Receiving a cancer diagnosis can have a profound impact on a patient’s life and that of their loved ones. As a physical therapist, you may choose from many specialties; however, the demand for physical therapists that specialize in breast cancer recovery is growing exceptionally fast. According to statistics, approximately 408,440 new cases of cancer of the breast are diagnosed annually. This figure includes invasive forms, non-invasive forms, and breast cancer diagnosed in men. In 2024, it is expected that 42,250 people in the United States, alone, will die as a result of breast cancer. Even more will successfully recover from breast cancer. If you have an interest in specializing in breast cancer recovery as a physical therapist, continue reading to learn more about this career.
Why is Physical Therapy Now Part of the Breast Cancer Recovery Plan?
Physical therapy is now part of the breast cancer recovery plan because of the fact that surgery, radiation treatments, and chemotherapy may result in side effects that may negatively impact a patient. As a physical therapist in this field, you will help in the reduction of bone pain, and pain in the joints, fatigue that naturally occurs with most treatments, the formation of scar tissue, and/or the development of Axillary Web Syndrome and Lymphedema. You may also assist in the elimination of the headaches that patients experience with chemotherapy.
Oncology Physical Therapy
If you specialize in breast cancer recovery, you will be considered an oncological physical therapist. Many patients have a swift recovery following surgeries associated with breast cancer; however, there are those that will have issues in moving their arms, experience mild degrees of weakness, and may suffer from swelling. By having physical therapy as soon as possible after surgery, many of these issues may be eliminated.
When you begin working with the patient, you will start by conducting a comprehensive evaluation that focuses on any complaints of pain, the patient’s range of motions, their posture, and the movement of their joints, as well as making assessments associated with the healing process. You may also have to help the patient with techniques on the prevention of Lymphedema – which always happens when lymph nodes are surgically removed for testing near the cancer that is removed.
Why Does Lymphedema Happen After Breast Cancer Surgery?
During the surgery for breast cancer, the lymph nodes located near the cancer are often removed to be tested. When this happens, the flow of the lymph throughout the body is then disrupted. In turn, this leads to swelling. It can impact a single arm, both arms, the head, the neck area, and/or the belly, the genitals, or the legs. Over time, the swelling has the potential to become severe. It may result in the development of skin sores and/or other types of problems. The areas that are affected are very likely to become infected. If the lymph nodes under the arm are removed from the body, it is likely that the patient will have lymphedema for the rest of their life. It could develop immediately following surgery and/or radiation treatment. For many women, the issue only occurs many months or years later.
Is it Possible to Prevent Lymphedema?
For patients that have very good skin care and engage in exercise after their breast cancer treatment, there is a lower risk of developing lymphedema. Additionally, advancements in lymph node surgery have helped in offsetting the risk of developing lymphedema. As of 2024, there is no 100% sure way to prevent the issue from developing, unfortunately.
The Different Types of Lymphedemas
There are many different types of lymphedemas. They are outlined below:
- Many get mild lymphedema which starts to develop a few days after the surgery and only lasts for a short time.
- It is possible for lymphedema to happen about 4to up to 6 weeks following surgery or any radiation treatment received and then it is possible for it to go away, eventually.
- A common form of lymphedema is painless and is known to develop slowly – sometimes up to 2 years – following surgery and it does not improve without treatment.
What are the Symptoms of Lymphedema?
The main symptom that lymphedema produces is swelling of the arm on the side where the lymph nodes were taken out of the body. Swelling amount may vary. Many have severe swelling and this causes the arm to be many inches larger than the opposite arm. Other patients will have only mild swelling. The other symptoms of the condition include the following:
- Feeling as if the affected area id full, tight, and/or heavy.
- Clothing, jewelry, and undergarments not fitting right.
- Pin or aching in the arm.
- Complications in moving and/or bending a joint that is affected in the hand, wrist, or the elbow.
- Swelling within the hand.
- Changes in the skin.
- Weakness in the arm.
If these symptoms are experienced, your patient must contact their doctor immediately. Treatment must be started to prevent the issue from getting worse. In addition to this, you may advise your patient on exercises that may be performed that will help in alleviating the symptoms associated with lymphedema.
What Treatments Are Given for Lymphedema?
The treatment that has to be right for your patient and how severe their condition is. The ultimate goal of treatment is to help in the prevention and the management of the condition. As a physical therapist, you will likely recommend the following treatments for your patient:
- Exercises that are known to improve the drainage of the lymph system.
- Wearing compressions sleeve or elastic bandages to aid in the movement of the fluid or prevent fluid from accumulating in certain areas of the body.
- Eating a healthy diet that is designed to control the weight.
- Ensuring that the arm stays raised above heart level because this will help to drain the fluid through the use of gravity.
- Massage therapy to help move the fluid out of the area that is experiencing swelling.
Tips You Can Give Your Patients for Lymphedema as a Physical Therapist
- Exercise – You should encourage your patients to exercise as the physical activity helps to improve the drainage of lymph in the body.
- Diet – A core component of treatment is to ensure that the patient follows a healthy diet and that they focus on managing their weight.
- Raising the Arm – The patient should raise the arm above the level of the heart whenever they are able to as that helps to drain the fluid.
- Bandages – The patient should be advised to wear either an elastic bandage or a compression sleeve. These help in moving the fluid and preventing the accumulation of fluid within the arm.
- Massage Therapy – You may specialize in massage therapy and massage the patient’s arm so that the fluid is moved out of the swollen area in the arm.
- Infection Prevention – The patient should be informed of the importance of protecting the skin in the area that is affected so that it does not become dry, cracked, experience breakdown, and/or become infected. You may advise the patient on how to properly care for the nails and/or the skin or refer them to their healthcare provider for information on this.
Educating the Patient on Infection and Injury Prevention
It is highly important to protect the arm on the side where the surgery occurred. If the drainage of the lymphatic system is poor, it can result in the development of infection of the arm and the arm may become more prone to injury and less sensitive to, say, extreme temperature. You may provide the following tips to your patients on preventing infection and injury to the affected arm:
- If blood has to be drawn, or if injections have to be done, advise the patient to have it done on the unaffected arm.
- Blood pressure tests should be done on the arm that is not affected by lymphedema.
- If the patient has to carry something – like a bag, suitcase, or a package – advise them to carry with the arm that does not have lymphedema
- Sunburns, burns, and other types of injuries should be avoided to that arm impacted.
- When using cleaners or gardening, gloves should be worn.
- The skin of the impacted arm should be cleaned daily and completely dried in a gentle manner and lotion should be applied.
- Nothing tight – such as bracelets, watches, tight bands, or elastic cuff should be worn on the arm with lymphedema.
- Only healthy foods that are low in sodium should be consumed.
- Fingernails should be well cared for and the cuticles should not be cut.
- If any cuts happen on the affected arm, they should be cleaned with antibacterial soap and water, dried. Then, an antibacterial ointment should be applied, followed by a sterile dressing.
- Movements that are repetitive or require the patient to push or pull should be avoided.
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If you are a physical therapist that is interested in having a multitude of resources, tools, and networks available to you, join us here at Colorado Physical Therapy Network today. To learn more, contact us at: 303-757-7004
