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Surviving breast cancer has been the main focus of treatment until recent years, when attention has begun to wane, as it seems to be the case for these three women. Credit: fitzcrittle / Shutterstock.com
The survival rate for breast cancer, the most commonly diagnosed cancer in women, is now about 90%, up nearly 20% since the 1970s.
With more women than ever – nearly 3 million – living beyond the diagnosis of breast cancer, it's important to think about how a woman lives after treatment. While many women with cancer are grateful to move forward after treatment, harsh treatments can pose problems for daily activities. These side effects persist or develop several years after the diagnosis. Women need to be aware of these effects to monitor and seek care before they become a problem.
As a rule, women with breast cancer undergo some degree of surgery. Lumpectomy is the least invasive. Only the tumor is removed and a large part of the breast tissue can be preserved. The second most invasive is a mastectomy, which involves taking all the breast tissue. Generally, the most invasive of all is the removal of lymph nodes in the armpit area, or something called a dissection of the axillary lymph nodes, on the side of the cancer.
These surgeries are often followed by intensive chemotherapy and radiotherapy treatments. The results and side effects of surgery and treatment can affect overall functioning and, ultimately, quality of life.
As a physiotherapist and researcher, I have studied the effects of cancer and its treatments on daily function – particularly the use of arms in women with breast cancer – for longer periods of time. a decade. The good news is that physical therapy can help women recover and resume full activity after cancer treatment.
Weapons that do not stop hurting
Surgical removal of the lymph nodes exposes women to a chronic condition that causes swelling, called lymphoedema, usually in the arms or legs, which affects 10 to 30% of women, depending on the type of condition. operation and radiotherapy.
Chemotherapy, particularly a class of drugs called taxanes, often result in nerve damage in the hands and feet, peripheral neuropathies, or peripheral nerve damage. This affects the balance system – or vestibular – and control of fine motor skills, such as the ability to hold a pen or text on a computer. A deficient balance puts people at risk of falling, the leading cause of disability and death for people 65 years of age and older. Taxanes and another type of medicine called anthracyclines can damage the heart, sometimes leading to heart failure.
The amount of radiation that women receive during radiation therapy is lower than that of women treated years ago, but remains problematic. Although radiation often saves life, it has serious side effects that can persist for years after treatment. Tissues in the radiation field, or the area exposed to radiation, become stiffer and more fibrotic or thicken over time. This includes all the tissues present in the field, including sometimes the heart, in addition to the muscles and ligaments of the chest.
As tissues stiffen, women may experience loss of movement, which may limit their ability to participate in sports, perform household chores at work or domestic, and even shower and swim. # 39; dress. This can affect what may seem like simple things, like a blouse or a long-sleeved blazer.
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A woman is shown in a device that administers radiation therapy. Side effects of treatment may persist for years. Credit: Mark_Kostich / Shutterstock.com
The removal of a large number of lymph nodes, the use of more invasive surgery and overweight or obesity expose women to later 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 all aggressively operated patients do not develop lymphedema. In addition, even women undergoing the least invasive surgery, or lumpectomy, may still have lymphedema.
New treatments and emerging approaches
Many of these side effects can be prevented or managed effectively, but only if they are treated quickly. The prospective surveillance model is a model of care that presents substantial evidence of effectiveness. This method advocates basic tests prior to cancer surgery, followed by interval monitoring after surgical and medical treatments. In carrying out the basic tests, any deficiency likely to affect the effectiveness of the medical treatment, in particular to be able to assume the necessary position for the radiotherapy, can be treated before the treatment of the cancer.
And the measures taken during this visit become the reference against which follow-up visits are taken into account. While this is not yet the standard of care, many of us who work with breast cancer survivors and physical therapists hope this will happen one day. Just as people consult a dentist twice a year for preventive exams, people with breast cancer undergo periodic exams performed by a physiotherapist after treatment, to make sure that the healing is not avoided. Tracking individuals periodically after surgery and medical treatments allows early detection of problems, so the intervention can treat these small problems before they become big problems.
An example is the development of lymphedema. In a study of 196 women diagnosed with breast cancer, women with a difference in arm size of 3% compared to the start of treatment received a compression garment and taught self-management and the massage of the member. Early intervention reversed the development of lymphoedema and these gains were maintained even four to five months after the intervention.
Although the ideal practice model addresses the problems before they occur, many women are treated in systems without this model and are instead treated after surgery, radiation therapy or chemotherapy treatment.
Physiotherapists also play an important role in the treatment of side effects that occur after treatment. Physiotherapists are movement experts and are well qualified to treat strength, movement and balance deficits.
This includes restoring function after breast cancer treatment. Many studies have examined the safety of physical activity after treatment for breast cancer and have revealed that the risk of developing lymphedema is minimal with most exercises.
As part of a large trial, 154 women at risk of lymphedema participated in a program of progressive strengthening exercises with no maximum weight limit. Women who participated in bodybuilding exercise developed lymphedema at a lower rate than the population without exercise. In a small pilot study examining the impact of yoga on arm volume in women with lymphedema, all participants found a decrease in arm volume after an eight-week program.
Physiotherapists also play an important role in the treatment of lymphedema. Many physiotherapists have specialized training in lymphedema management and are certified lymphedema therapists. These specialized practitioners use lymphoedema-specific massage, bandages and compression garments, and exercise to treat lymphoedema.
With 2.8 million women living beyond a cancer diagnosis in the United States, it is important to return to previous activity levels. The early intervention and ongoing surveillance advocated by the prospective surveillance model ensure that these women can find what is important to them, life.
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