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Physical Therapy: A Component of the Cancer Care Plan
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Physical Therapy: A Component of the Cancer Care Plan

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Physical Therapy: A Component of the Cancer Care Plan

Physical Therapy: A Component of the Cancer Care Plan

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  • Introduced April 1, 2009


  • 1. Physical Therapy – A Component of the Cancer Care Plan Chris Marrow MPT Sibley Hospital Outpatient Rehabilitation Department
  • 2. What is your plan?
    • Many people fail to see that, from a cancer survivor’s perspective, a “system” of care for cancer simply does not exist.
    • Seldom do people with cancer have any kind of a written or electronic plan for their care.
      • (National Coalition of Cancer Survivorship)
      • http://www.canceradvocacy.org/take-action/nccs-policy/comprehensive.html
  • 3. Comprehensive Cancer Care Improvement Act (CCCI)
    • CCCI - (H.R. 1844, introduced by Reps. Lois Capps (D-CA) and Charles Boustany (R-LA))
    • Physical Therapy / Occupational Therapy can allow you to safely start or resume an exercise program and should be part of the plan.
  • 4. Why Exercise?
    • Improved mental and physical strength
      • Annals of Behavioral Medicine, Courneya et. al
      • Statistical analysis of 24 studies
  • 5. Why Exercise
    • Improved Quality of Life:
      • Stamina
      • Strength
      • Self-esteem
      • Less fatigue during/after chemotherapy and radiation
      • Decreased pain
  • 6. Why Exercise
    • Prevention of lymphedema
      • Increase in chance of lymphedema in women with a body mass index (BMI) over 40
        • (The study, "Post-Op Swelling and Lymphoedema Following Breast Cancer Treatment," was published in the Journal of Lymphoedema , Vol. 3, No. 2.)
      • Exercise helps decrease body fat
  • 7. Physical Therapy’s role in the continuum of care for the post-op breast cancer patient
    • Patient Education
    • Lymphedema Prevention and Management
    • Range of Motion Restoration
    • Postural Awareness/Correction
    • Strengthening
    • Reverse/Halt side effects of radiation and chemotherapy
    • Return to Exercise and Recreation safely
  • 8. Lymphedema
    • Education on lifelong risk factors
    • Baseline limb circumferences taken on first visit
    • Lymph drainage massage as indicated
    • Precautions
      • After axillary node dissection, no upper body resistive exercises for 6 weeks
      • VERY SLOW progression of exercise
  • 9. Prevention of Lymphedema
    • Patient Education is Key
      • Use of compressive sleeve
        • Air travel
        • Exercise
      • Burns, bites, abrasions
      • Blood pressure cuffs
      • Racquet sports, golf, bowling
      • Shaving
      • Slow progression of exercise
  • 10. Range Of Motion and Posture
    • Scar tissue, fibrotic tissue common
    • Minimum Shoulder AROM needed prior to strengthening
  • 11. Range Of Motion and Posture
    • Forward-head, rounded-shoulder posture is common
    • Self check
  • 12. Range of Motion and Posture
    • Axillary Web Syndrome (Cording)
    • Limits overhead motion
    • From Axilla down arm
    • Can go as far as thumb
  • 13. Reconstructive Surgery
      • TRAM flap – loss of rectus abdominus, need to do core exercises to prevent loss of lumbar stabilization
      • Lat flap – loss of latissimus dorsi, leading to weakness in muscles supporting shoulder blade.
      • Expanders – can lead to spasm of pectoralis major
  • 14. Radiation and Chemotherapy
    • Fibrotic tissue
      • decreased range of motion
    • Heart and lungs / cardiomyopathy
      • Need for cardiovascular exercise
      • Low impact if neuropathy in feet
  • 15. Radiation and Chemotherapy
    • Sudden Menopausal onset
      • Risk of Osteoporosis
      • DEXA scan important
    • Peripheral Neuropathy
      • Avoid impact exercises (if in feet)
      • Do balance exercises (if in feet)
  • 16. What Next ?
    • Talk to your doctor about your plan
      • If PT/OT indicated, get a prescription
    • Seek care from a PT or OT experienced in cancer care