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PRIMARY PREVENTION AFTER BREAST CANCER TREATMENT. PRIMARY PREVENTION PROTOCOL
M. CESTARI, S. AMATI, F. APPETECCHI, L. CURTI, C. DE REBOTTI
O.U. Territorial Rehabilitation Domus Gratiae Center - NHS Umbria2 - Terni, Italy
Introduction: The authors have decided to focus the attention on patients who underwent oncological breast surgery, without clinical evidence of oedema, and have planned a preventive protocol, in experimental phase, which highlights the importance of primary prevention in order to avoid lymphoedema onset.
Materials and Methods: The preventive protocol is organized in 3 steps:
1. Oncologists of DH-NHS Umbria2-Terni and DH-S. Maria Hospital-Terni send patients to O.U. Territorial Rehabilitation Centre-NHS
Umbria2-Terni for evaluation.
2. A lymphologist and a physiotherapist evaluate patients: a centimetrical measurement of compared arms, a clinical examination, a lymphoscintigraphy request and a shoulder functionality evaluation.
3. Patients are divided into 4 groups after the start up of a rehabilitative project:
– Informative Group: includes a lymphologist, a physiotherapist and all patients; the end-point is the information on behavioural
rules and listening to the patients’problems.
– Individual Lymphological Early Treatment: includes patients with lymphoscintigraphy slower radiotracer flow and the treatment
of problems related to surgery.
– Individual Rehabilitation Treatment: includes patients with limited shoulder functionality who undergo specific treatment after
physiatrical assessment.
– Physical Activity Group: includes patients without or with mild limited shoulder functionality (gymnastics, breathing exercises,
relaxation technique, music-therapy, listening to their problems).
All patients evaluated are included in a follow-up.
This preventive protocol was applied in 83 patients: Informative Group all patients, Individual Lymphological Early Treatment 20 patients (then included in a Physical Activity Group), Individual Rehabilitation Treatment 8 patients (then included in a Physical Activity Group) and Physical Activity Group 55 patients (included at once).
Results: The preventive protocol highlights the awareness of patients about the possibility of preventing lymphoedema onset (only 1 patient experienced lymphoedema onset after exertion), the complete recovery of shoulder functionality, when present, and the usefulness of Physical Activity Group in order to achieve a physical and psychological well-being.
Conclusions: The preventive protocol, in experimental phase, highlights the importance of primary prevention as well as the role of a multidisciplinary team. All patients showed appreciation for the organized Groups and for the early and holistic approach of the team.
THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXVI - Nr. 72 - 2015
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