Breast Cancer Recovery: The Role of a Physiotherapist

Breast cancer is the most common cancer in the United Arab Emirates (UAE), with most cases characteristically occurring in women younger than 50 years. Fortunately, due to the evolving management of breast cancer, survival rates have improved. Therefore, a larger focus needs to be put on improving the quality of life for women and men who undergo for treatments of breast cancer.

Breast cancer requires holistic treatment with a multi-disciplinary team. Your physiotherapist is one of the members of this team. Breast cancer recovery takes place along the entire cancer journey. Rehab planning can start immediately after diagnosis, known as ‘Prehab’, and continue into treatment and long into the road to recovery.

Breast Cancer Treatment

Breast cancer often involves some type of surgery which can include:

• Breast conservation therapy (lumpectomy) – involves the removal of a mass from the breast and is often accompanied by an adjunct treatment such as radiation and/or chemotherapy.
• Lymph node surgery – this can involve biopsy to determine if cancer is present in the lymph nodes, or dissection to remove of the lymph nodes.
• Mastectomy – this involves surgical removal of the breast tissue and may involve removal of the nipple, lymph nodes and pectoral fascia (tissue that covers the chest muscles).
• Breast reconstruction – this involves plastic surgery to make the breast look and feel as natural as possible following total or partial removal.

Treatment Side Effects

Side effects can occur with any type of treatment for breast cancer. During breast cancer recovery, some common side effects from treatment or surgery are:

Lymphedema

Lymphedema is characterized by local swelling in the body caused by the abnormal accumulation of lymph. This swelling can lead to restricted range of motion, pain and altered sensation. The specialised treatment for this (which is called decongestive lymphedema treatment) consists of manual lymphatic drainage, multilayer compressive bandaging, the use of compression garments, exercise, and skincare.

Joint Arthralgias (Painful joint)

The shoulder’s range of motion and strength can be limited due to surgical scarring, swelling, deconditioning and other treatments such as radiation and chemotherapy. Evidence has concluded that physiotherapy post-surgery can have excellent effects on shoulder range of motion and strength.

Numbness or tingling in the arm (Chemo Induced Peripheral Neuropathies)

Physiotherapists are also able to assess and treat various causes of numbness and tingling in the upper extremity. This symptom can be the result of swelling, nerve damage, muscular tension malalignment or other issues related to cancer treatment.

Osteoporosis

Osteoporosis is low bone mass resulting in porous bone structure. Breast cancer survivors have a 68% risk of getting osteoporosis and osteopenia compared to cancer-free women and 77.8% of breast cancer survivors who have osteoporosis are not diagnosed. Progressive resistance training, weight bearing impact exercises and high-velocity powerlifting have shown improvement in bone mass density.

Fatigue

Fatigue can be a major issue after any type of breast cancer treatment. Nearly all patients who are undergoing treatment report cancer-related fatigue with almost half rating it as severe. Exercise and activity are the most beneficial ways to combat cancer-related fatigue. A Cochrane Review found that aerobic exercise is beneficial for those with cancer-related fatigue during and post cancer therapy.

Sexual Dysfunction

Sexual dysfunction in this population can be due to structural changes to the pelvic region, systemic hormonal changes, or psychological factors. A pelvic floor physiotherapy can help to strengthen muscles and lengthen the overactive muscle around the pelvic floor.

Headaches

Headaches are a common side effect of breast cancer treatments including chemotherapy, hormonal therapy, and immunotherapy. While some types of headaches cannot be prevented, many steps can be taken in managing headaches. Getting enough sleep, eating well, and managing stress through relaxation, yoga and mindfulness techniques can help to manage headaches.

Scar tightness

Scar tissue may result from radiation treatment or surgery. Hypertrophic or keloid scars are the result of a dysfunction in the regular wound-healing process that results in excessive scar tissue formation. The scar tissue mobilisation techniques had a significant effect on pain, pigmentation, pliability, and itchiness.