Rehabilitation After Breast Cancer Treatment

Hi, Bestie! For the past couple of chats, we’ve been talking about breast cancer. We’ve covered the basics of breast cancer including prevalence and likelihood of survival, as well as medical interventions commonly used to treat this type of cancer. Today, let’s discuss the role of rehabilitation following breast cancer. As I’ve mentioned, the most important thing about cancer treatment is ridding the body of the cancerous cells and improving the chance for survival. However, cancer treatments are extremely intense and can leave the patient with lifelong impairments. This is where physical therapy comes in. It can be a great tool for improving the impairments left by cancer treatments and returning to a high quality of life.

Common impairments following breast cancer treatment include pain, fatigue, limited shoulder range of motion (ROM), skin changes, sensation changes, and lymphedema. Let’s talk about physical therapy intervention for each of these impairments:

-       Pain: Neck and shoulder pain can occur immediately after breast cancer treatment, but it can also pop up years later. No matter when it presents itself, your physical therapist will be able to help you improve your symptoms. The therapist will use soft tissue massage, stretches, and exercises to help reduce your pain.

-       Fatigue and muscle weakness: Folks often experience weakness of the shoulder muscles following breast cancer treatment. Surgery and chemotherapy can both impact muscle strength and mass. Your physical therapist can help you improve your shoulder muscle strength through resistance exercises targeted toward the specific muscles that are weak. It is essential to listen to your body and take rest breaks as needed. Fatigue will likely be present following cancer treatment and pushing too hard won’t allow you to get the maximal benefit out of the exercises. You may need more frequent or longer rest breaks than you needed before cancer treatment, but that is okay! Also, keep in mind that resistance training has not been shown to increase risk for lymphedema following breast cancer treatment and it can actually improve symptoms of lymphedema (1,2). Cardiovascular exercises can improve your mood and your cardiovascular fitness and may even improve your levels of fatigue.   

-       Shoulder ROM: Shoulder ROM can be affected by surgical treatment for breast cancer. After surgery, such as modified radical mastectomy (MRM), scar tissue and adhesions can form where the tissue has been disrupted. These adhesions cause the shoulder joint to feel tight and decrease the available ROM. A physical therapist can help you improve your shoulder ROM by utilizing soft tissue massage to reduce adhesions, exercises to promote full ROM, and modalities to reduce pain associated with a lack of mobility.

-       Skin changes: Radiation can cause redness and skin breakdown over the radiated area. Skin that has been exposed to radiation may be inflamed, painful, and tight. Your therapist will be able to educate you on appropriate ways to care for your radiated skin, including use of sunscreen over the area, methods for reducing risk of infection, and referral to a wound care specialist, as necessary. Radiation may also cause the skin to shrink and tighten (kind of like shrink wrap) and your therapist can help you to regain shoulder ROM if you are experiencing a lack of mobility due to radiation.

-       Sensation changes: Some types of chemotherapy can result in peripheral neuropathy, or damage to the nerves outside the brain or spinal cord. Peripheral neuropathy can cause weakness, numbness, and/or pain in the affected nerves. The hands, arms, and feet are most likely to be affected. Your physical therapist can work on desensitization techniques for peripheral neuropathy if you are experiencing pain, burning, or hypersensitivity.

-       Lymphedema: Lymphedema of the upper extremity is common after breast cancer treatment. Any time the lymph system is disrupted, lymphedema can occur. Surgery, radiation, and chemotherapy all have an impact on the development of lymphedema. A physical therapist will be able to help you manage your lymphedema. Management includes daily lymphatic drainage techniques, wearing appropriate compression items on the affected limb, exercise, and working with your therapist for more extensive manual lymph drainage. Some folks will experience post-operative cording or axillary web syndrome where tight cords of backed up lymph fluid can be felt in the armpit area (3). This can be resolved in physical therapy with the use of gentle exercises, mild heat, and light traction to the arm.

Once you are declared “cancer free,” there is still a way to go before returning to your prior level of function. Physical therapy is an important part of the rehabilitation process and will not only help you feel better physically, but can even help you get your confidence back. After cancer treatment, you may also deal with mental health changes. Your physical therapist can refer you to the appropriate mental health medical provider if you are struggling with your mental health post-breast cancer. Breast cancer is a complex diagnosis and should involve a team of medical providers to ensure the best care possible. Have you or a loved one had breast cancer? If so, what was the experience like?

XOXO,

Your Pelvic Bestie

References:

1.     Harris SR, Niesen-Vertommen S. Challenging the myth of exercise-induced lymphedema following breast cancer: a series of case reports. J Surg Oncol 2000;74:95–99. 

2.     Bicego D, Brown K, Ruddick M, et al. Exercise for women with or at risk for breast cancer–related lymphedema. Phys Ther 2006;86(10): 1398–1405.

3.     Irion JM Irion G. Women’s Health in Physical Therapy. Wolters Kluwer Health/Lippincott Williams & Wilkins; 2010.

*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives