions and thus improving their quality of life.
Residual Functional Capacity and Job Options
Since breast cancer affects sensory and motor functions, patients with breast cancer can perform light duties and walk short distances. Patients with breast cancer are unable to perform heavy duties and walk long distances because they experience fatigue. “There is growing evidence to suggest that fatigue may persist for months or even years after completion of breast cancer treatment, particularly among patients who have received adjuvant chemotherapy” (Bower, Ganz, Desmond, Rowland, Meyetrowitz, & Belin, 2011, p. 743). This shows that adjuvant therapy is responsible for fatigue that breast cancer patients experience during therapy and even years after the therapy. Moreover, sexual dysfunction due to loss of libido is a long-term effect of breast cancer. After undergoing therapy, some patients usually lose their sexual ability. Concerning cognitive and adaptive functions, patients with breast cancer portray normal cognitive abilities and adaptive functions. Hence, breast cancer and treatment have no significant impact on the cognitive and adaptive capacities of patients.
Conclusion
Breast cancer is a tumor that is dominant among women. Chemotherapy, radiotherapy, and surgery are common treatment options for breast cancer. Additionally, rehabilitation options for breast cancer are pain-relieving, reduction of fatigue, exercise, and psychotherapy. Analysis of functional assessment and residual functional capacity indicates that breast cancer affects motor, sensory, cognitive, emotional/behavioral, and adaptive functions of patients.
References
Bower, J., Ganz, P., Desmond, K., Rowland, J., Meyetrowitz, B., & Belin, T. (2011).
Fatigue in breast cancer survivors: Occurrence, correlates, and impact on quality of life. Journal of Oncology, 18(4), 743-753.
Lin, Y., & Pan, P. (2012). The use of rehabilitation among patients with breast cancer: A retrospective longitudinal cohort study. Health Services Research, 12(282), 1-7.
Melisko, M., Goldman, M., & Rugo, H. (2010). Amelioration of sexual adverse affects in early breast cancer patient. Journal of Cancer Survival, 4(3), 247-255.
Perry, S., Kowalski, T., & Chang, C. (2007). Quality of life assessment in women with breast cancer: Benefits, acceptability, and utilization. Health and Quality of Life Outcomes, 5(24), 1-14.
Silver, J. (2007). Rehabilitation in women with breast cancer. Physical Medicine and Rehabilitation Clinics of North America, 18(3), 521-537.