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Breast cancer rehabilitation
This document outlines physiotherapy interventions for breast cancer rehabilitation. It discusses assessments and treatments for surgical cases, including management of pain, pulmonary complications, lymphedema, and range of motion issues. It also covers physiotherapy techniques during chemotherapy and radiation therapy, such as supervised aerobic exercise to improve outcomes. The primary physiotherapy approaches for lymphedema include manual lymphatic drainage, compression bandaging, and decongestive exercises as part of complex decongestive physical therapy.
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Breast cancer rehabilitation
- 1. BREAST CANCER REHABILITATION Dr.NidhiAhya (Asst Professor) Cardiovascular & Respiratory PT DVVPF College of Physiotherapy, Ahmednagar 414111 1 Dr.Nidhi( MPT-Cardio-Vascular & Respiratory PT)
- 2. Objectives Post operative assessment Physiotherapyintervention in surgical cases Physiotherapy interventions during chemotherapy Physiotherapy interventions during radiotherapy Dr.Nidhi( MPT-Cardio-Vascular & Respiratory PT) 2
- 3. Physiotherapy Intervention InSurgical Cases: Pre- Operative Assessment • Detailed History (Obsteritic & Gynecological h/o) • Chest assessment • Lung function tests (PFT) • Stage of cancer, extent of the disease • Surgical plan should be documented -length & duration of surgery, type of incision & details of the flap used for reconstruction • Assess the involvement of lymph nodes, posture, mobility • Checking of the Exercise capacity considering the patient’s tolerance 3 Dr.Nidhi( MPT-Cardio-Vascular & Respiratory PT)
- 4. Post- operative Assessment •Chest Assessment • Examination of Surgical site • Severity of Pain(NPRS) • Evaluation Of Posture and mobility • Lymphoedema Evaluation- Skin changes Girth measurement Levels- Volumetric Measurement- 9” above elbow Water displacement compared B/L 6” above elbow ( > 200ml taken as cut-off) 3” above elbow 6” below elbow 3” below elbow ( British Journal Of Surgery ,2000) 4 Dr.Nidhi( MPT-Cardio-Vascular & Respiratory PT)
- 5. Problem List: • Post-operative Pain • Pulmonary Complications • Lymphoedema • Decreased Shoulder Mobility • Weakness and Impaired Functional Control Of involved upper extremity • Posture Malallignment • Fatigue and decreased Endurance • Psychological Considerations 5 Dr.Nidhi( MPT-Cardio-Vascular & Respiratory PT)
- 6. Pain • Surgical pain •Neuropathic pain Management Options: • Drug therapy is the mainstay of pain management • Therapeutic applications of cold packs • High Frequency TENS has been proved to be effective (Duration-15 to 20 mins,twice a day uptill POD7) • Positioning and posture correction to avoid pain due to muscle spasm 6 Dr.Nidhi( MPT-Cardio-Vascular & Respiratory PT)
- 7. Pulmonary Complications • BreathingPattern • Effective Airway clearance • Symmetrical Lung Expansion 7 Dr.Nidhi( MPT-Cardio-Vascular & Respiratory PT)
- 8. Lymphoedema • Excessive andpersistent accumulation of extravascular and extracellular fluid and protien collection in tissue spaces • International Society Of Lymphology Classification for Lymphoedema Grade I : Swelling pits on pressure, reduces on elevation Grade II : Firmer, non-pitting skin, hair loss, skin texture changes Grade III : Elephantiasis- very thickened skin with loose folds 8 Dr.Nidhi( MPT-Cardio-Vascular & Respiratory PT)
- 9. Grade I GradeII Grade III 9 Dr.Nidhi( MPT-Cardio-Vascular & Respiratory PT)
- 10. Pathophysiology: Dissection of axillarylymph nodes causing interrupted lymphatic drainage Inability to clear protein concentration from interstitial spaces Disturbance of fluid- protein concentration across capillary membrane Increased fluid into interstitial spaces Excess load on lymphatic vessels exceeding capacity Lymphoedema 10 Dr.Nidhi( MPT-Cardio-Vascular & Respiratory PT)
