Physical therapy important for women treated for breast cancer

The survival rate for breast cancer, the most commonly diagnosed cancer among women, is now about 90 percent, increased by nearly 20 percent since the 1970s.

With more women than ever – nearly 3 million – living beyond a breast cancer diagnosis, it’s important to consider how a woman lives after treatment. While many women with cancer are grateful to move on after treatment, the harsh treatments can cause problems for daily activities. These side effects persist or develop many years after diagnosis. Women need to be aware of these effects to watch out for them and get care before they become a problem.

Typically, women with breast cancer undergo some level of surgery. The least invasive is a lumpectomy, wherein only the tumor is removed and much of the breast tissue can be conserved. The second most invasive is a mastectomy, which involves the removal of all of the breast tissue. Typically, the most invasive of all is removal of lymph nodes in the armpit region, or something called a axillary lymph node dissection, on the side of the cancer.

These surgeries are often followed by intense chemotherapy and radiation therapy treatments. The results and side effects of the surgery and treatments can harm overall function and ultimately quality of life.

As a physical therapist and researcher, I have studied the effects of cancer and its treatments on daily function – especially arm use in women with breast cancer – for over a decade. The good news is that physical therapy can help women recover and return to full activity after cancer treatments.

Arms that won’t stop hurting

Surgical removal of lymph nodes places women at risk for a chronic condition that causes swelling, typically in the arms or legs called lymphedema, which affects anywhere from 10 percent to 30 percent of women, depending on the type of surgery and radiation treatment received.

Chemotherapies, especially a class of drugs called taxanes, often result in damage to the nerves in the hands and feet, or what is called peripheral neuropathies, or damage to peripheral nerves. This affects the balance – or vestibular – system and fine motor control, such as the ability to hold a pen or type on a computer. Impaired balance places people at risk for falls, a major cause of disability and death in people 65 and older. Taxanes and another type of drugs called anthracyclines can damage the heart, sometimes resulting in heart failure.

A woman is shown in a device that administers radiation therapy. Side effects of the treatment can persist for years. Mark_Kostich/
The amount of radiation that women receive during radiation therapy is less than for women treated years ago but still remains problematic. While radiation is often lifesaving, it comes with serious side effects that can persist for years after treatment. The tissues in the radiation field, or the area exposed to radiation, become stiffer and more fibrotic, or thickened, over time. This includes all tissues in the field, which sometimes includes the heart, in addition to the muscles and ligaments in the chest.

As tissues stiffen, women can experience a loss of motion, which can limit their ability to participate in sports, complete work or household chores and even their abilities to shower and dress. It can affect what may seem like simple things, such as fitting into a long-sleeved blouse or blazer.

Removing large numbers of lymph nodes, having more invasive surgery, and being overweight or obese places women at [risk for more late effects such as lymphedema] The problem with these risk factors is that there is no magic number: no magic number of lymph nodes, no magic weight. And, not everyone who has aggressive surgery ends up developing lymphedema. Also, even women who undergo the least invasive surgery, or lumpectomy, still can experience lymphedema.