Physiotherapy after breast cancer

Key Points

1. Current medical management: Breast cancer treatment often involves surgery, radiation therapy, chemotherapy, endocrine therapy, and targeted therapy.
2. Common side effects: Treatments can lead to pain, upper limb dysfunction, and cancer-related fatigue (CRF).
3. Physiotherapy management: Physiotherapy plays a crucial role in managing these side effects, improving patients’ quality of life.
4. Clinical implications: Understanding the side effects and appropriate interventions helps clinicians tailor treatments to individual patient needs.
5. Study limitations: The reviewed studies often have methodological limitations, impacting the generalisability of their findings.

Physiotherapy after breast cancer

This blog discusses the comprehensive management of breast cancer and the critical role Physiotherapy plays in addressing treatment-related sequelae. It focuses on the various medical and physiotherapeutic interventions available and their effectiveness in managing common side effects like pain, upper limb dysfunctions, and CRF. The article emphasises the importance of an integrated approach to care, combining medical and therapeutic interventions to enhance patient outcomes.

Current medical management of breast cancer

Breast cancer treatment typically includes:

• Surgery: Removal of the tumour through procedures like lumpectomy or mastectomy.
• Radiation Therapy: Use of high-energy radiation to eliminate remaining cancer cells.
• Chemotherapy: Cytotoxic drugs targeting rapidly dividing cancer cells.
• Endocrine Therapy: Hormonal treatments like aromatase inhibitors and tamoxifen.
• Targeted Therapy: Drugs targeting specific proteins like HER2 to inhibit cancer cell growth.

Common side effects of breast cancer treatment

Breast cancer treatments can lead to several side effects:

• Pain: Acute and chronic pain in the breast, chest wall, and upper limb regions.
• Upper Limb Dysfunctions: Issues like decreased range of motion, muscle strength, and persistent pain especially after a mastectomy.
• Cancer-Related Fatigue (CRF): Persistent tiredness not proportional to activity levels, significantly impacting daily functioning.

Physiotherapy management of breast cancer-related sequelae

Pain management

• Manual Therapy: Techniques like massage and myofascial release have shown mixed results in pain reduction.
• Exercise Therapy: Specific and general exercise programmes can help manage pain and improve upper limb function, especially when supervised.
• Mind-Body Exercises: Activities like yoga and tai chi have shown benefits in managing pain and improving overall well-being.

Upper limb dysfunctions

• Manual and Myofascial Therapy: May provide limited benefits, particularly in the early postoperative period.
• Specific Exercise Therapy: Critical in restoring shoulder mobility and function post-surgery.

Cancer-related fatigue (CRF)

• Education: Helps manage fatigue, although the benefits are often short-term.
• General Exercise: Aerobic and resistance exercises, particularly when supervised, can significantly reduce CRF.
• Mind-Body Exercises: Yoga and tai chi can improve CRF and enhance sleep quality.

Physiotherapy treatment modality and outcomes

Conclusion

The study concludes that integrating Physiotherapy into breast cancer treatment protocols significantly improves patients’ quality of life. Effective management of pain, upper limb dysfunctions, and CRF requires a comprehensive approach combining education, exercise, and manual therapies. However, the quality of evidence varies, and further high-quality research is needed to establish definitive guidelines.

Implications for patients

As a patient, understanding the potential side effects of breast cancer treatment and the role of Physiotherapy can help you make informed decisions about your care. Engage with your Physiotherapist to tailor a Physiotherapy programme that addresses your specific needs, particularly in managing pain, improving limb function, and reducing fatigue.

Implications for Physiotherapists

Physiotherapists should consider integrating these evidence-based interventions into their practice to improve patient outcomes. Understanding the limitations and benefits of each modality can enhance clinical reasoning and patient management strategies. Special attention should be given to the timing and supervision of exercise interventions to maximise their effectiveness.

Ref:
Devoogdt, N., & De Groef, A. (2024). Physiotherapy management of breast cancer treatment-related sequelae. Journal of Physiotherapy, 70(2), 90-105.

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