Physiotherapy is an independent specialty that is concerned with medical treatment, supervision, and recovery. Such principles extend to the treatment of cancer patients in all phases of care and recovery, from diagnosis to the end of life. Physiotherapists perform regular assessment of the needs of this group of patients and their caregivers in order to apply professional strategies essential to the independence, functional ability and quality of life of patients. The physiotherapist ‘s position as an integral member of the multidisciplinary team is vital to the effective recovery and treatment of cancer patients and palliative care needs. The lack of physiotherapy activity will affect patient care and the patient / family’s ability to cope with the impact of the disease or its treatment on its functional potential and quality of life.1
Cancer and its various treatments are associated with a wide variety of distressing physical and psychological effects, which may affect patients for years after treatment has finished. Exercising will improve the quality of life for patients with cancer regardless of the form and stage of their illness. Inclusion of exercise driven by physiotherapy within cancer pathways can reduce and prevent impairment. Specialist physiotherapy may also relieve distressing symptoms such as lymphoedema and tiredness, which weakens 75-95% of all patients with cancer.
Evidence suggests exercise decreases the risk of recurrence and death from cancer. Mortality in stomach, breast and prostate cancer can be decreased by 50 per cent, 40 per cent and 30 % respectively. In addition, the incidence of disease was decreased by 57% in men with prostate cancer who had moderate intensity exercise three hours a week.
Excessive weight gain and loss may be an problem for many patients, depending on their cancer diagnosis, stage and form. Specialist physiotherapists are critical to maintaining good weight and to avoid muscle wasting in patients with cancer.
Physiotherapy prevents risks in future health, strengthens the body and can improve the ability of an person to return to work. Some cancer therapies can reduce the consistency of the bone leading to osteoporosis, an increased risk of fractures of fragility, pain and disability. Exercising physiotherapy may minimize bone loss and the risk of dropping in patients with low bone density.
Cancer patients may have pain control issues-physical, psychological , and spiritual. As a result, pain can lead to a vicious cycle of anxiety, inactivity and more impairment and hence increase the duration of stay in hospital. Physiotherapy has been shown to minimize the number of stays in hospital – with less nights as a doctor representing greater quality of life and cost savings.
How physiotherapy can help?
One of the main ways physiotherapy may benefit is treating cancer-related exhaustion, one of the most common side effects among those undergoing therapy. A physiotherapist may assess a patient, and decide exactly what problems they face. Addressing these issues may include strength training to compensate for any deteriorating muscles or bones; aerobic training to fix energy problems related to pacing and breathlessness; cardiovascular and endurance training; or kinesiology, movement science that can help patients learn how to resolve weaknesses and make the most efficient use of their physical abilities.
Managing pain is another critical area where physiotherapists can support almost any patient. There are many ways in which cancer can cause physical pain. That is where the cancer itself is found. The fact that decreased mobility can lead to stiffness in the joints or muscles is another. Peripheral neuropathy is a dysfunction of the nerves which causes pain due to damaged nerves. Physiotherapy should resolve these issues by treating them with therapies such as massages or mobilization therapy and by advising patients how to prevent pain.
Lymphedema, the swelling of body parts due to fluid accumulation, is another side-effect of some cancer treatments. Typically this occurs in the arms, or the cancer-affected body portion. This fluid is retained if the lymphatic system is damaged, which may occur due to surgery or radiation therapy, infection, or cancer itself due to scarring. Physiotherapists may resolve this by draining the fluid themselves, teaching the patient several exercises and using different strategies for bandaging.
While physiotherapy is not used to deal with the cancer itself, it can be a very useful way to help patients improve their quality of life. This is not only important for their mental health but also empowers them to pursue certain methods of coping with the cancer by giving them the strength and freedom. While the number of potential routes to cope with cancer may often seem daunting, physiotherapy may help patients develop a base of strength to follow as many of these alternatives as possible, enabling them to seek all possible routes to beat the disease.
Genitourinary complications: Incontinence and sexual dysfunction are normal for men undergoing treatment for prostate cancer and for women undergoing treatment for bladder or ovarian cancer. A professional physical therapist may help restore the intensity of the pelvic floor to enhance urinary continence and reduce the sexual function-related pain.
Neuromusculoskeletal Conditions Post Treatment:
Conditions of the neuromusculoskeletal system are normal following surgery. In view of this, a few things to remember need to be discussed briefly.
