You may be aware of the most direct side effects of breast cancer stemming from surgery, but there are other side effects from radiation and chemotherapy that you should be aware of as you and your oncologist talk about cancer rehab. A breast cancer rehab program should address or anticipate therapy treatments for shoulder mobility issues, post surgical weakness, lymphedema, scar tissue problems, radiation fibrosis, peripheral neuropathy (CIPN), and frozen shoulder, among others. While not all of the side effects occur with everyone, the therapy methods often overlap so that you can alleviate many of your symptoms with an integrated program. Here we will address some of the common side effects of breast cancer treatments.
Cancer Rehab for Lymphedema
Lymphedema is a build-up of fluid caused by damaged or surgically removed lymph nodes, and it can cause permanent tissue damage if not addressed. It affects about 40% of breast cancer survivors and is one of the most common side effects to be targeted in a breast cancer rehab program.
Lymphedema manifests as general swelling and tightness where there would otherwise be normal lymphatic flow. Breast surgery can result in swelling in the hand, arm, chest wall, breast area and back. How do you know if you are affected? At times, your clothing and accessories may feel tighter and you may feel like you have less flexibility. You won’t necessarily put on weight, but you may look more bloated or swollen as fluid accumulates. Lymphedema can also cause aching and tingling/pins and needles feelings as well as redness at the site of swelling.
Cancer rehab for lymphedema is best started as early as possible. As Oncology Rehab and Wellness’s certified lymphedema therapist, I treat all the patients who come to us affected by lymphedema. The earlier they come in, the quicker their recovery. Early intervention can actually reverse the disease process. When at all possible, it is advisable for patients to be seen by a therapist BEFORE surgery to obtain baseline measurements. This single step can provide a much quicker way to diagnose any onset and leads to improved overall outcomes. If a patient comes with more advanced lymphedema, therapy will help them, but it will take more effort and may become a more chronic condition.
A typical rehab program for lymphedema may include manual lymphatic drainage (a special massage), skin care education, compression bandages applied by a CLT, compression garment fitting and prescription and exercise. Weight-lifting in particular can have a beneficial effect on lymphedema. When oncologists and/or surgeons refer their patients pre-operatively, I often recommend weight-lifting to my patients before they start cancer treatments (and instruct in a program for post-op movement exercises that help to speed up the recovery process). Pre-op education is important so that patients have time to get used to the exercises before they even need them.
One of my clients, Kathy from New Jersey, did strength training and cardiovascular exercise throughout and following her treatment. She says, “I lifted weights before, during, and after my treatment and as a result, did not have the usual problem of loss of muscle strength.” Weights as light as 1-2lbs is enough; it’s as much about getting the blood and body fluids moving as it is about maintaining strength.
Cancer Rehab for Radiation Fibrosis
Radiation fibrosis is a possible side effect of radiation therapy that causes thickening and scarring of soft tissues in the radiation field. It’s not often seen until much later, after the treatment ends. Simply put, cells damaged by radiation produce fibrin protein in abnormal amounts, which results in scar tissue, which then can damage nerves, cause muscle imbalance, and reduce mobility of the affected area. Radiation fibrosis in breast cancer patients typically affects the tendons, muscles, organs, and bones within the neck, shoulder, underarm, and torso area.
Cancer rehab therapy for radiation fibrosis is similar to lymphedema therapy in the sense that it includes massage and mobility exercises. Again, my personal recommendation is that patients start rehab even before treatments begin because it makes recovery so much faster. At the very least, they should begin during treatments to head off fibrosis before it sets in.
Cancer Rehab for Peripheral Neuropathy/CIPN
Nerve damage is a recurring theme in cancer treatments and Chemotherapy Induced Peripheral Neuropathy (CIPN) is another potential side effect (with certain chemotherapy drugs). While fibrosis results from radiation, CIPN results from chemotherapy drugs. Symptoms include tingling, shooting or stabbing pain, numbness, problems with balance, and loss of touch sensation. CIPN typically starts at the extremities (ends of fingers, toes) and then progresses up the limb.
Because CIPN involves loss of touch sensation, it can make daily tasks difficult and increases the risk of falling. Consequently, cancer rehab therapy for CIPN is more targeted. For example, common therapies include gait training to prevent falls, hand strengthening and fine motor training to help complete delicate tasks, and aerobic exercise to stimulate nerve regrowth.
Cancer Rehab for Frozen Shoulder
Breast cancer survivors often end up with reduced shoulder mobility after surgery. If patients do not address the mobility issues (or they wait too long to begin reusing the shoulder), they can end up with muscle strength imbalance and a condition called adhesive capsulitis, which means “frozen shoulder.”
In adhesive capsulitis, the multiple pieces in the shoulder joint “adhere” together while inflamed, greatly restricting range of movement and preventing a return to normal mobility. Frozen shoulder is accompanied by significant pain, muscle spasms, and stiffness.
Cancer rehab for frozen shoulder involves exercises to increase the shoulder’s range of motion and manage inflammation and pain.
What Happens in a Breast Cancer Rehab Program
A breast cancer rehab program starts with surveillance and assessment to determine what issues need to be addressed. Because every breast cancer survivor is different, some issues may be more urgent and some may not come up at all. That said, most breast cancer rehab programs include some kind of medical massage (for lymphedema, fibrosis, or surgery recovery), physical exercise in the form of weight-lifting, aerobics, and/or mobility exercises, and medication and diet advice to reduce inflammation.
If you read my blogs, you know that I believe cancer rehab should start early — before treatments even start. That is because the earlier you begin the rehab process, the better and faster you will recover when treatments are done. At Oncology Rehab and Wellness we use the Prospective Surveillance Model (PSM) to guide our cancer rehab program, a standardized assessment framework that makes it easy to detect problems early on and address them in a complete, thorough way.
If you are just beginning breast cancer treatments, or even if you are well into them, a breast cancer rehab program will help you maintain and improve your quality of life.
Call us to schedule an appointment at our cancer rehabilitation clinic: (703) 789-0367.