Helpful Rehab Hints

Physical Therapists Key in Ongoing Care of Women Living with Breast Cancer

ALEXANDRIA, VA ¾ Physical therapists play a key role in restoring function and assisting breast cancer patients’ return to their daily life and routines, says the American Physical Therapy Association (APTA).

"Often the first stage in treatment for breast cancer is surgery," says Elizabeth Augustine, PT, MS, president of APTA's Oncology Section. "Rehabilitation after surgery is a crucial first step in the road to recovery for women living with this disease. Correctly managing post-surgical care is a critical part of oncology rehabilitation."

After surgery, patients often experience a loss of range of motion and function in the shoulder and arms. Physical therapists help patients perform stretching and strengthening exercises to regain lost range of motion and function. Physical therapists will also perform scar massage to keep tissue mobile and supple during healing and to prevent the scar tissue from adhering to the tissue beneath it, called a scar contracture. If not prevented, scar contractures can severely limit the range of motion and function of the affected arm and shoulder. Many physical therapists also create cardiovascular exercise programs for post-surgical patients and those dealing with fatigue caused by chemotherapy and/or radiation.

Breast cancer is the second most common cancer among women as well as the second leading cause of cancer death in women. This year nearly 192,200 women in the United States will be diagnosed with invasive breast cancer and about 40,600 women will die from the disease, according to the American Cancer Society.

One in three women who undergo an axillary dissection, removal of the lymph nodes near the armpit, for breast cancer will develop lymphedema of the arm, a chronic and irreversible condition that can develop weeks, months, or even years after surgery or radiation. Lymphedema causes swelling, reduced oxygen to the tissues and, in some cases, a serious infection. Lymphedema can be managed and greatly improved through a comprehensive physical therapy program.

"The good news is that the majority of women will not develop lymphedema," says Augustine. "The bad news is that no one can predict who will develop lymphedema or when, because it [lymphedema] can be triggered by a trauma to the limb such as an injury or injection."

Physical therapists, or PTs, manage lymphedema by using a combination of techniques. PTs perform manual lymphatic drainage massage, which works to push lymph fluid towards functioning lymph nodes. Low-stretch compression bandaging and properly fitted compression garments are worn on the affected areas. After massage, drainage and pressure garments, exercises, such as shoulder raises and bicep curls, for the arm and shoulder can be performed. "I counsel my patients to be mindful and keep the arm active and mobile, while properly outfitted in the pressure garment," adds Augustine.

Since lymphedema is a chronic, lifelong condition, perhaps the most important aspect of treatment is coaching a patient on home management of lymphedema. PTs teach patients how to do their own manual lymph drainage and massage, and how to bandage the area for daily activities and exercise. Physical therapists also educate their patients on skin care. "It is crucial to keep the skin clean and well-moisturized." says Augustine, "The swelling of the skin in lymphedema makes it so important to keep the area moisturized to prevent cracking, which can lead to infection."

There are many components to breast cancer rehabilitation. "Breast cancer patients should ask their physicians whether physical therapy would be helpful in their case," Augustine says. Physical therapy interventions will vary depending on the consequences of the medical treatments necessitated by the stage of the disease. Ideally, a PT works with a patient pre-operatively to establish baseline measurements, determine patient goals, and educate the patient about what to expect from physical therapy after surgery, chemotherapy and/or radiation therapy.

"Our job as physical therapists is to encourage that recovery so our patients can continue to both fight the disease and live full, active lives," concludes Augustine.

The American Physical Therapy Association is a national professional organization representing more than 66,000 members. Its goal is to foster advancements in physical therapy practice, research and education.