Your Physio Guide to Managing On-Going Breast Cancer Side Effects

After the initial phases of breast cancer treatment, there are often on-going symptoms experienced by women, which can last weeks, months, or even years.  Many of these side-effects, unfortunately, often do not receive much attention nor education provided by primary care providers and oncology physicians. Physiotherapists experienced in breast cancer and lymphedema can be a great resource in addressing these topics, providing education, hands-on manual therapy and exercise advice, and the result can be a significant and meaningful improvement in the quality of life of women with on-going symptoms. 

In follow-up to a webinar presented to the Rethink Breast Cancer community, our hope is to illuminate the most common survivorship topics and on-going symptoms experienced by women during and after breast cancer treatment, and the treatment options that are available to help! 

Lymphedema

Lymphedema is defined as the accumulation of lymphatic fluid (most commonly experienced as swelling) in a region of the body, when normal lymphatic drainage is impaired. Lymphatic fluid is produced in all tissues on an on-going basis, but (as in the case of a breast cancer patient), if lymph nodes are removed, or the vessels or nodes are exposed to radiation, lymphatic drainage can be compromised and fluid accumulation can result. 

In a breast cancer patient, lymphedema most commonly presents in the arm, hand, breast, chest, or back, on the same side as the breast cancer. While actual visible swelling is the easiest indicator of lymphedema to detect, it can also present as a feeling of heaviness or ache sensation in the arm or breast, or a change in the ‘density’ of the tissue. Lymphedema can take days, weeks, months, or (much less commonly) years, to develop. Those who tend to be at higher risk have typically had higher numbers of lymph nodes removed, complications after surgery, more extensive radiation, and/or have a higher body mass index.

The good news is, lymphedema is a condition that can be very well managed, and is treated by therapists with Combined Decongestive Therapy designation (C.D.T.), using a combination of techniques:  manual lymphatic drainage massage, compression and/or taping, infection prevention strategies, and exercise prescription. Self-management techniques are instructed and women learn quickly how to manage their symptoms and improve any swelling they may experience. Lymphedema, when managed properly, does not have to be a limitation to a woman’s participation in the things she loves to do, be it at home, at work, or in her recreation/sport endeavors.

Exercise

Exercise has an almost endless number of physiological benefits for anyone who has gone through cancer treatment, including but not limited to: decreased risk of recurrence, decreased fatigue, decreased pain, improved cardiopulmonary status, normalized heart rate, blood counts, and body weight, improved bone density and immune responses, faster return to work, significant psychological and emotional benefits, and improved overall quality of life. Exercise has been shown to help prevent the onset of lymphedema and greatly improves its management in those that do have swelling.

The general guideline for aerobic exercise following breast cancer treatment is 20-30 minutes at a time, 3-5 days/week, at 60-85% of maximal effort. Strength training is also recommended for breast cancer patients and has been shown to be safe (in fact, beneficial!) for women with lymphedema. A physiotherapist can help devise an appropriate and progressive program to incorporate both aerobic and resistance training. Yoga has also been shown to have positive effects on lymphedema in a breast cancer population when performed in a specific series of poses, due to the movement and stretching of the limbs and torso, the sequence of muscular contractions involved, and the incorporation of diaphragmatic breathing. Keeping cool during exercise (as best you can!) is a great idea for those with lymphedema, and wearing a compression garment during exercise may be recommended to you by your C.D.T. therapist.

Scar Tissue and Radiation Effects

Scarring from surgery, reconstruction, and/or tissue changes caused by radiation comprise a large part of what our patients experience difficulty with. It typically presents as tension and/or pain across the chest, in the armpit area, along the side of the torso, and/or at their scar sites themselves. This form of tightness isn’t helped much by stretches alone and can often make it difficult to elevate the arm, sleep comfortably on that side, and maintain optimal posture of the trunk. Other side-effects we see include cording (ropey bands), pinching or pain at the shoulder in certain positions or movements, hardening or increased density of breast tissue, implant immobility or contracture. 

More good news: these issues can be readily addressed with manual therapy, and we encourage patients to seek the care of a physiotherapist or massage therapist who is comfortable treating breast cancer side effects, to get these tissues released. Self-release techniques are instructed for optimal and speedy resolution, and can be very effective in conjunction with stretching in order to restore normal tissue quality in the area, and render the shoulder and arm to have ‘freedom of movement’ and full range again. It’s important to restore full range of motion and address any adherent tissues, as they challenge the normal biomechanics of the shoulder joint, which can lead to other orthopaedic issues down the road. Moreover, lymphatic drainage benefits from full and easy range of motion of the arm, and we always want to restore proper mechanics before strength training. If tissue restrictions exist due to reconstruction procedures, these too can be readily treated (once an appropriate amount of healing time has passed), which can greatly improve the overall outcome of these procedures. 

We encourage anyone with persisting side-effects from breast cancer treatment to address them with their healthcare team, as many common issues can be meaningfully improved, if not alleviated altogether.  Self-management strategies and hands-on therapy can make a significant difference in the day-to-day experience of these women.  We hope the information presented here and in the video serves both to inform and empower women to pursue the improvement of any side-effects they may be experiencing from their breast cancer treatment. 

Lindsay Davey is a Registered Physiotherapist who specializes in Cancer Rehabilitation and Lymphedema Treatment. Lindsay is the Owner and Clinical Director of Toronto Physiotherapy and is a well-known speaker and educator on the topics of lymphedema and cancer recovery.