Pilot Study Hopes to Treat Possible Effects of Breast Cancer Treatment

October 2012

Made possible by funding support from the Avon Foundation, the pilot study "Clinical feasibility of the prospective surveillance model for rehabilitation for women with breast cancer" aims to promote monitoring for breast cancer related physical impairments during and after treatment. The design of the study was led by PI Sheryl Gabram, MD, director of the AVON Comprehensive Breast Center, Grady Health System; surgeon-in-chief at Grady Memorial Hospital; and a surgical oncologist of the Department of Surgery, Emory University School of Medicine. Jill Binkley, PT, executive director of TurningPoint Women's Healthcare, a not-for-profit women's rehabilitation center based in Atlanta, and Winifred Thompson, PhD, from the Rollins School of Public Health, worked with Dr. Gabram on structuring the study and will be collaborating with her throughout.

"The current model of medical care for women with breast cancer focuses on treatment of the disease, followed by intermittent surveillance to detect recurrence and any other problems patients report," says Dr. Gabram. "While these are extremely critical, most women may have subtle physical impairments as a result of their breast cancer treatment that impact function and quality of life.”

The Prospective Surveillance Model (PSM) is the first instance of a dedicated plan for breast cancer patients that guides functional rehabilitation, identifies an individualized rehabilitation prescription, and encourages healthy behaviors during and after cancer treatment. The PSM promotes close monitoring of such common breast cancer-related conditions as shoulder problems, fatigue, weight gain, weakness, lymphedema, and osteoporosis. Ideally, the model will establish a standard practice of early detection of breast cancer treatment impairments through periodic examinations and therapies both during and after cancer treatment, leading to rehabilitative and exercise programs when problems are identified.

"Our research suggests that if feasible, a pre-operative assessment followed by an early postoperative reassessment visit should take place 1-2 weeks after surgery, and upper-extremity range-of-motion exercises should be initiated within the first month after surgery," says Dr. Gabram. "Being among the first centers to implement this innovative model affords an opportunity to study the true incidence of treatment-related impairments, the feasibility and logistics of implementation, its associated costs, and the degree of patient benefit derived. We plan to open the study in November 2012 at the Avon Comprehensive Breast Center at Grady, the Winship Cancer Institute of Emory University, and at TurningPoint, giving us the opportunity to compare the implementation across different practice sites so the data can be extrapolated, published, and referred to for others to examine and apply."