- Post-surgery mobility of the shoulder is usually impaired 2-4, so it is important that physiotherapy seeks to regain this to enhance patient functional capacity and to place the shoulder in the necessary radiotherapy positions.
- Active, active assisted, and passive Range of Motion (ROM) exercises are also good practice for the shoulder girdle. Physiotherapy would strive to restore full ROM in the shoulder and reduce associated morbidity in the upper extremity.5
- Manual therapy strategies have been shown to be of no major benefit when used in combination with intensive upper limb exercises to further improve the supply of ROMs.
Musculoskeletal Physiotherapy Interventions Post Surgery:
A physiotherapists treatment plan should include:
- Motional movements to enhance the extensibility of tissue and promote natural patterns of motion.
- Myofascial release to enhance mobility and the extensibility of tissues. 7-10
A physiotherapist may perform different types of manual therapy to treat those impairments. We cover the following:
- Joint mobilization techniques
- Soft tissue release techniques
- Neurodynamic techniques
Physiotherapy Interventions for Lymphedema:
Complex decongestive physiotherapy for lymphedema: This treatment includes skin care, manual lymphatic drainage, bandaging, exercises, and clothing support. Manual drainage of lymphoedema is a massage technique which only involves the surface of the skin. Which follows the lymphatic anatomical pathway. In general, the manual lymphatic drainage technique should start centrally in the neck and trunk to relieve any lymphedema in the main lymphatic pathway, thereby promoting the drainage in the arm. Complex decongestive physiotherapy was proposed as the preferred treatment for patients suffering from breast cancer. This treatment involves skin care, stretches, stretching, and the treatment of manual lymphedema. If conventional elastic compression was ineffective, complex decongestive physiotherapy has proven to be an effective tool for treating lymphedema. One research reported positive findings in 95 per cent of 400 patients reducing the volume of the affected extremity. A follow-up found that the outcomes of these treatments were sustained at 3 years.
Elevation: Elevation is widely used to provide the most effective therapy, along with other therapies. Most generally a multidisciplinary approach is used in the treatment of breast cancer where the patient is exposed to massage and exercise. A particular massage technique is usually applied called manual lymphatic drainage. Manual lymphatic drainage is a form of massage that is used to move oedema fluid from distal to proximal areas, and from stagnant areas to healthy lymphatics.
Compression: One method of treatment for lymphedema that has proven most effective in the treatment of patients with breast cancer is the use of standard elastic compression garments. Studies found substantial results using simple elastic compression therapy for lymphedema, where 34 percent of patients reported major reductions in arm oedema at 2 months and 39 percent of patients at 6 months. Even this result was used in patients over the age of 65.
Physiotherapy to prevent secondary lymphedema arising
- Stretching for muscles of the shoulder: Levator scapulae; upper trapezius; pectoralis major and the medial and lateral rotators of the shoulder
- Progressive active and active assisted shoulder exercises.
- Functional exercise activities.
- Proprioceptive neuromuscular facilitation exercises.
For patients with cancer, exercise is gradually being used as a treatment tool.12 It has become apparent in recent years that exercise has a key role to play in managing and avoiding chronic disease. Physical exercise has proved to be an effective alternative treatment to treat chronic long-term illnesses, and has been active in decreasing mortality and increasing overall quality of life. There is ample evidence to support the effects of breast cancer exercise both before and after chemotherapy.
Evidence has shown that physical activity and exercise are successful in enhancing quality of life ( QoL), cardiorespiratory health, physical functioning in patients with breast cancer and survivors.13 Compared to previous research, these research are evaluated in different components such as protection, aerobic fitness, muscle power, body size and shape, QOL, exhaustion, anxiety. Physical exercise has proved to be an effective alternative treatment to treat chronic long-term illnesses, and has been active in decreasing mortality and increasing overall quality of life.
A study of Corneya’s 12 existing literature provided an analysis of the impact of exercise on cancer studies. Twelve trials met the inclusion criteria, and the effects of exercise during breast cancer demonstrated statistically significantly beneficial results. More so, the studies showed benefits in terms of exercise efficiency, body weight and overall quality of life.
The American College of Sports Medicine (ACSM) addressed cancer survivor recommendations and independently reviewed findings during and after breast cancer. The ACSM compared breast cancer studies using the following headings; health, aerobic fitness, muscle mass, body size and composition, QOL, tiredness, anxiety.
How we can help?
