The role of physiotherapy in breast cancer care

There is a growing evidence reporting the physiological and psychological benefits of physiotherapy as a safe and effective adjunct to breast cancer treatment. It is imperative that health professionals must now focus on meeting the unique needs of breast cancer survivors. Physiotherapy interventions empower patients in the management of their symptoms, side-effects of treatment or recovery from surgery.

The physiological and psychological benefits from physiotherapy for breast cancer patients have been well documented, with improvements observed in terms of morbidity, mortality and importantly, quality of life.

In Nigeria, breast cancer has overtaken cervical cancer as the leading female malignancy and an African woman is more likely to present with a more aggressive tumor than her Western counterpart. The need for additional treatment alongside standard breast cancer treatment is clear and here at Physio Centers of Africa, we are committed to providing the highest standard for breast cancers sufferers and survivors.

There are a range of issues following breast cancer that can be successfully treated with physiotherapy.

Reduced range of motion

No matter what type of surgery you have, it’s important to do exercises afterward to get the arm and shoulder moving again. Exercises help to decrease side effects of your surgery and help you get back to your usual activities.

If you’ve had radiation therapy after surgery, exercises are even more important to help keep your arm and shoulder flexible. Radiation may affect your arm and shoulder long after treatment is finished. Because of this, it’s important to develop a regular habit of doing exercises to maintain arm and shoulder mobility after radiation treatments for breast cancer.It is very important that early rehabilitation is implemented to promote functional movement to the patient’s previous level of activity.

Lymphoedema

All women who undergo breast cancer surgery are at risk of developing lymphoedema, which may not appear until months or even years post surgery. Risk is higher for women who have undergone a full axillary lymph node dissection.

Radiation treatment may also cause, or if already present, exacerbate lymphoedema. Pain, loss of range of motion and strength in the upper extremity, as well as impaired function, are common effects of lymphoedema.

As exercise has shown to be a safe and essential part of lymphoedema management, physiotherapy can play a meaningful role in prevention and treatment.

Bone Loss

The rate and magnitude of bone loss caused by cancer treatment is significantly higher than age-related bone loss in the non-cancer population. Chemotherapy-induced premature menopause and anti-estrogen therapies, for example, are believed to contribute to the increased rate and magnitude in this population.

As within the general population, initial management for decreased bone density includes education on the benefits of a lifestyle that includes, among other interventions, regular weight-bearing exercise.

Physiotherapists are able to confidently advise these individuals on safe exercise options to maximise bone integrity.

Upper Extremity Dysfunction

Decreased range of motion, rotator cuff strain, adhesive capsulitis, paraesthesia and weakness are all common developments in the upper extremity post breast cancer surgery and/or radiation therapy. Whether appearing independently or in combination, these impairments can severely impact activities of daily living and employment, resulting in functional disability and a decreased quality of life.

Physiotherapy has been shown to be effective in managing post-surgical musculoskeletal symptoms. For example, exercise rehabilitation has shown to result in clinically meaningful improvements in shoulder range of motion.

Fatigue

Fatigue is a frequently reported yet poorly managed symptom reported by cancer patients. It is a complex symptom with various overlapping causes, some of which include anaemia, pain, sleep disturbance, thyroid dysfunction, and mood disorders.

Physiotherapists can help their cancer patients manage fatigue through a focused history screening to determine the main contributors; by teaching the importance of planning and pacing their day; by designing a graduated exercise program to increase strength and energy levels.

Pain

Another complex symptom with multiple causes reported by cancer patients is pain, often requiring a multi-disciplinary approach to management.

A physiotherapist’s role in pain management comes in the form of exercise prescription and acupuncture, both of which have been shown to be effective treatments for pain.