The Role of Physical and Occupational Therapy in Recovering from Breast Cancer Treatment
By: Jennifer Heiligman, PT, MPT
October is Breast Cancer awareness month, as well as, National Physical Therapy Month. This presents the perfect opportunity to discuss both topics and illustrate how physical (and occupational) therapy are extremely beneficial to patients recovering from treatment for breast cancer.
As of January 1, 2019 there were more than 3.8 million US women living with a history of breast cancer.¹ Treatment for breast cancer can include chemotherapy, radiation, and surgery ranging from a lumpectomy to a double mastectomy. The most common form of treatment is surgery with some cases involving multiple surgeries. These treatments often come with side effects which can have long term impacts on a patient’s quality of life. These side effects can include:
- Range of Motion (ROM) limitations
- Scar tissue adhesions
- Weakness and fatigue
- Pain- including Post Mastectomy Pain Syndrome (PMPS)
Physical and Occupational therapy can minimize the above side effects and optimize function.
Range of Motion (ROM) Limitations
After undergoing breast surgery, breast reconstruction and/or radiation therapy to the breast or chest wall, the patient may experience limitations in reaching their hand over their head or reaching behind their back. Decreased shoulder ROM is very common and can negatively impact a patient’s function. These limitations can impact dressing, washing and styling hair and hygiene. By providing manual stretching and ROM exercises, the therapist can work to improve the patient’s upper extremity movement.
When body tissue undergoes trauma such as surgery or radiation therapy, the tissue can form scar adhesions. This is when the compromised tissue will become bound down and not mobile. Scar adhesions can also lead to decreased ROM and mobility and can cause pain with movement. By using specific manual therapy techniques, the therapist can work to break up those adhesions allowing the tissue to become mobile again, leading to increased extremity motion.
During surgery for breast cancer, lymph nodes may be removed to either assess or prevent the progression of the cancer from spreading to other areas of the body. Lymphedema is a condition that is caused by this disruption or damage to the normal drainage pattern in the lymph nodes leading to abnormal swelling, most commonly in the arm, but it can also occur in the breast or chest. Lymphedema can be uncomfortable, painful and can even lead to infections over time.
Physical and occupational therapy can help treat and manage the symptoms of lymphedema. Some therapists even become certified in lymphedema management. Therapists use manual lymphatic drainage techniques, compression bandages, intermittent pneumatic compression garments and therapeutic exercises to help treat lymphedema. Education in self care is also very important since this condition can be chronic.
Weakness and Fatigue
Many breast cancer patients suffer from weakness and fatigue as a result of the treatments used to fight the cancer. Chemotherapy, radiation and surgery are all taxing on the body leading to fatigue and energy loss. This can in turn, lead to decreased endurance and strength since the patient may not have the energy to participate in their previous exercise routine or even normal daily activities.
A systematic review conducted in 2017², “found that an exercise intervention program can produce short-term improvements in physical functioning and can reduce fatigue in breast cancer patients.” It is recommended that any program be started in a supervised setting. A physical therapist can establish an exercise program for the patient to safely follow. The program would include strengthening exercises to help build back muscle mass that may have been lost, stretching and aerobic activities to improve endurance. In addition to the physical benefits, a regular exercise routine can also help boost the patient’s mental outlook.
In a study published in the Journal of Multidisciplinary Healthcare³, it was found that shoulder or arm pain can be present in 30-40% of patients at a 5 year follow up. The most common impairments leading to pain include cervical radiculopathy, rotator cuff tendonitis, adhesive capsulitis, edema and post-mastectomy pain syndrome (PMPS).
Pain can decrease the patient’s quality of life, but this, like the other side effects, can be treated by PT and OT in combination with other interventions. By addressing the underlying cause of the impairment, including decreased tissue mobility, joint tightness, and edema, the therapist may, in turn, be able to produce a reduction in pain level. Less pain leads to improved function.
Unfortunately, 1 in 8 women will develop breast cancer over the course of her lifetime. However, the good news is that the number of people surviving breast cancer continues to increase. This is secondary to increases in early detection and improvements in the course of treatments themselves. Unfortunately, some of these survivors may suffer from the side effects of the treatments rendered to cure the disease. But, there is help out there. Physical and occupational therapy have been proven to be effective in minimizing the long term effects of cancer treatment and improving the survivor’s quality of life.
¹Miller KD, Siegel RL, Lin CC, et al. Cancer treatment and survivorship statistics, 2019. CA Cancer J Clin. 2019:1-23.
²Juver LK, Thune I, et al. The effect of exercise on fatigue and physical functioning in breast cancer patients during and after treatment and at 6 months follow-up: A meta-analysis, 2017. J.Breast. 2017 Jun;33:166-177.
³Amatya B, Khan F, Galea M. Optimizing post-acute care in breast cancer survivors: a rehabilitation perspective, 2017. J Multidiscip Healthc. 2017; 10: 347–357.