October is National Breast Cancer Awareness Month, which is an important time for breast cancer survivors. October is also National Physical Therapy month, which is a great time to highlight physical therapy and how it can improve the lives of cancer survivors. After battling the deadly disease of breast cancer and winning, it is paramount for women to know how to optimize their physical health and decrease their risk of having this condition return. Many survivors stick to a strict diet in order to maintain a healthy weight, or may have to take medication for months or years. Survivors can also be encouraged by data in the last 4-5 years that highlight the benefits of regular exercise in lowering the risk of the return of breast cancer. In a 2015 article by Alappattu and colleagues in Physical Therapy, authors describe data from 418 cancer patients receiving physical therapy (PT). Genitourinary cancer and breast cancer were the most prevalent types of cancer reported in this study, with lymphedema ranking #1 in the common symptoms found in breast cancer patients. Loss of strength and flexibility in the upper extremities were also common findings for women battling breast cancer. For informed women who received PT following breast cancer treatment, they experienced individualized evaluation and treatment that typically addressed common cancer-related impairments, including:
Lymphedema: Swelling in an extremity due to increased lymphatic fluid, called lymphedema, can be defined by a girth measurement of more than 2 cm difference between the affected and nonaffected limb. Effective lymphedema management is accomplished through manual lymph drainage, range of motion exercises, aerobic exercise, and lymphatic bandaging.
Cancer Related Fatigue (CRF): This feeling of extreme exhaustion can be improved through individualized aerobic training, strength training, and functional management training both during and after medical cancer treatments, especially radiation.
Pain: Pain can result from surgical management of the disease, as well as immobilization following treatment. PT can provide many pain relief strategies that can reduce the intensity and frequency of pain after cancer treatment. Specifically, treatment strategies including soft tissue mobilization, therapeutic massage, modalities, therapeutic stretching, and strengthening can be helpful.
Peripheral neuropathy: Oftentimes, cancer survivors experience peripheral neuropathy, which is abnormal nerve function that can be experienced as pain, numbness, and tingling. PT can help to improve nerve function or find ways to compensate for nerve dysfunction.
Deconditioning: Rebuilding endurance for activities and cardiovascular function can be difficult during and after cancer treatment. A skilled physical therapist is able to educate and monitor cardiovascular training that improves endurance without increasing fatigue.
Muscle shortening and contracture: Loss of strength and flexibility, especially in the shoulder, neck, and upper back, can occur after surgery or prolonged immobilization or bed rest. A physical therapist can guide the survivor through safe movements that increase both strength and range of motion while avoiding pain.
It is never too late to find help for any of these complications, even if PT was not part of the initial post-surgical care plan. Even more importantly, a physical therapist can design an exercise program that can help the survivor reach the levels of intensity and types of movements needed to reduce the likelihood of the return of breast cancer, according to the American Cancer Society. So, make October the month that you fight back against this disease with exercise and PT, and tell cancer to take a hike.
Resources: Alappattu M, et al. Clinical Characteristics of Patients with Cancer Referred for Outpatient Physical Therapy. Phys Ther, April 2015, 95(4):526-538; cancer.org/cancer/breast-cancer/about;