Rebecca Crane-Okada, PhD, RN, CNS, AOCN: Neurosensory and Functional Recovery after Breast Cancer Surgery

Rebecca Crane-Okada, PhD, RN, CNS, AOCN
Asst. Professor, Division of Nursing Research and Education
Department of Population Sciences
City of Hope National Medical Center

The Group Room at the 2011 Oncology Nursing Society Research Conference is my possible, in part, by:

Selma R. Schimmel, Founder, Vital Options International

This is Selma Schimmel in Los Angeles at the Oncology Nursing Society, eleventh research conference,a nd we’re to continue on our discussion.  We are now joined by Rebecca Crane-Okada.

Rebecca Crane-Okada, PhD, RN, CNS, AOCN, City of Hope National Medical Center

Thank you.

Selma R. Schimmel:

How are you?

 

Rebecca Crane-Okada:

Good, thank you.

Selma R. Schimmel:

So, what is neurosensory and functional recover?  What does that mean?

Rebecca Crane-Okada:

Well, in technical medical terms we often call them parasthesias and complications as a result of breast cancer treatment.  Neurosensory, in the way I’m defining it and have studied it, is looking at patterns of numbness, tingling, strange sensations in the arm or the breast or the chest after surgery and radiation and chemotherapy and arm swelling as self-reported and measured, which we, by diagnostic terms, would call lymphedema.

Selma R. Schimmel:

Now, in your research it says that the study participants completed questionnaires about their upper arm use, symptoms in the arm, shoulder and chest or breast before surgery, I would imagine?

Rebecca Crane-Okada:

Correct.

Selma R. Schimmel, Founder:

That baseline information is extremely important.

Rebecca Crane-Okada:

It is.

Selma R. Schimmel:

What would be your approach with someone who is newly diagnosed and post-op if you were the one counseling the patient? …for the viewers listening now.

Rebecca Crane-Okada:

Well, I think a lot depends on the actual procedure they’re going to have done.  A woman who’s having breast conservation surgery with a sentinel node biopsy alone is much different from a woman who’s having a mastectomy with reconstruction, and so those instructions for self-care would need to be tailored to the procedure they’re going to have done.  I think it’s critical to do some type of an assessment, that would be my preference, before surgery and that would be an assessment of shoulder movement, finding out if the woman has or man has any limitations of movement and potentially getting a referral to physical or occupational therapy for evaluation before surgery so that any limitations could begin to be addressed before surgery.  After surgery, again, it depends on the practice.  In the practices I’ve worked with with surgeons, we tend to mobilize women earlier than later and there’s a lot of controversy about when to mobilize if one has a drainage tube after surgery.  But I would begin a simple movements in this range right after surgery and simple movements that involve flexibility of the elbow but don’t require full extension of the shoulder.  But the real experts at this are the physical and occupational therapists who see these patients and making sure that people get referrals for a program of rehabilitation after surgery.

Selma R. Schimmel:

Do you think it would be advisable mirroring what you’ve done in your own study with the analysis about evaluating a patient, their upper arm, their chest and breast area, all of that prior to surgery, would there be benefit?  Especially if someone has any kind of pre-existing issues that they share this information or have any kind of extra evaluation as far as their range of motion and mobility even prior to having surgery?

Rebecca Crane-Okada:

Absolutely.  Absolutely, I think people who have any pre-existing problems, if they’ve had shoulder problems with rotator cuff, carpel tunnel problems in their hands, previous trauma and they have any limitations, I think, seeing someone before surgery would be a very good preventative measure.

Selma R. Schimmel:

What are the discussions a woman needs to have with her doctor prior to going into surgery, the key questions she needs to ask prior to having a lymph node dissection?

Rebecca Crane-Okada:

Besides what are you going to do, how are you going to it, in terms of, “What are you removing? What do you expect the potential complications to be right after surgery or long term? And, should I have any problems, who will you be referring me to to help me in that recovery?” And then even before that I would say, “What can I do for myself to recover full function of my arm and shoulder after surgery? After radiation? During treatment?”

Selma R. Schimmel:

Let’s review the warning signs for a patient who is in recovery and begins to note whether she’s got the numbness or tingling or swelling or edema beginning to develop perhaps in her wrist or her hand.

Rebecca Crane-Okada:

I think the first thing I try to tell women and encourage them to do is if they have a new symptom, no matter what it is, to trust their gut and if they feel that it is something new or different for them, and even if they think it’s a silly question, go ahead and make that contact to their provider to find out if this is a normal response or it needs to be evaluated.  A lot of these evaluations cannot be done easily over the phone, the eyes need to see and sometimes we need to do some further physical assessment.  Any sign of swelling, a new onset of swelling should not be ignored and the sooner one gets in for treatment, if it is lymphedema, the sooner that can be stopped or reversed.

Selma R. Schimmel:

What is your ultimate goal with the research because as you gather more information all of this really does impact and can make the direction shift in standard of care?

Rebecca Crane-Okada:

Correct, and I think we were discussing in our recent panel just this morning that we need stronger standards and there are coming out new standards for lymphedema teaching, education of patients and care in referrals in breast centers.  And I would hope that one of the studies that needs to be done is looking at potential immune or inflammatory markers and lymphedema risk and different patterns.  We’re seeing that lymphedema sometimes is episodic and may or may not be related to the actual treatment, but it needs to be diagnosed and treated.  But we still don’t understand why some women or men develop lymphedema and some don’t.  And we don’t understand why some develop it early and some develop it later.  And we don’t understand yet why some… I had one patient who had it just right around the wrist, some develop it in the entire arm, some develop it very localized.  We still don’t understand any of that.

And until we have better evidence I think it just makes common sense to avoid unnecessary trauma.  And the evidence we’re getting now is going to help us understand, with exercise, what that means in terms of safety, repetitive movement, weight lifting, some of those things that we’ve been in the grey zone.

Selma R. Schimmel:

I appreciate what you’re doing because you’re also validating an area of medicine as it relates to breast cancer that may not seem as significant because it isn’t the core of what is life threatening but it really is the core of our ability to function and feel like we have the ability to use our bodies in the way we were meant to use them.

Rebecca Crane-Okada:

Absolutely.  Absolutely.

Selma R. Schimmel:

Thank you, Rebecca Crane-Okada.

Rebecca Crane-Okada:

My pleasure.  Thank you.

Selma R. Schimmel:

Pleasure back.

END OF VIDEO