Exercise Interventions for Upper Limb Dysfunction Due to Breast Cancer Treatment
Commentary: Talk to your doctor about pain, stiffness, swelling
By Renata Beaman
At the end of a breast cancer patient’s follow up appointment with her oncologist, as the doctor’s hand was on the doorknob, she asked, “I have pain in my shoulder and I have trouble reaching overhead … is it supposed to feel this way?” The answer is “No.” A question that was not asked was, “What can I do about it?”
A recent study stated that two thirds of women who were treated for breast cancer did not discuss their pain, decreased shoulder motion, or swelling with their healthcare providers. Another study revealed that 96 percent of patients surveyed had pain, stiffness, swelling and/or weakness after breast cancer treatment but only one third received physical therapy. Why are breast cancer patients not getting the help they so deserve?
Part of the problem stems from a lack of awareness: by the patient as well as by the medical professional. People are often not aware of or willing to acknowledge that they have a stiff and painful shoulder, or swollen breast, trunk or arm. They often just “deal with it” hoping it will get better, just wanting the whole cancer experience behind them. They want to move on with their lives, but become frustrated that they have ongoing pain, stiffness or swelling. Oftentimes even if recognized, people may not know where to turn for help.
A friend called me a few weeks ago after a bilateral mastectomy and told me: “Since the surgery I have been told minimal things about how little or how much I can do. My surgeon is done with me, my plastic surgeon says just ‘stretch’ and my oncologist says to sign up for LiveStrong at the local Y. I just need some parameters so I don’t do too little or too much.”
Physical therapists are trained to look at and correct faulty movement patterns, strength, stiffness and swelling. Some therapists receive special training in oncology, exercise, balance and lymphedema treatment. Recent research confirms that following surgery and/or radiation for breast cancer, muscle activity around the shoulder is altered and may place some people at a higher risk of shoulder pain. The most common complaints are an inability to lay on the affected side, difficulty reaching overhead, pain reaching into the back seat of a car or behind the back, and swelling, or lymphedema.
I have worked with cancer patients for over 10 years and am always shocked when patients come in to my clinic after being shuffled inefficiently through the system. One of my patients told me “you are the third physical therapist I have been to for shoulder pain and the first to look at my scars.” Another, a medical professional, was not aware that she lacked 40 degrees of motion in her shoulder. We were able to help both people – but why they had to live for so long with these problems is what we are trying to address now.
We need to recognize that breast cancer patients deserve the full continuum of care. We need to improve communication between patients, doctors, nurses and therapists. We need to help return people to their prior level of function.
If you are one of these women or men, have a conversation with your doctor about any pain, stiffness, or swelling you may have. Ask your doctor for a prescription to a physical therapist with experience in oncology and/or lymphedema. You may be able to refer yourself to a physical therapist if your insurance does not require a doctor’s referral. Ignoring the problem and hoping it will go away – well, that is just unacceptable. It’s not just about life and survivorship, it’s about quality of life.
Renata Beaman of Eden Prairie is a physical therapist at OrthoRehab Specialists in Eden Prairie and Edina. She can be reached at (952) 922-0330.
