**3. Management strategies for breast cancer**

Despite the prolonged survival and improved lifespan, there are a few manifestations that breast cancer survivors' physical utility might diminish more rapidly than that of their peers. These survivors might facilitate from an approach that is frequently applied in the aging population [34]. First, survivors encounters several, congregate and chronic features. Second, survivors display psychological, physical, and behavioral variations that may hamper their efficient status and lead to dependence and impairment, as revealed by higher fall risk, reduced physical exercise and distinguishes limitations in both basic and highly developed activities of daily living [3]. Thus, a subset of characteristic breast cancer survivors set to benefit from a management approach that is regularly applied in the elderly medicine situations, one that is: multidisciplinary (e.g., behavioral and physical factors); multifactorial (i.e., one intervention targets multiple symptoms simultaneously); augmented use of nonpharmacological treatment intervention options; and setting therapeutic goals (i.e., recognizing that complete resolution may not be achieved, but improvement is likely) [35] (**Table 1**). Various pharmacological and nonpharmacological interventions are used for the therapeutics of breast cancer as well as post therapeutics are shown in **Figure 1**. In a below section, we will demonstrate this concept by stressing basic measurement and management principles that apply evenly across numerous frequently observed physical and emotional features in breast cancer survivors, such as adjustment disorder, cognitive dysfunction, or other vasomotor symptoms, psychosocial distress, and fatigue and insomnia.

growing in number with increase in cost for their well-being, follow up and other medical care facilities [29]. The role of primary care providers is increasingly being taken up for follow-up care and same should be maintained as we have limited secondary care facilities [30]. There should be a systematic registry and data maintenance that follow up is being done and breast cancer survivors are effectively treated in primary care [3]. There is a short and long term side effect on health of breast cancer survivors including physical, emotional, sexual and social consequences such as pain, depression, fatigue, weakness [31]. The loss of confidence in leading a normal life is one of the increasing factors which is treated by primary care system and are involved more as compared to control patients [32]. It is important that PCPs should provide good and maximum care to cancer survivors and need of patient's should be satisfied. PCPs prefer to guide on disease recurrence and risk management involved in cancer treatment and survival of patient [32]. The evidence based recommendations are provided to PCPs for cancer survivors and are available for clinical practice guidelines [32]. Most of the recommendation is available on how recurrences occurs in a breast cancer patient and are concerned with diagnosis [3, 33]. Mammography has been recommended to breast cancer patients on follow-up in five guidelines and physical examination of breast in three of them [3, 33]. Ultrasound is recommended in one of the guideline while undergoing mammography [33]. All these guidelines advise genetic counseling for risk factors and patients are educated enough to know about signs and symptoms of recurrence or any other underlying cause and sign, how to resolve it and

Despite the prolonged survival and improved lifespan, there are a few manifestations that breast cancer survivors' physical utility might diminish more rapidly than that of their peers. These survivors might facilitate from an approach that is frequently applied in the aging population [34]. First, survivors encounters several, congregate and chronic features. Second, survivors display psychological, physical, and behavioral variations that may hamper their efficient status and lead to dependence and impairment, as revealed by higher fall risk, reduced physical exercise and distinguishes limitations in both basic and highly developed activities of daily living [3]. Thus, a subset of characteristic breast cancer survivors set to benefit from a management approach that is regularly applied in the elderly medicine situations, one that is: multidisciplinary (e.g., behavioral and physical factors); multifactorial (i.e., one intervention targets multiple symptoms simultaneously); augmented use of nonpharmacological treatment intervention options; and setting therapeutic goals (i.e., recognizing that complete resolution may not be achieved, but improvement is likely) [35] (**Table 1**). Various pharmacological and nonpharmacological interventions are used for the therapeutics of breast cancer as well as post therapeutics are shown in **Figure 1**. In a below section, we will demonstrate this concept by stressing basic measurement and management principles that apply evenly across numerous frequently

inform your medical advisor [3, 33].

20 Cancer Survivorship

**3. Management strategies for breast cancer**


**Table 1.** Long term and short term short comings of breast cancer therapeutic interventions.

lymph node biopsy, there is no requirement of axillary lymph node dissection (ALND) [39]. This in turn reduces the risk of lymphedema and other complications such as nerve injury and mus-

Breast Cancer: Management and Survivorship http://dx.doi.org/10.5772/intechopen.82297 23

Some patients with early breast cancer relapse with stage IV breast cancer even after surgery, reason may be the presence of micrometastatic disease present before the surgery [2]. For this reason in breast cancer patients adjuvant systemic therapy are used to halt the process of cancer recurrence [2]. It has been shown and proved by several trials that 6 months anthracycline therapy following surgical treatment of cancer results in about 40% reduction in mortality rates from breast cancer in women below age of 50 years and 20% reduction in between 56 and 69 age group [2, 41]. Further analysis showed that the addition of taxane based chemotherapy

At least 18–20% of breast cancer patients tumor cells overexpress HER-2 proteins [42]. In these patients trastuzumab (monoclonal antibody) is given as an adjuvant therapy [2, 42]. Full course of 52 treatments are given to woman with breast cancer [42]. Trastuzumab is well tolerated at therapeutic doses but may result in cardiac toxicity in patients initially given anthracycline regimen or in patients having baseline cardiac problem [43]. Left ventricular dysfunction and heart failure is reported in some patients by administration of trastuzumab [42]. All breast cancer patients should have scheduled cardiac monitoring before and during

The majority of breast cancers are estrogen receptor (ER) positive [2, 42]. In those women with ER positive breast cancer, adjuvant endocrine therapy is routinely offered [2, 42]. The addition of endocrine therapy following either adjuvant chemotherapy or radiotherapy confers a further reduction in mortality rates [2, 42]. Tamoxifen is the mainstay of endocrine treatment in premenopausal woman [2, 42]. In post-menopausal woman aromatase inhibitors are the

A thorough approach to evaluate the symptom management is to investigate in detail whether symptoms can be accredited to cancer and associated therapeutics and other procedures

cular problems, associated with the axillary lymph node dissection surgery [40].

to anthracycline based regimen reduced mortality rate by further 15% [2, 41].

**5.3. Adjuvant endocrine therapy and breast cancer management**

**5. Pharmacological interventions**

**5.1. Adjuvant chemotherapy for breast cancer management**

**5.2. Adjuvant trastuzumab monoclonal antibody**

**6. Non-pharmacological interventions**

**6.1. Psychophysiological symptoms**

administration of therapy [2, 42].

agents of choice [2, 42].

**Figure 1.** Different therapeutic targets in breast cancer treatment explain role of each new agent, its benefit to survivors.