- 11. Management Strategies: SkinCare Manual Lymphatic Drainage Compression Bandaging Decongestive Exercises • These strategies are incorporated together and termed as – Complex Decongestive Physical Therapy 11 Dr.Nidhi( MPT-Cardio-Vascular & Respiratory PT)
- 12. Manual Lymphatic drainage: •Manual Lymphatic Drainage was pioneered by Dr. Emil Vodder in the 1930s • It is a gentle manual technique which improves the activity of the lymph vessels by mild mechanical stretches on walls of lymph collectors Step 1:stimulate lymph node in non affected side of the trunk. Step 2 :edema fluid is pushed from congested quadrant of chest to quadrant free of edema Step3: trunk followed by proximal and then distal parts 12 Dr.Nidhi( MPT-Cardio-Vascular & Respiratory PT)
- 13. • A verylight pressure of <9 ounces per sq inch and rhythmic circular movements are given • In fibrotic tissue , greater pressure is applied , but not too much to cause redness • Sliding of the skin is not done , instead the skin is pushed and stretched • Following this there is a resting phase , where pressure is not applied but contact with the skin is sustained • This change in pressure creates a pumping effect 13 Dr.Nidhi( MPT-Cardio-Vascular & Respiratory PT)
- 14. • Starting atthe trunk bordering at the edematous area , slowly moving distally and ending with the hand • It is given for 45 mins twice daily • Various techniques- Pump Technique; Rotary Technique, Stationary circular strokes, scoop strokes 14 Dr.Nidhi( MPT-Cardio-Vascular & Respiratory PT)
- 15. Compression Bandaging • Thisprovides mechanical assistance to prevent re- accumulation of fluid post lymphatic drainage - Low stretch compression bandage - Pneumatic compression Device 15 Dr.Nidhi( MPT-Cardio-Vascular & Respiratory PT)
- 16. Decongestion Exercises • Active,non-resistant, repititive, ROM exercises • Role of exercises is based upon the fact that flow along the valved lymphatic vessels is stimulated by contraction of adjacent striated muscles • Excessive exercise may increase blood flow into the limb , possibly exacerbating the problem • Dynamic exercises prefered over static exercise 16 Dr.Nidhi( MPT-Cardio-Vascular & Respiratory PT)
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- 20. Physiotherapy Intervention during Chemotherapy: •Patients undergoing chemotherapy present with- Reduced exercise time Reduced VO2 Max Abnormal Heart rate response ST and T wave changes Exercise induced hypotension • Subacute sensory neuropathy has also been observed in patients undergoing chemotherapy 20 Dr.Nidhi( MPT-Cardio-Vascular & Respiratory PT)
- 21. • Exercise inChemotherapy: Aerobic exercise in the form of supervised daily supine bicycle ergometry to HR of 50% of calculated HRmax, for 5-15-minute intervals over a period of 30 mins- Benefits- Less pain Reduced decrement in treadmill performnce Reduced fatigue levels shorter hospitalization Better recovery 21 Dr.Nidhi( MPT-Cardio-Vascular & Respiratory PT)
- 22. Physiotherapy Intervention during Radiationtherapy • Prevent chest wall adhesions • Specific shoulder girdle exercises • Relaxation techniques • Aerobic conditioning 22 Dr.Nidhi( MPT-Cardio-Vascular & Respiratory PT)
- 23. ACSM Guidelines • Intensity– 55-85% of max HR or 40-75% of max heart reserve or 40-75% of max oxygen uptake • Duration – 20-60mins (minimum of 10mins, continuous bouts throughout the day) • Frequency – atleast 2days per week • Total exercise period - 6 week 23 Dr.Nidhi( MPT-Cardio-Vascular & Respiratory PT)
- 24. Summary Post operative assessment Physiotherapyintervention in surgical cases Physiotherapy interventions during chemotherapy Physiotherapy interventions during radiotherapy Dr.Nidhi( MPT-Cardio-Vascular & Respiratory PT) 24
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