Physical therapy helps cancer patients bounce back
Spokesman-Review (Spokane, WA)
May 21--To Susana Soth, the scar tissue from her mastectomy six weeks ago feels like a rubber band wrapped tight around her chest. But the band is loosening, she said, thanks to help from her physical therapist.
And she's hopeful that by loosening up that tissue, she'll be able to maintain as much mobility in her arm as she can even after she undergoes radiation as part of her breast cancer treatment.
Physical therapy can help cancer patients regain motion after surgery, heal wounds and combat uncomfortable swelling. But it's sometimes overlooked, said Bill Olson, a Spokane physical therapist who treats Soth and other cancer patients during and after their treatment.
While insurers usually cover physical therapy for cancer patients, other hurdles can prevent patients from accessing therapy, Olson said -- including the stress and exhaustion often related to cancer treatment.
It's easy for cancer patients to get overwhelmed by chemotherapy appointments, surgery and radiation -- and the medical fallout of each. Cancer's tendency to disrupt patients' lives in other ways and the cognitive impairment that many survivors call "chemo brain" are other roadblocks.
For some people, treatment becomes a "huge, growing snowball," said Patty Williams, a registered nurse at Cancer Care Northwest in Spokane. Even when care providers refer patients to physical therapy, many forget or make it a low priority, she said.
Yet, by necessity, cancer treatment is often a destructive process, Williams noted. Surgery and radiation for breast cancer create scar tissue, which can cause tightness in the chest and sometimes contribute to mobility loss in the shoulder and arm. The removal of lymph nodes can cause fluid buildup and swelling in the arms and legs called lymphedema. Deep tissue surgery in patients with melanoma skin cancer can lead to nerve damage and scar tissue that leaves muscles trapped, causing patients to walk with a limp.
Nearly 25 percent of adult cancer survivors reported poor physical "health-related quality of life" after their treatment, compared with 10 percent of adults without cancer, according to an analysis of data from the 2010 National Health Interview Survey.
Patients are "left with this legacy of their treatment," said Olson, of Spokane Physical Therapy at Riverpoint. "Great, you survived your cancer -- but now you can't use your arm."
Patients' range of arm and shoulder motion after surgery depends on the severity of the operation, said Dr. Carol Guthrie, medical director at the Spokane Breast Center at Providence Cancer Center. Cancer may require a lumpectomy or a mastectomy along with the removal of some or most of the lymph nodes under the arm.
While she instructs her patients on exercises to help them regain their range of motion in their arms and shoulders after they're done healing, she asks them to call for a physical therapy referral if they don't see improvement.
"Not that many people do, and I don't know whether it's because they all get (mobility) back or they're all caught up in their cancer treatment and it's good enough -- they can do what they need to do," Guthrie said.
More often, Guthrie refers patients to physical therapy to learn drainage and massage techniques to address lymphedema.
"There's not a lot of data that says you can prevent it, but I think it helps for people to know the exercises, be concious of it, have education about activities so they aren't limiting what they do out of fear of lymphedema," Guthrie said.
The swelling can grow severe, usually in one arm or leg and usually as a side effect of cancer treatment.
To intervene, physical therapists use compression bandages or garments; drain the fluid using therapeutic massage; and talk to patients about modifying their activities to control the swelling.
Soth, a 42-year-old mother and 20-year registered nurse, knows how difficult cancer treatment can be.
The Spokane resident had been getting annual mammograms since age 37, but it took an ultrasound to spot the tumor in her breast. Incorporating strategies prescribed by her naturopath, Soth embarked on treatment, starting with aggressive chemotherapy to shrink the tumor before surgery.
The chemo left her with an abnormally low count of white blood cells to fight off infections. Hospitalized with a staph infection, she got sepsis, a potentially fatal condition.
Now, as Soth recovers from her mastectomy before undergoing radiation, she's added another level of care, regular visits to Olson's office. By breaking up the scar tissue on her chest, he's reducing the pressure she feels along with the pain in her arm. By easing the tension on her skin, physical therapy is also benefiting her slow-to-heal surgical wound, she said.
As a nurse, Soth has seen a lot of pain and suffering. She said she believes an interdisciplinary approach to care would help reduce it for cancer patients, including physical therapy to help cancer survivors regain physical well-being.
"The traditional model, I think, is very important, but there are things we can do to complement it to make patients feel better," she said.
Guthrie, the surgeon, said she views breast cancer as an "entire-body experience."
"We definitely get very focused on eradicating the disease, either through a combination of surgery, radition chemotherapy, medications, long-term hormone-blocking medications," she said. "But it does impact the entire body and it is important to make effort to restore the person as close to normal as possible."
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