Breast Cancer and the Role of Physical Therapy

Desiree Dutton, MPT
Marcus Daly Rehabilitation Center
1200 Westwood Drive
Hamilton, MT 59840
(406) 375-4570

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!



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