Rehabilitation of Patients with Primary Breast Cancer: Assessing the Impact of Adjuvant Therapy

Abstract

During the past decade, the primary treatment of breast cancer has become increasingly complex owing to the use of radiation therapy as an alternative to mastectomy (Fisher et al. 1985; Veronesi et al. 1981) and the more extensive use of adjuvant chemotherapy and adjuvant hormonal therapy (Bonadonna and Valagussa 1987; Lippman 1986, Report from the Breast Cancer Trials Committee 1987). With these changes in primary therapy has come increased participation of the patient in treatment decisions, frequently intensifying the psychologic difficulties she must face (Holland and Rowland 1987; Sinsheimer and Holland 1987). Primary therapy is often protracted and no longer ends with the initial surgery, but continues for an additional 2–3 months if breast conservation therapy is used, with further extension of the period of initial treatment from months to years if adjuvant therapy is used. In addition, adjuvant therapy is now being extended to a larger segment of the population with breast cancer (e.g., treatment of node-negative patients) (Report from the Breast Cancer Trials Committee 1987; Bonadonna et al. 1986). Breast cancer patients currently face a wide range of physical, psychosocial, and economic problems as a consequence of these events.

Supported by grant no. CA 43461 from the National Institues of Health/National Cancer Institute.