• 6 Essential Reasons To See A Cancer Physiotherapist

Want to thrive, not just survive your cancer? Did you know that a cancer physiotherapist can help you throughout all stages of your cancer diagnosis, treatment and recovery, such as improving your range and pain, managing your side effects (such as fatigue).

1 in 2 males and 1 in 3 females will be diagnosed with cancer by their 85th birthday and there is estimated to be over 385,000 Australians living with cancer1. Cancer survival rates have dramatically increased over the past 40 years and yet cancer survivors are still living with the side effects of their cancer and cancer treatments when there are options out there to help.

These just some of the reasons seeing a cancer physiotherapist is essential – from just after diagnosis all the way through to remission and beyond.

1: Relief from pain and muscular tension

This is bread and butter for most physiotherapists, even if your pain is not the result of a sporting injury. Pain is one of the most commonly reported side effects from cancer, with 80-100% of cancer survivors experiencing pain at some stage of their recovery and 5-10% go on to suffer with ongoing chronic pain that is affecting their function and quality of life2. You don’t need to simply accept cancer pain, it can be helped!

Sources of pain vary depending on your type and location of cancer and treatments involved. Whether it is pain from your surgical scar, neck pain and headaches from posture and stress of the treatments, or shoulder pain from lack of mobility and muscle tightness after breast cancer or reconstruction, your cancer physiotherapist will have plenty of tools and techniques available to help alleviate your symptoms drug-free. Your physiotherapist may use some gentle manual therapy techniques, acupuncture, massage and gentle stretches and exercises among others, to get you feeling more comfortable.

Neck Pain and Headaches can be a side effect


Neck Pain and Headaches can be a side affect

If you are going down the operative route, see a cancer physiotherapist as early before your surgery as possible to get the ball rolling with your recovery and improve your levels of pain and muscular tension post operatively from the get go. Your cancer physiotherapist will be able to screen your whole body and in particular, the joints likely to be affected by your surgery and you can get some stretches, strengthening exercises or other strategies to help you minimise your pain post operatively.

Some people undergoing chemotherapy drugs (such as taxanes, platinum agents, vinca alkaloids and thalidomide) experience chemotherapy-induced peripheral neuropathy (CIPN) due to damage to peripheral axons and nerve cell bodies. This can cause pain and sensory impairments including numbness, tingling, burning and other abnormal sensations, decreased touch and vibration thresholds and decreased deep tendon reflexes. All hope is not lost for these damaged nerves though – your cancer physiotherapist is able to utilise manual techniques, low level laser therapy, acupuncture, neural mobilisations, stretches and exercises to help.

2: Lymphoedema management

Lymphoedema is the build-up of fluid and swelling that is commonly seen in the upper limb post breast cancer, but can occur anywhere throughout the body from many different types of cancer. Imagine your circulatory system with blood vessels circulating all around your body – your lymphatic system is similar to this but transports fluid (lymph) from your body back to the bloodstream which helps maintain the volume and protein concentration of the extracellular fluid in the body and helps the immune system destroy pathogens and remove waste products from your tissues.

If lymphatic vessels or nodes are removed or damaged as a result of your cancer treatments, there are fewer routes for this lymphatic fluid to get back to the bloodstream (ie the demand for lymphatic drainage exceeds the capacity of the lymphatic circulation) and this creates a backlog of fluid in the affected limb.

Lymphatic drainage System

Over 20% of breast, genitourinary, gynaecological and melanoma survivors experience lymphoedema4. The earlier the signs of lymphoedema are picked up (such as swelling, aching, heaviness, stiffness, tightness, temperature changes or pain), the better the outcome of specific lymphoedema treatment will be. Your physiotherapist will assess and work with you to determine the best treatment for you and may include home exercises and stretches, breathing techniques, massage, compression garments or bandaging, low level laser therapy and vibration therapy among others. Gone are the days where lymphoedema sufferers were told not to use their affected limb – physical activity and general exercise have been shown time and time again to be one of the most effective and realistic ways of managing lymphoedema.

If you have any risk factors for developing lymphoedema (such as the extent of your surgery, lymph node dissection/removal, radiation treatment, trauma, infection, increased BMI and immobility), your physiotherapist can get you started on a program to improve your lymph flow and reduce the risk of lymphoedema developing.

3: Improve your energy levels and manage fatigue

Feeling like you are just so exhausted – more than what a good night’s sleep would fix? Fatigue occurs in up to 94% of breast cancer patients at some point after diagnosis but is common in all types of cancer5. And for many people, this is what limits them returning to full participation in life including work, daily tasks at home and social activities. The proposed causes of cancer related fatigue include:

  • The cancer itself and the cancer treatments changing normal protein and hormone levels that are linked to inflammatory processes which can cause or worsen fatigue
  • Cancer treatments killing normal cells AND cancer cells which leads to a build up of cell waste and requires the body to use more energy to clean up and repair damaged tissues
  • The cancer forming toxic substances that change the way normal cells work
  • Secondarily from results of cancer and cancer treatments such as low levels of certain blood cells, sleep problems, stress, pain, lack of exercise and not eating enough

Fatigue often starts during chemotherapy or radiation but if not managed well, can last long after cancer treatments have ended. It is such a frustrating and debilitating side effect which is often not managed at all by your medical team. Fatigue is more than just feeling a bit tired, and many of your family, friends and even doctors may struggle to understand this but your cancer physiotherapist does and is able to help.

Active coping strategies such as physical activity and stress management have been shown to be most effective in relieving fatigue and therefore improving your quality of life. When you feel so fatigued, often the last thing you feel like doing is getting out there and exercising but your physiotherapist can help you through an individualised exercise program at an intensity and volume you can handle which will really work. Your physiotherapist can also provide realistic advice on structuring your daily routine and rest periods – working with you so you can take control of what you can do to help yourself and improve your quality of life.

