Desiree Dutton, MPT
Marcus Daly Rehabilitation Center
1200 Westwood Drive
Hamilton, MT 59840
Breast Cancer and the Role of Physical Therapy
Although many people may not think of physical therapy and breast cancer
treatment as being related, physical therapists can have a very important
role in a breast cancer treatment plan. Oncologic physical therapists
treat patients of all ages and can practice in acute care and rehabilitation
hospitals, skilled nursing units, outpatient clinics and home health settings,
as well as health/wellness centers.
Breast cancer is the most common cancer among women in the United States
(other than skin cancer). Cancer is a group of diseases that cause cells
in the body to change and grow out of control. Most types of cancer cells
eventually form a lump or mass called a tumor, and are named after the
part of the body where the tumor originates. Breast cancer begins in the
breast tissue that is made up of glands for milk production (lobules),
and the ducts that connect the lobules to the nipple. The remainder of
the breast is made up of fatty, connective, and lymphatic tissues. Breast
cancer typically is detected either during a screening examination, before
symptoms have developed, or after symptoms have developed, when a woman
feels a lump. In 2013, over 232,000 women were estimated to have invasive
breast cancer. But breast cancer not only affects women - 2,240 men were
estimated to be diagnosed with breast cancer in 2013. Presently, millions
of women in the United States are surviving the disease thanks in part
to early detection and improvements in treatment.
Breast cancer treatment decisions are made by the patient and the physician
after consideration of the optimal treatment available for the stage and
characteristics of the cancer, the patient's age and preferences,
and the risks and benefits associated with each treatment protocol. Treatment
options for breast cancer may include surgery, radiation therapy and/or
chemotherapy. Recovery varies greatly for each patient and not every patient
with breast cancer will require rehabilitation services post-treatment.
Some common impairments which a physical therapist or occupational therapist
address include: pain, swelling, scar tissue and adhesions, restricted
range of motion and weakness of the involved arm, postural dysfunction,
and cancer-related fatigue.
Surgical procedures as well as radiation therapy causes many patients
to experience pain and stiffness in the chest, armpit, shoulder and back.
There is also initial swelling near the surgical incision and there may
be pain from the incision itself or the sutured skin may feel tight along
the incision as the movement of your arm pulls on the incision. Patients
may have pain and/or muscle spasms in the neck or shoulder region as a
result of muscle guarding. Another side effect of breast cancer treatment
includes nerve irritation which can result in numbness, pain or tingling
sensations. Restrictive scar tissue or adhesions on the chest wall, around
the breast or in the armpit can develop as a result of surgery, radiation
fibrosis, or wound infection. Scar tissue can lead to loss of shoulder
range of motion, postural dysfunction, or discomfort in the neck, shoulder
blade and upper back. Decreased use of the involved shoulder and resulting
weakness may also increase your chance of developing a "frozen shoulder".
Some may develop posture faults because of pain, skin tightness or psychological
reasons. Asymmetry of the trunk and abnormal shoulder blade alignment
may also occur. Any of these impairments can impact the ability to participate
in daily activities.
One of the most effective ways to treat the side effects of breast cancer
treatment is exercise. It is important to talk to your doctor before starting
any exercise program, or your doctor may suggest that you see a physical
therapist or occupational therapist. PTs can teach patients basic exercises
that will stretch and strengthen the muscles of the chest, back, shoulders
and arms, preventing stiffness and reducing pain. A supervised, return
to exercise can also help reduce fatigue. Patients can begin a physical
therapy program after adequate healing of the surgical incision.
Women and men who have been treated for breast cancer may be at risk for
lymphedema which manifest as swelling in one of the arms because of a
blockage of lymph vessels and the body's inability to drain fluid
from surrounding tissues. Most who have had breast cancer will not develop
this side effect, but many will. Recognition and prevention of lymphedema
is critical in cancer rehabilitation. Treatment for lymphedema includes
education about skin care, manual lymphatic drainage/massage, exercise
and compression. Compression is a vital component to managing lymphedema
and some patients must continue to wear a compression garment long-term
to keep the swelling under control.
Physical therapists are often involved during the early stages of an individual's
cancer diagnosis and can be vital throughout the course of a patient's
treatment by helping maintain/gain strength, flexibility, and endurance
and maximizing function.
Sources: American Physical Therapy Association and American Cancer Society
Questions and or comments regarding this week's health column please
contact Desiree Dutton, MPT at Marcus Daly Rehabilitation Center, a service
of Marcus Daly Memorial Hospital, 1200 Westwood Drive, Hamilton, MT 59840.
Working together to build a healthier community!