Physical Therapy After Breast Cancer

Breast cancer has become the most diagnosed cancer among women. Many of those undergoing treatment or in recovery are still unaware of the many benefits physical therapy can offer as they traverse their journey.

Immediate, short-term treatment for breast cancer may involve surgery, chemotherapy, radiation therapy or more. Although the goal is to rid the body of cancer, the side effects are long lasting and can cause multiple functional impairments. These side effects include scarring, pain, radiation burns, numbness/neuropathy, decreased upper extremity motion, decreased strength, decreased endurance, cancer related fatigue, axillary web syndrome (or cording) and lymphedema to name a few. Most women experience one or more of these common physical impairments. They often go unrecognized and untreated and negatively impact function and quality of life for many years.

Physical therapy can offer solutions for these impairments at many stages along the way. As an outpatient physical therapist, I have treated clients post-operatively, pre-radiation and after radiation and chemotherapies. In years past, evidence showed that after completion of breast cancer treatment (that includes radiation therapy and chemotherapy) women may have biomechanical changes and impairments from 12 months to 3 years later. However, results have been seen in clients 15 years later who were still struggling with soft tissue restrictions, pain and dysfunction.

A comprehensive physical therapy evaluation focuses on one’s posture, arm size, strength, and movement of the shoulder blade, shoulder, neck and trunk. The physical therapist will also assess the integrity of any incisions and all soft tissue structures of the chest, armpit, neck, trunk and stomach. The presence of any pain or cording will be noted. Along with manual techniques to address cording, soft tissue and joint dysfunction, a tailored exercise program will be prescribed. Exercise after breast cancer affords many benefits. These include decreased fatigue, decreased severity of nausea, improved weight control and improved self-image, reduction in lymphedema, and decreased risk of cancer recurrence.

Physical therapy should be part of the journey for anyone diagnosed with breast cancer.

References and useful sites:

1. World Health Organization. Breast cancer: prevention and control. Breast cancer burden. 2016. www.who.int/cancer/detection/breastcancer/en/index1.html. Accessed 12 Oct 2020.

2. Stout NL, Binkley JM, et al. A prospective surveillance model for rehabilitation for women with breast cancer. Cancer. 2012; 118 (8 Suppl): 2191-200.

3. Springer, et al. Pre-operative Assessment Enables Early Diagnosis and Recovery of Shoulder Function in Patients with Breast Cancer. Breast Cancer Res Treat. 2010 Feb; 120 (1): 135-147.

4. Harris SR. Axillary web syndrome in breast cancer: a prevalent but under-recognized postoperative complication. Breast Care (Basel) 2018;13(2):132–135.

5. Academy of Oncologic Physical Therapy. https://oncologypt.org/about-us/.

6. Holmes, et. al. Physical Activity and Survival After Breast Cancer Diagnosis. JAMA. 2005;293(20):2479-2486. doi:10.1001/jama.293.20.2479

7. American Breast Cancer Foundation (www.abcf.org)

8. Facing Breast Cancer together (fbctogether.org)

9. Breast Cancer.org (breastcancer.org)

10. Susan G Koman (ww5.komen.org)

11. The Breast Care Site (thebreastcaresite.com/tbcs)