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ず4-9）（早期のリハビリテーション治療開始はこれら有害事象を増やす可能性がある），リンパ浮腫の発症リスクも増えることはなく，むしろ低下する（⇒p122）。引用文献 1） Springer BA, Levy E, McGarvey C, et al. Pre-operative assessment enables early diagnosis and recovery of このように，術後の包括的リハビリテーション治療は，術後経過にあわせてきめ細かく実施すれば，有害事象なく，上肢機能改善，上肢動作能力の改善が得られるため，行うことが強く勧められる。 ＊注1：ADLの評価は，一般的に機能的自立度評価法（Functional Independence Measure；FIM）を用いることが多いが，上肢機能評価にはより細かい評価項目が用いられる。例えば，表6-1は「ファスナーを上げる」「ブラジャーをつける」など，更衣の中でも女性に特有で，肩関節の可動域制限によって不自由になりやすい動作項目が含まれ，生活の中での不自由さをより詳細に評価できる。shoulder function in patients with breast cancer. Breast Cancer Res Treat. 2010; 120: 135-47. 2） 高橋將人．乳癌外科療法．臨放．2019; 64: 573-84． 3） McNeely ML, Campbell K, Ospina M, et al. Exercise interventions for upper-limb dysfunction due to breast cancer treatment. Cochrane Database Syst Rev. 2010: CD005211. 4） Box RC, Reul-Hirche HM, Bullock-Saxton JE, et al. Shoulder movement after breast cancer surgery: results of a randomised controlled study of postoperative physiotherapy. Breast Cancer Res Treat. 2002; 75: 35-50. 5） de Rezende LF, Franco RL, de Rezende MF, et al. Two exercise schemes in postoperative breast cancer: comparison of effects on shoulder movement and lymphatic disturbance. Tumori. 2006; 92: 55-61. 6） Cinar N, Seckin U, Keskin D, et al. The effectiveness of early rehabilitation in patients with modified radical mastectomy. Cancer Nurs. 2008; 31: 160-5. 7） Beurskens CH, van Uden CJ, Strobbe LJ, et al. The efficacy of physiotherapy upon shoulder function following axillary dissection in breast cancer, a randomized controlled study. BMC Cancer. 2007; 7: 166. 8） Na YM, Lee JS, Park JS, et al. Early rehabilitation program in postmastectomy patients: a prospective clinical trial. Yonsei Med J. 1999; 40: 1-8. 9） Wingate L, Croghan I, Natarajan N, et al. Rehabilitation of the mastectomy patient: a randomized, blind, prospective study. Arch Phys Med Rehabil. 1989; 70: 21-4. 10） Lotze MT, Duncan MA, Gerber LH, et al. Early versus delayed shoulder motion following axillary dissection: a randomized prospective study. Ann Surg. 1981; 193: 288-95. 11） Abe M, Iwase T, Takeuchi T, et al. A randomized controlled trial on the prevention of seroma after partial or total mastectomy and axillary lymph node dissection. Breast Cancer. 1998; 5: 67-9. 12） Schultz I, Barholm M, Grondal S. Delayed shoulder exercises in reducing seroma frequency after modified radical mastectomy: a prospective randomized study. Ann Surg Oncol. 1997; 4: 293-7. 13） Abe M, Iwase T, Takeuchi T, et al. A randomized controlled trial on the prevention of seroma after partial or total mastectomy and axillary lymph node dissection. Breast Cancer. 1998; 5: 67-9. 14） Ahmed RL, Thomas W, Yee D, et al. Randomized controlled trial of weight training and lymphedema in breast cancer survivors. J Clin Oncol. 2006; 24: 2765-72. 15） Wingate L. Efficacy of physical therapy for patients who have undergone mastectomies. A prospective study. Phys Ther. 1985; 65: 896-900.（田沼　明・阿部恭子・村岡香織）108第６章　乳がん・婦人科がん