Physical Therapy for Breast Cancer Patients Minimizes Side Effects

By Joanna Shea O'Brien - Beth Israel Deaconess Medical Center Correspondent

Last year, an estimated 230,480 new cases of breast cancer were diagnosed among women.  Though recovery varies greatly for each patient, and not every one of these patients with breast cancer will require rehabilitation services post treatment, swelling and range-of-motion problems following treatment can prevent them from returning to normal daily activities.

Treatment for breast cancer, which includes surgery, radiation and chemotherapy, causes many patients to experience pain and stiffness in the chest, shoulder and back muscles, as well as initial swelling and numbness near a surgical incision site. Other common side effects of breast cancer treatment include nerve irritation, as radiation and surgery can cause nerves to become swollen, which can result in numbness, pain or tingling sensations.  Fatigue is also common, and can easily overwhelm a patient.

An integrated, multidisciplinary team of physicians, nurses, physical therapists and social workers can help identify a patient's rehabilitation needs. The BreastCare Center at Beth Israel Deaconess Medical Center works closely with Outpatient Rehabilitation Services to ensure that patients who need rehabilitation receive proper care.

Kathleen Shillue, a physical therapist, is the Clinical Services Manager for Outpatient Rehabilitation Services and has worked with patients with breast cancer for the last two decades.

"One of the strengths of our hospital is that it does not have the feel of a big institution," she says. "Health care providers work closely together and communicate about our patients, and I think the patients feel that when they come in for treatment."

Shillue and the Outpatient Rehabilitation team meet with patients to assess their condition, including their range of motion and pain level, and begin a course of exercises to regain strength and flexibility.

One of the most effective ways to treat the side effects of breast cancer treatment is to begin a provider-approved course of arm exercises.  Occupational and physical therapists can teach patients basic exercises that will stretch and strengthen the muscles of the chest, back, shoulders and arms, preventing stiffness and reducing pain. Increased flexibility can improve a patient's posture, which helps with pain management. And a supervised, gradual return to exercise can also reduce both nerve irritation and fatigue.

"Patients can begin a physical therapy program after adequate healing of the incision," Shillue says. "One of the benefits of rehabilitation and physical therapy is that exercise can help with fatigue, which is a very common complaint among patients with breast cancer."

Recognition and prevention of lymphedema, a post-surgery complication risk, is also critical in breast cancer rehabilitation.  Lymphedema manifests itself as swelling in one of the arms because of a blockage of lymph passages and the body's inability to drain fluid from surrounding tissues.

Shillue integrates the search for signs of lymphedema into her work with patients. Some patients first notice a swelling in the fingers or hands, and it can be in the first year or two after surgery, or as much as ten or twenty years later, though that is much less common.

The treatment for lymphedema has four components: education about skin care, compression, manual lymphatic drainage or massage and exercise. Compression is really the mainstay, and some patients must continue to wear a compression garment long term to keep the swelling under control.

"Only a small percentage of patients are afflicted with lymphedema, but it is critical to recognize it immediately and begin treatment," notes Shillue.  BIDMC physicians at the BreastCare Center are working with Shillue to open a Lymphedema Clinic to make it even easier for lymphedema patients to get accessible and coordinated care in their recovery process.

If you would like to schedule an appointment at the BreastCare Center at BIDMC, please call 617-667-2900.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.