Systematic Review of Functional Outcomes in Cancer Rehabilitation.

OBJECTIVE: To systematically review the evidence regarding rehabilitation interventions targeting optimal physical or cognitive function in adults with a history of cancer and describe the breadth of evidence as well as strengths and limitations across a range of functional domains. DATA SOURCES: PubMed, Cumulative Index to Nursing and Allied Health Plus, Scopus, Web of Science, and Embase. The time scope was January 2008 to April 2019. STUDY SELECTION: Prospective, controlled trials including single- and multiarm cohorts investigating rehabilitative interventions for cancer survivors at any point in the continuum of care were included, if studies included a primary functional outcome measure. Secondary data analyses and pilot/feasibility studies were excluded. Full-text review identified 362 studies for inclusion. DATA EXTRACTION: Extraction was performed by coauthor teams and quality and bias assessed using the American Academy of Neurology (AAN) Classification of Evidence Scheme (class I-IV). DATA SYNTHESIS: Studies for which the functional primary endpoint achieved significance were categorized into 9 functional areas foundational to cancer rehabilitation: (1) quality of life (109 studies), (2) activities of daily living (61 studies), (3) fatigue (59 studies), (4) functional mobility (55 studies), (5) exercise behavior (37 studies), (6) cognition (20 studies), (7) communication (10 studies), (8) sexual function (6 studies), and (9) return to work (5 studies). Most studies were categorized as class III in quality/bias. Averaging results found within each of the functional domains, 71% of studies reported statistically significant results after cancer rehabilitation intervention(s) for at least 1 functional outcome. CONCLUSIONS: These findings provide evidence supporting the efficacy of rehabilitative interventions for individuals with a cancer history. The findings should be balanced with the understanding that many studies had moderate risk of bias and/or limitations in study quality by AAN criteria. These results may provide a foundation for future work to establish clinical practice guidelines for rehabilitative interventions across cancer disease types.

Women's Rehabilitation Experiences Following Breast Cancer Surgery.

BACKGROUND: Breast cancer survivors represent 23% of the 15.5 million cancer survivors in the United States. Treatment-related morbidities such as adhesive capsulitis and lymphedema impact functional ability and quality of life. Postoperative exercises have been recommended for years. However, few studies exist that describe the postoperative rehabilitation experience of breast cancer survivors. PURPOSE: The purpose of the study was to examine the rehabilitation experiences of women following breast cancer surgery. METHODOLOGY: The study used a descriptive-correlational design. A convenience sample of 594 breast cancer survivors completed and returned a mailed questionnaire. FINDINGS: Results indicated that 61% reported that postoperative exercises were prescribed. Forty-eight percent reported performing the exercises as instructed. Performing exercises as instructed was significantly associated with increased functional ability (p < .0001). CONCLUSION: Breast cancer survivors who perform postoperative rehabilitation exercises as instructed may improve functional ability. CLINICAL IMPLICATION: Rehabilitation nurses can have an instrumental role in the postoperative rehabilitation care of this population.

Trastuzumab and doxorubicin-related cardiotoxicity and the cardioprotective role of exercise.

Women diagnosed with breast cancer typically undergo a multimodal approach to treating their disease. The treatments used often result in sequelae such as fatigue, hair loss, nausea and vomiting, and functional impairment. Many of these sequelae can be controlled or eliminated with pharmacological, physical, or social interventions. However, 2 effective cytotoxic agents, doxorubicin and trastuzumab, are associated with a potentially life-threatening sequela, cardiotoxicity. Currently, these agents are dosage and duration limited to circumvent cardiac damage. Exercise prior to and during the administration of these agents is emerging as a possible cardioprotective intervention based on the findings of animal model studies. Incorporating exercise into the breast cancer treatment trajectory may eliminate the dosage and duration restrictions of these antineoplastic agents and ultimately affect survival and quality of life. The authors present the pharmacological mechanism for each agent and the exciting results of animal model studies that lay the groundwork for future clinical trials.

Breast cancer and the role of exercise in women.

Cancer of the breast is a significant health problem for women from the time of diagnosis through the treatment and survivorship trajectory. The disease and treatments are an assault to a woman's body, resulting in sequelae that can be debilitating. Although women diagnosed with breast cancer are living longer, concerns about functional limitations, recurrence, and survival remain paramount. Physical activity and exercise are preventative and rehabilitative measures that can be employed at various points along the breast cancer trajectory. Current research supports the beneficial role that physical activity and exercise play in reducing the risk for developing breast cancer and preventing or attenuating disease and treatment-related impairments.

Evidence-based practice and the road to Magnet status.

Conducting research and using evidence-based practice play a major role in achieving Magnet status, the sought-after recognition awarded by the American Nurses Credentialing Center to healthcare institutions that exhibit nursing excellence. The authors present a synopsis of a conference sponsored by a Sigma Theta Tau International consortium in which a panel of nurse leaders distinguishes between research and evidence-based practice and discusses strategies to achieve both in the journey to Magnet status.

The prevention of disablement: A framework for the breast cancer trajectory.

More than 2 million women in the United States are breast cancer survivors. This is largely due to advances in early detection and treatment and is underscored by a survival rate of 88% at 5 years postdiagnosis for all stages of breast cancer. Although much progress has been made in combating the disease, women diagnosed with breast cancer endure multiple assaults to the body both from the disease and treatments. Surgical and adjuvant therapies are associated with complications and side effects that may lead to functional limitations, disability, and a poor quality of life. The Model of Disability and Disability Prevention provides a framework for addressing the challenges of the breast cancer trajectory. From pathology to disability, the model offers an approach to preventative and restorative interventions. Exercise is highlighted as an intervention that significantly affects the breast cancer experience at multiple points along the disablement continuum.

Sepsis and treatment-induced immunosuppression in the patient with cancer.

Treatment for cancer is frequently an assault to the immune system. The immunosuppression that results significantly increases the patient's risk for infection. In this patient population, infection can quickly progress to sepsis, septic shock, and death. A high index of suspicion during nursing assessments is a critical strategy in early identification of infections. In addition, judicious adherence to infection control measures, appropriate use of prophylactic agents, and immediate employment of broad-spectrum antibiotics that are empirically based are essential strategies to maximize the patient's likelihood for survival.