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R. Farah1,2, W. Groot1, M. pavlova1
1Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Department of Health Services Research, CAPHRI, Maastricht, Netherlands, 2Bellevue Medical Center, Rehabilitation & Physical Therapy, Mansourieh El Metn, Lebanon
Background: Undergoing a mastectomy has many significant physical and emotional consequences. Cancer Rehabilitation (CR) programs aim to improve cardiopulmonary function, reduce fatigue, manage lymphedema (swallowing) and increase well-being of cancer survivors. CR empowers patients.
Purpose: CR is not routinely prescribed post mastectomy and above all not present in developing countries. In the current case study, the patient, residing in Lebanon, underwent a right total mastectomy in 2013 and received radiation therapy. Following her cancer treatment, the patient was not advised to start rehabilitation program and to perform any physical exercises post mastectomy. The patient became sedentary and living with right upper limb (UL) lymphedema, pain, fatigue and less quality of life for 6 years.
Methods: In June 2019, the patient participated in a CR program for 2 months. The aim of this tailor-made treatment was first to manage the swallowing of the right UL by a specialist trained and based on Leduc methods. The second part of the treatment was to participate in a Home-Based Rehabilitation program prescribed at the hospital with support offered on a weekly based via electronic mail to increase cardiopulmonary and muscular functions, and to decrease fatigue. An assessment was done before CR program and after 2 months. Increasing the quality of life and wellbeing of the patient were checked by the SF-8TM and furthermore by a qualitative interview which was recorded and transcribed.
Results: Results showed a total reduction of the chronic lymphedema in 2 weeks treatment confirmed by perimetry. In addition, a 2-month reassessment showed that the patient increased her global muscular strength and triple her muscular force of the right UL. Likewise, cardiopulmonary fitness improved: VO2max which increases of 3.5ml/min/kg. 6MWD increases of 100 meters more (640m). Qualitative semi-structured interview and piper scale shows that the cancer-related fatigue was attenuated, and patient gain a better healthy lifestyle confirmed by SF-8TM survey.
Conclusion(s): CR appears to promote quality of life. Health professionals need to work together to increase quality of care and promoting lifestyle post mastectomy. Home-based rehabilitation needs to be developed for cancer survivors above all in Lebanon and in the Middle East.
Implications: This clinical case study might have implications for cancer rehabilitation research and might recommend the use of a rehabilitation program to treat the lymphedema. Education, awareness in this field are missing or even absent and are highly recommended for best practice. Primary healthcare providers like physicians need to refer the patient suffering from breast cancer at discharge to rehabilitation to give the best quality of care. New policies and procedures need to be implement in the country by the policy providers to have better equity in the access of healthcare and rehabilitation. According to our findings, we could say that quality of life of the patient increased, and her anxiety was reduced even after 5 years post mastectomy and we implemented a new rehabilitation program in the country.
Funding, acknowledgements: /
Keywords: breast cancer, cardiopulmonary rehabilitation, lymphedema
Topic: Education: clinical
Did this work require ethics approval? No
Institution: Bellevue Medical center
Committee: Bellevue Medical center
Reason: ethic approval was not required for a clinical case study
All authors, affiliations and abstracts have been published as submitted.
