PORi oncology and breast cancer rehabilitation therapist, Gabriella Kourie, highlights lymphoedema and the importance of rehabilitation.
For many years the primary care for cancer patients has been focused on chemotherapy, surgery or radiation to remove a tumour. However, there is an important aspect of treatment that is often overlooked: rehabilitation.
The journey of treating cancer, breast cancer in particular, can leave many patients with painful symptoms and side effects that rehabilitation could help ease. One of the more common secondary side effects associated with breast cancer is the onset of lymphoedema.
What is lymphoedema?
Lymphoedema is the abnormal build-up of excess fluid in soft tissue that is caused by a blockage or gap in the lymphatic system. The main function of the lymphatic system is to help fight infection and other diseases by carrying lymph throughout the body. Our lymph travels throughout the body via a network of thin tubes called lymph vessels.
Most common causes of lymphoedema in breast cancer survivors
- Surgery: during which lymph nodes may be removed causing a gap in the lymphatic system.
- Radiation: the main effect of radiation being inflammation which places tension on the lymphatic system.
- Blockage on the lymph nodes and/or lymph vessels by the cancer.
Undergoing procedures, such as surgery and/or radiation, can put a patient at risk of developing lymphoedema. It can develop immediately after surgery or it may occur months after treatment (usually six to eight weeks).
The onset of lymphoedema may begin slowly and isn’t always easy to detect. Sometimes the only symptoms may be aching or heaviness in the affected limb. Other times, it may begin more suddenly.
Lymphoedema can trigger anywhere in the body, however, it most commonly occurs in the extremities (arm on the side where surgery and/or radiation was performed), the operated breast or on the front and sides of the chest wall.
Symptoms specific to the breast cancer patient include feelings of heaviness or achiness in the arm of the affected side, feelings of fatigue or weakness in the arm, numbness and tingling, and changes in the way jewellery, clothes and bras may fit.
It’s important to know what the warning signs of lymphatic strain are, and to contact a lymphoedema trained occupational therapist (OT) or physiotherapist to start therapeutic intervention as soon as possible.
Treatment
The aims of treatment will be to: prevent the onset of swelling, or prevent the already present swelling from getting worse; aid the lymphatic system in lymph flow and drainage; address any of the psychological aspects of lymphoedema a patient may be facing as well as improving the quality of life.
The most important factor when choosing a therapist is to ensure that they are trained in the field of oncology rehabilitation as well as lymphoedema management. Both OTs and physiotherapists are eligible to train and qualify in this field.
OT and physiotherapy are both beneficial to the breast cancer patient. The difference between OT and physiotherapy is that OT focuses more on improving the patient’s ability to perform their daily activities, addressing the physical, cognitive and social aspects that are applicable to the patient. While physiotherapy focuses on improving a patient’s ability to perform a movement.
According to WHO, OT and physiotherapy both aim to improve a patient’s overall functioning and quality of life. Both types of therapy also provide hands-on care tailored to the patient’s individual needs as well as goalsetting to assess the patient’s progress and how to achieve their goals.
There can even be some overlap in the tasks performed. For example, OTs may also teach stretches or exercises and physiotherapists may work on movements to help the patient with daily activities, such as dressing in an adapted manner.
Through evidence-based practice, it has been proven that patients with breast cancer have greatly benefitted from rehabilitation services, during and after treatments. There are various problems that rehabilitation can address, with lymphoedema being only the tip of the iceberg.
References
Kyle Urban. Michigan Medicine: University of Michigan. (2020). 5 Reasons Rehabilitation Care Is Important After Breast Cancer.
PORi – PHYSIOLOGICAL ONCOLOGY REHABILITATION INSTITUTION. (2021).
MEET OUR EXPERT – Gabriella Kourie
Gabriella Kourie is a qualified occupational therapist. She further trained and qualified as a PORi oncology and breast cancer rehabilitation therapist and is currently qualifying in Lymphoedema Assessment and Treatment.