Rehabilitation services can tremendously improve the quality of life of breast cancer patients. Many programs are now available through our department to help patients in returning to an independent lifestyle.
Cancer-related fatigue
Multiple studies have shown the benefits of exercise in overcoming or reducing the effects of cancer related fatigue. Physical and occupational therapists can evaluate a cancer patient for strength, neurological and functional deficits; and build a program based on the patient's capabilities. As a patient gets stronger we modify and adapt the program accordingly. We work with the patient to choose functional goals addressing their everyday needs. They may be quite simple, such as: “tolerates 20 minutes of playing with children”; “able to make it to the store and go food shopping”; or more advanced such as: “tolerates a three-mile hike.” An important aspect of goal setting involves working with the patient to see the future in terms of health and well-being and setting goals that are achievable. The greatest gain is when the patient begins to lose his or her sense of hopelessness and realizes that there are functional activities that he or she can participate in daily.
Some patients may be compromised to the extent that they are unable to accomplish tasks of daily living, such as tying shoes and showering. Occupational therapists can teach patients how to adapt their environment to their needs, allowing them to complete activities at a higher functional level.
Pain and decreased range of motion
A cancer patient may experience pain for a wide variety of reasons, and a therapist may choose a combination of techniques to help ease this pain. Examples include myofascial release, scar massage, joint mobilizations and exercise.
Myofascial release is a manual therapy technique that affects the connective tissue fibers and helps restore flexibility and function, while decreasing pain due to tightness. Scar tissue massage can also be quite helpful in decreasing sensitization to the surgery site.
Additionally, a therapist may use gentle joint mobilizations or manual ranging techniques to improve flexibility and joint function. Specific home exercise programs are created for each patient addressing issues of strength, range of motion and pain. These programs are designed to improve a patient's functional level and help him or her regain an independent lifestyle.
Lymphedema education
With the removal of lymph nodes, patients may be concerned about lymphedema. Physical therapists will educate patients on the anatomy and physiology of the lymphatic system and lymphedema risk reduction to decrease their fear of this diagnosis. Therapists are able to safely guide patients to continue with strengthening programs and daily activities that involve lifting, while understanding the signs and symptoms of lymphedema.
Lymphedema treatment
If a person appears to have lymphedema we determine the severity of the edema and perform manual lymph drainage, a massage that facilitates drainage of the edematous region. Bandaging or tensoshape is used for compression, depending on the patient's tolerance and level of commitment. Exercises are taught that utilize the muscle pump to decrease edema. Lastly, a patient is referred for a day-time permanent compression garment and/or nighttime sleeping foam garment as needed.
Aquatic program
Aquatic therapy can be a very comfortable transition to land-based exercise. Water is an effective medium for relaxation and many patients are amazed at what they can accomplish in the pool versus on land. Aquatics allow patients to gain greater flexibility and strength by working against water resistance, with the added benefits of increased circulation and decreased edema. If a patient is severely compromised, he or she can attend with a caregiver and they will be trained together in an appropriate program.
In summary, rehabilitation assists patients in regaining their quality of life and returning them to their highest functional level. For some patients, it may be as simple as restoring shoulder function, and for another it could be improving his endurance so he can resume normal activities. These skills are invaluable to the cancer survivor's sense of hopefulness and well-being, while supporting her treatment plan.
