Breast Cancer Thriver  Patient centered Program to promote optimal function during breast cancer survivorship Bridget McLemore Director Rehabilitation Services Christina Morrissey Breast Cancer Survivor CONTRIBUTORS: Janet Benedict Physical Therapist, Certified Lymphedema Therapist Diane Bullock Physical Therapy Assistant, Certified Lymphedema Therapist GOAL: To establish a prospective surveillance program for early identification and treatment of physical impairments and functional limitations that commonly occur following breast cancer treatment in order to broaden the spectrum of the traditional model of treatment to encompass wellness during survivorship. THE RESULTS: ADD TOTAL # of study participants A total of 40% of the patients were found to have impairments and limitations that were treatable by physical therapy intervention 26 ( %) identified during the screening process 5 ( %) self- identified deficits due to the education received during their screening sessions Under the traditional model of treatment for breast cancer these 31 patients may not have been identified as needing skilled rehabilitation intervention or there may have been delayed intervention. The therapy services that they received enabled them to correct and minimize any functional limitations that were identified so that they did not negatively impact their overall wellness. By identifying and initiating treatment early we are also able to stop any negative sequalae events that may have occurred if these limitations had persisted. Continuing as a fully funded program supported by Elmhurst Memorial Hospital Board and Foundation HOPE LIVES HERE CHRISTINA’S STORY: I was cruising through life…had just turned 40… began running for the first time ever and was actually enjoying it  when I heard those dreaded words, “You have cancer”. My world spun out of control. It was a whirlwind…13 days from the day of my diagnosis, I underwent a bilateral mastectomy with the beginnings of reconstructive surgery. I am one of the lucky ones…stage 1 with no lymph node involvement. I didn’t have to withstand chemo or radiation and I was young and strong so I knew I would get through this. I approached cancer just like everything else in my life…with unwavering resolve and determination and a whole lot of Faith. After surgery, reality hit. I could barely lift my arms (my 2 daughters ages 8 and 10 would offer to do my hair for me) and my left arm, the side where lymph nodes were removed, was tingling constantly with a numb left hand. I thought this was normal…after all I just had major surgery. But luckily, my reconstructive surgeon directed me to Janet. It was Janet that educated me on Lymphedema. I also had a strange phenomenon called “webbing” in my armpit that prevented me from lifting my arms. Through a few sessions of massage and much education, all my symptoms have resolved. I now know the warning signs of lymphedema and if I am not able to see results with the massage techniques that Janet has given me for my home program, then a therapy session or 2 with Janet does it. It is so important to catch lymphedema before it is a problem. Unfortunately though, many breast cancer patients are not educated pre- operatively on the warning signs of lymphedema. Most women, like me, can’t discriminate between normal and abnormal post-op swelling. The symptoms of lymphedema are gut-wrenching both from a physical and psychological standpoint. I learned from Janet that insurance often times will not cover lymphedema treatment. “Why not?” I asked. Wouldn’t it be in the best interest of the patient to catch it early before it becomes a debilitating condition? I am honored to be a part of Elmhurst Memorial Hospital’s free lymphedema screening program. In partnership with the EMH Foundation, EVERY woman diagnosed with breast cancer at EMH receives a pre-operative exam to attain baseline measurements and education on how to prevent lymphedema. This is what healthcare should be about….not just treating patients when they are sick, but preventing them from even getting to that point. Because as well all know…it is not just about surviving, but thriving. Gratefully, Christina Morrissey Breast Cancer Thriver  BREAST CANCER PATIENTS: Often experience life style altering deficits from breast cancer-related treatments. 6 years after diagnosis, more than 60% of women experienced 1 or more side effects amendable to rehabilitation interventions. Deficits may include sensory or motor symptoms and impairments such as pain, weakness, tightness, poor range of motion, nerve palsies, or swelling. Earlier intervention and treatment can improve their level of function, with hopes to returning patients to their prior level of function sooner. Surveillance of breast cancer patients by rehabilitation reduces the overall costs of treatment (costs to the patients, insurance, and the hospital) by earlier identification of lymphedema or other physical deficits. Earlier intervention for those identified with these deficits will assist with facilitating early treatment intervention, therefore, improving their level of function, with hopes to returning them to their prior level of function sooner. FINANCIAL CONSIDERATIONS: Approximate cost to the facility per patient: $180 Downstream revenue as a result of the evaluation and treatments provided to those identified as needing skilled rehabilitation intervention offsets the costs to provide this service. REFERENCES: Cancer Facts and Figures 2014 Hayes et al. Upper-Body Morbidity After Breast Cancer. CANCER Apr 15, 2012 Schmitz et al. Prevalence of Breast Cancer Treatment Sequelae Over 6 Years of Follow-up. CANCER Apr 15, 2012 Scaffidi et el. Early Rehabilitation Reduces the Onset of Complications in the Upper Limb following Breast Cancer Surgery. EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE. Vol 48, No. 4 December 2012. Stout et al. A Prospective Surveillance Model for Rehabilitation for Women with Breast Cancer. CANCER Apr 15, 2012 Schmitz et al. Prospective Evaluation of Physical Rehabilitation Needs in Breast Cancer Survivors. CANCER Apr 15, 2012 Cheville et al. Cost Considerations Regarding the Prospective Surveillance Model for Breast Cancer Survivors. CANCER Apr 15, 2012 Funding for the study: The ream foundation ELMHURST MEMORIAL HOSPITAL REHABILITATION’S RESEARCH: A Prospective Surveillance Study to promote optimal function during breast cancer survivorship THE PROGRAM: Three screening sessions, starting prior to surgical intervention and ending 3 months post operatively. The first visit establishes baseline measurements for the patient in the areas of arm range of motion, strength and volume, grip strength, posture, pain and cording. The same measurements are reassessed at the next two visits post-operatively at 4 weeks and 3 months to see if there have been any changes. If any changes are identified they are communicated to the physician with the recommendation for skilled physical therapy intervention. www.eehealth.org