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
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,"
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
"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
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