The APTA Oncology Section will host “Breast Cancer Rehabilitation,” presented by Barbara E. Nicholson, PT, MSPT, CLT-LANA, October 1-2, 2011 at Kadlec Medical Center, Richland, Wash. The course is open to PTs, PTAs, OTs and OTAs who are interested in working with patients who have breast cancer or are already working with this population because of shoulder dysfunction.
Attendees will receive 1.6 CEUs, 16 contact hours, for attendance. Registration closes Sept. 9, 2011 and costs $475 for section members, $525 for other APTA members and $600 for nonmembers.
Here are some thoughts from Nicholson on how PTs can help improve the lives of breast cancer survivors.
Physical Therapists Help Improve the Lives of Breast Cancer Survivors
Barbara E. Nicholson, PT, MSPT, CLT-LANA
There are 2.6 million breast cancer survivors in the United States. These courageous women are mothers, friends, sisters, wives, partners, daughters and grandmothers. They will see surgeons, oncologists, radiation oncologists, nurses, social workers, integrative medicine physicians and physical therapists. The side effects of breast cancer treatment can create functional and physical impairments that can keep these women from doing activities that bring joy to their lives. It can be the mother who does not have the strength to lift her child, the athlete who wants to return to her sport or the woman who needs her arm strength to return to work. As PTs we can assist in decreasing the side effects of cancer treatment that can lead to frozen shoulder, pain, upper extremity weakness and lymphedema.
Axillary web syndrome can occur one to eight weeks after the surgical removal of axillary lymph nodes for breast cancer staging. This disorder is characterized by fibrous bands or cords that originate in the axilla and may extend to the wrist or palm. Cording is palpable when the shoulder is in 90 degrees of abduction. 2 These cords have been found to consist of sclerosed lymphatic vessels and veins. Women with axillary web syndrome will complain of pain or they may have difficulty lifting their hand above their head. Shoulder range of motion will be most limited in abduction. In physical therapy treatment we can educate them on the benign nature of this process, teach gentle shoulder and trunk exercise and perform myofascial release techniques to decrease cording. This treatment can help decrease painful guarding that may lead to frozen shoulder.
Six to twelve months after breast cancer surgery 50 percent of women report shoulder range of motion restrictions. Breast reconstruction can also contribute to limited shoulder range of motion. Expanders or implants placed under the pectoralis muscle can cause an anterior pull of the scapula, changing the scapulo-humeral rhythm and creating impingement.
Radiation treatment can cause fibrosis in the pectoral muscles increasing tension over the expander or implant. These physical changes can be reduced with rotator cuff and postural muscle strengthening, stretching, joint mobilization and myofascial release techniques.
Breast cancer related lymphedema may occur after the removal of axillary lymph nodes. The reported incidence of this lymphedema ranges from 7 to 47 percent. Risk factors depend on the number of axillary lymph nodes removed, radiation treatment, infection and body mass index. Lymphedema may affect the upper extremity, trunk and breast. It can cause achiness, decreased shoulder motion, weakness, difficulty wearing clothes and self-esteem issues. Recent research is beginning to show that early treatment of lymphedema can decrease the progression of this chronic condition and allow the patient improved function and mobility.4
Working with women with breast cancer is an extremely rewarding experience for both the practitioner and the patient. Physical therapy plays an important role in improving the quality of lives of women who are healing from breast cancer. Our techniques greatly improve shoulder range of motion, strength, tissue mobility and decrease lymphedema, allowing patients to gain trust in their ability to heal and strengthen their bodies again. If you are interested in learning more about working with breast cancer survivors, the Oncology Section of the American Physical Therapy Association is offering a course in Richland, Wash. October 1-2, 2011. For more information and to register please visit www.oncologypt.org.
 SEER Cancer Statistics Review Bethesda , MD: Nation Cancer Institue, http://seer.cancer.gov/statfacts/html/breast.html#survival
 Moskovitz A, Anderson B, Yeung R, Byrd D, Lawton T, Moe R.: Axillary web syndrome after axillary dissection. Amer J Surg 2001; 181: 434-439
3 Thomas- MacLean RL, Hack T, Kwan W, Towers A, Miedema B, Tilley A.: Arm Morbidity and Disability After Breast Cancer: New Directions for Care. Journal Club. Oncology Nursing Forum 2008; VOL 35, No 1:65-71
4 Stout-Gergich N, Pfalzer L, McGarvey C, Springer B, Gerber L, Soballe P: Preoperative Assesment Enables the Early Diagnosis and Successful Treatment of Lymphedema. Cancer 2008; VOL 112, No 12.