**8. Conclusion and future perspective**

**6.9. Lymphedema associated with breast cancer treatment**

30 Cancer Survivorship

About 40% women breast survivors face a very higher risk of developing lymphedema [1, 3, 86]. Breast cancer related lymphedema results from obstruction of the lymphatic system due to removal of lymph nodes and tissue damages caused by radiotherapy [87]. Survivors personal habits like obesity and overweight can increase the chances of lymphedema [88]. Lymphedema has associated psychosocial problems that hamper day to day lives of breast cancer survivors [89]. Infections can trigger and worsen and the symptoms of lymphedema, so it is important to have good personal hygiene in order to reduce the risk of infection [3]. All patients in which lymphedema has developed should be referred to a physical or occupational therapist or to lymphedema specialists [3]. Management of lymphedema remains a major challenge for patients and health care professionals [3]. Routine check-ups for lymphedema management, physical therapy, use of bandages, special lotions and frequent infections creates a huge financial burden not only to breast cancer survivors but also to the health care system [86]. Breast cancer-related lymphedema can occur in shoulders, breast, and thoracic area [86]. Treatments include pharmacological therapy and adjuvant therapies [3, 86]. Drugs included in the pharmacological management of lymphedema are benzopyrones, flavonoids, diuretics, hyaluronidase and selenium [86]. Surgical treatment for lymphedema in breast cancer survivors included lympholymphatic anastomoses, debulking and liposuction [3, 86]. Chronic lymphedema in breast cancer survivors sometimes lead to formation of excess subcutaneous adipose tissue which can be removed by liposuction [86]. Liposuction increases the blood flow in skin capillaries without damaging already compromised lymph transport capacity in breast cancer survivors with lymphedema [1, 3, 86].

**7. Strategies to improve breast cancer survivorship symptom care**

There has undoubtedly been a call from all over the globe to stress on the importance of largely on cancer survivorship and care. In recent past, first cancer survivorship symposium was held by ASCO, and highlights the crucial issues faced by cancer survivors and patients with numerous cancers following treatment. Survivorship care strategies are recommended as crucial tool to assist communication and distribution of responsibility during the course of transition from active therapeutics to survivorship care. This care plan directs recommendations for the type and timing of follow-up imaging, laboratory tests, and other office visits. In addition cancer survival plan should incorporate necessary information regarding the deleterious effects of chemotherapy and what to watch for specifically based on the type of cancer and treatment received. Ideally, the oncology team should also work with the patient to develop an individualized cancer survivorship care plan for breast cancer survivors. A brief outline of a patient's diagnosis and treatment received should be presented by the oncologist team when a patient with breast cancer transitions care to other providers; a treatment outline should explain the type and stage/side of the cancer, type of surgery, the name of the chemotherapy/hormones/biologics and collective doses of chemotherapy, and the types and collective doses of radiation therapy, together with the fields and extent of the radiation. However, the field of oncology in context with cancer survivorship and care plan is mostly struggling with how to excellently meet this recommendation and in categorize the

**7.1. Survivorship care plan**

Despite the increasing number and longevity of breast cancer survivors the symptomology associated to therapeutics can be burdensome, multifaceted and long lasting and usually undertreated. Recent data suggest that management symptomology of these survivors could improvement of QoL, while evidence about its ability to reduce healthcare utilization is scarce. Cancer survivorship programmes help breast cancer survivors organize and remember their appointments. Communication and cooperation among providers and survivors are critical in the management and survivorship of breast cancer patients after treatment. Oncology teams all are working to develop a cancer survivorship care plan for breast cancer survivors. This care plan should guide survivors about the future laboratory tests, cardiovascular diseases, musculoskeletal issues, psychosocial issues, and other issues from which they usually suffer after treatment. The care plan should include information on the risk for late effects of treatment. To summarize, cancer survivorship care is need of a hour to allow better care for a larger number of breast cancer survivors in a financially sustainable manner.