Live video physiotherapy sessions with ZenOnco.io now allow people from all over the world to talk and consult with one of our physiotherapists in their own home privacy. It is suitable for people in remote areas, home loneliness, traveling people, or simply being physically unable to turn it into their normal physiotherapy.
They are a highly effective alternative to face-to – face in-room appointments, as we can assess, diagnose and assist you with exercises and rehabilitation programs through video.
You may also want to get a second opinion about your injury, or speak to someone who actually knows what they are doing. With the right exercises we will motivate you, correct your shape and technique as well as educate you about what to do next. You can get an online video assessment and inquire about your pain or injury with an initial appointment, as well as a tailored therapy plan specifically designed for you to support you through your recovery. You can also book video-consultations as needed.
The benefits of a physiotherapy treatment in ZenOnco.io consist of:
- Efficient pain control
- Comprehensive rehabilitation and recovery
- Flexible movement of the joints
- Win back your confidence, mobility, and stability
- Lesser dependence on others
- Better quality of life
Physiotherapy has moved to a next level, with an improvement in technology and state-of-the-art facilities. Several innovative treatments include:
- Post-surgical rehabilitation
- Total knee replacement program
- Neuromuscular rehabilitation
- Regular cerebral palsy therapy
Physiotherapy could not be the best option for all. Persons with reduced mobility and chronic pain often opt for surgery, rather than physiotherapy. We think surgery is an efficient way of treating the problem. Most physiotherapists nevertheless refer patients to physiotherapy as the first course of action.
- The Role of Physiotherapy for People with Cancer – CSP Position Statement. The Chartered Society of Physiotherapy, July 2003. Available at http://www.csp.org.uk/uploads/documents/csp_statement_physioandcancer.pdf.
- Dahl AA, Nesvold I, Reinertsen KV, Fosså SD. Original Article: Arm/shoulder problems and insomnia symptoms in breast cancer survivors: Cross-sectional, controlled and longitudinal observations. Sleep Med 2011;12:584-590.
- Freitas-Silva R, de Freitas-Júnior, R. ( 1 ), Conde DM(2), Martinez EZ(3). Comparison of quality of life, satisfaction with surgery and shoulder-arm morbidity in breast cancer survivors submitted to breast-conserving therapy or mastectomy followed by immediate breast reconstruction. Clinics 2010 / 06 / 01 /;65(8):781-787.
- Harrington S(1), Padua D(2), Myers J(2), Battaglini C(3), Groff D(3), Michener LA(4), et al. Comparison of shoulder flexibility, strength, and function between breast cancer survivors and healthy participants. Journal of Cancer Survivorship 2011 / 06 / 01 /;5(2):167-174.
- Todd J, Topping A. A survey of written information on the use of post-operative exercises after breast cancer surgery. Physiotherapy 2005;91:87-93.
- Amaral MTPd, de Oliveira M,Maia Freire, Ferreira NdO, Guimarães R, Vidigal, Sarian L, Otávio, Gurgel MSC. Manual therapy associated with upper limb exercises vs. exercises alone for shoulder rehabilitation in postoperative breast cancer. PHYSIOTHER THEORY PRACT 2012 05;28(4):299-306.
- McAnaw MB, Harris KW. The Role of Physical Therapy in the Rehabilitation of Patients with Mastectomy and Breast Reconstruction. Breast Disease 2002 12;16(1):163-174.
- Levangie PK, Drouin J. Magnitude of late effects of breast cancer treatments on shoulder function: a systematic review. Breast Cancer Res Treat 2009;116(1):1-15.
- EBAUGH, D., SPINELLI, B. AND SCHMITZ, K.H., 2011. “Shoulder impairments and their association with symptomatic rotator cuff disease in breast cancer survivors”, Medical Hypotheses. Vol. 77, pp. 481–487.
- Pacurar R, Miclaus C, Miclaus M. Morbidity associated with breast cancer therapy and the place of physiotherapy in its management. Timisoara Physical Education & Rehabilitation Journal 2011 05;3(6):46-54.
- Torres Lacomba M, Yuste Sánchez MJ, Zapico Goñi A, Prieto Merino D, Mayoral dM, Cerezo Téllez E, et al. Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial. BMJ (Clinical research ed ) 2010 / 01 / 01 /;340:b5396
- Courneya KS. Exercise in cancer survivors: an overview of research. Medicine & Science in Sports & Exercise 2003 11;35(11):1846-1852
- PANEL E. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. 2010.