4: Improving your range of motion and strength

Reduced range of motion (flexibility) can occur from surgery, chemotherapy or radiation through:

  • Formation of scar tissue from surgery
  • Disuse of a joint after chemotherapy or surgery
  • Fibrosis (connective tissue scarring) from irradiation – even up to a couple of joints away from the site of radiation

These symptoms often appear during or directly after surgery or treatments begin and it is important to improve your flexibility early through manual techniques such as joint and soft tissue mobilisations and massage with your physio and guided stretching and exercises so it doesn’t become an ongoing restriction. Often seemingly less-invasive surgeries can affect your range of motion just as much as more invasive operations.

There are a number of reasons almost all cancer sufferers experience a decline in their strength:

  • Muscle wasting (cachexia) from tumour produced inflammation that breaks down molecules such as muscle tissue into smaller ones
  • Surgical damage to muscle groups leading to weakness
  • Damage to muscle or peripheral nerves (so the message to activate certain muscles is not as strong) from surgery or radiation and chemotherapy (especially the vinca alkaloids, taxanes and platinum agents)
  • Pain, fear and fatigue lead to inactivity which leads to even further reduced muscle strength and aerobic capacity

Your physiotherapist can work with you to provide an individualised flexibility and strengthening program to maintain your muscle strength during your treatments and then to improve your strength to help you not only get back to your daily life, but reach any goal you are dreaming about.

  1. Stress management and ongoing education and support

We are on your team

Going through cancer is such an overwhelming, stressful and complex time which is not improved by all the doctors’ appointments, overload of information with so much medical jargon and so much focus on this disease called cancer. Your family and friends try to understand and help, but they aren’t really sure how and if what you are experiencing is normal.

A physiotherapist is part of this medical world in the sense that they can liaise with your doctors about your treatment plan, explain those confusing medical terms and help educate you on what to expect throughout your treatments and afterwards in terms of you and your function. However, more than doctors often are able to, your physiotherapist is able to spend more time with you to listen to your concerns, reassure you that what you are feeling and your side effects are normal and to provide you with strategies to manage these but can also alert you and your doctor if something doesn’t seem right. It is so reassuring and empowering to have someone in this medical world who understands, is there to guide you through recovery and help you shift focus from your illness to your wellness!

Your physiotherapist may help you through some breathing exercises for you to practice at home to directly help lower your stress levels, and indirectly by addressing your other side effects and restrictions. With reduced pain or nausea etc, just imagine how much clearer your mind would be, giving you hope and allowing you to set goals for now and the future.

6.  Improving your ability to beat the cancer and prevent relapse

Evidence continues to emerge that physiotherapy and especially exercise therapy can lower the risk of death due to cancer by significant proportions, depending on the type and stage of cancer. As an example, 3 hours per week of moderate intensity physical activity (that your cancer physiotherapist can help you attain) after diagnosis of colon cancer gives a 50-63% reduction in the risk of total death and 39-59% reduction in death due to colon cancer6.

Even more, evidence suggests that by increasing physical activity you can decrease your risk of death due to relapse by up to 40%! Specifically, research shows a decreased risk of lung cancer by 20%, breast cancer 20-80%, colon cancer 30-50% and prostate cancer 70%.  Yet only 19-30% of cancer patients are physically active – a figure that does not match with these clear benefits. If any drug gave such benefits, everyone would be taking it!

Other important benefits of cancer physiotherapy include:

  • Improving overall conditioning and increasing your physical stamina to not only improve quality of life during cancer treatments but to optimise your physical and functional recovery, improve muscle tone and body composition, improve mental health, motivate and encourage good habits for life
  • Improve your ability to directly recover from surgery (from providing a pre-op treatment plan to improve factors that may affect your recovery to post surgical exercises, soft tissue mobilisations and scar management)
  • Improving general wellbeing and reducing other side effects during cancer treatments
  • Improving abdominal strength and spinal stability through functional and Pilates style exercises to improve posture, strength and attain your goals
  • Individualised recovery – dependent on your physical condition, healing time frames, type of surgery and cancer involved, courses of adjuvant treatments and other individual factors
  • Improve your quality of life to enable you to live as fully and actively as possible – returning YOU to YOU and beyond

    Elle Woodford

  • AND MORE!

There are many things that you cannot control with cancer but your cancer physiotherapist is ready to help you take control of what you can. Let’s get moving towards a healthier you – improving your quality of this wonderful life! We want to get you thriving, not just surviving!

Call Orion Family Physiotherapy on 3470 1203 to make an appointment with Elle (our PINC certified cancer physiotherapist) today.

References:

1 – https://canceraustralia.gov.au/affected-cancer/what-cancer/cancer-australia-statistics

2 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4031191/ Pain in Cancer Survivors

3 – http://www.lymphoedema.org.au/about-lymphoedema/what-is-lymphoedema/

4 – National Breast and Ovarian Cancer Centre

5 – Berger AM, Gerber LH, Mayer DK. Cancer-related fatigue: implications for breast cancer survivors. Cancer. 2012; 118(suppl 8): 2261-2269.

6 – Meyerhardt JA et al 2006. Physical Activity and Survival After Colorectal Cancer Diagnosis. Journal of Clinical Oncology, 24, 3527-3534 AND Meyerhardt JA et al 2006. Impact of Physical Activity on Cancer Recurrence and Survival in Patients with Stage III Colon Cancer. Journal of Clinical Oncology, 24, 3535-3541.

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