Background: Breast cancer related lymphedema (BCRL) is a progressive, morbid, and incurable disease with an incidence rate of 6-47%. (Soran 2016) Early detection models have been discussed since 2013, but very few (if any programs) existed at this time. Early detection of BCRL correlates to less physical limitation, joint pain, medical costs, and improved quality of life. (Lacomba 2010, Soran 2016, Soran 2014) Early detection includes a pre-operative assessment to obtain baseline data/measurements, followed by post-operative follow up assessments at frequent intervals. The program at the Stefanie Spielman Comprehensive Breast Center is focused on a comprehensive prehabiltiation model that includes a functional assessment, as well as lymphedema surveillance. Methods: The prehabiliation model of care at The Stefanie Spielaman Comprehensive Breast Center was initiated in January 2018. This model includes a comprehensive physical therapy evaluation; assessing shoulder range of motion, posture, girth measures with a tape measure and bioimpedance spectroscopy. The patients are referred from their surgical oncologist before surgery and after surgery. Patients are followed for lymphedema surveillance for the first two years following surgery at set time intervals. The main goals of this prehabilitation program are to detect and treat early subclinical lymphedema, promote the full return of function, and proactively identify potential functional side effects of breast cancer treatment such as radiation fibrosis and fatigue. Results: The data will demonstrate an increase in percentage of pre-operative assessments since the implementation of this program in January 2018. In addition, the data will demonstrate the increased opportunity to treat subclinical lymphedema, improving the quality of care delivered to these patients. Conclusion: Early post-surgical physical therapy intervention has been supported in the literature, as well as in clinical practice. (Petito 2014) However, this prehabilitaiton model of care provides a proactive pre-surgical approach to care for patients with breast cancer that focuses not only on lymphedema surveillance but functional recovery as well.
QIM20-126: Prehabilitation Model of Care for the Patient with Breast Cancer
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