Physical therapy for the
patient with breast cancer

Physical therapy treatment can be useful in addressing musculoskeletal impairments and lymphedema that can sometimes occur after treatment for breast cancer. Side effects of radiation and surgery can include development of tightness and adhesions that may limit mobility and function. Another side effect of these treatments is an increased risk of developing lymphedema, a chronic condition whereby protein-rich fluid accumulates in a particular body part. Breast cancer patients are at risk for developing lymphedema in their arm and/or chest on the affected side. Lymphedema therapists can help patients return to their pre-cancer level of function and educate them in strategies to decrease risk of lymphedema.

Helping patients to regain mobility and function

While completing treatment for breast cancer, many patients notice decreased mobility, strength and function. At this point in their journey, they are working to get back to the "normal" life they had prior to diagnosis. Physical therapists are trained to work with patients to address musculoskeletal impairments and dysfunctions, helping them reach their goals and improve functional ability and quality of life. With a referral from a physician, patients may begin physical therapy. The therapist performs an evaluation on each patient to determine impairments and goals and then works with the patient to develop an individualized treatment plan. Treatment may consist of patient education to learn more efficient ways to perform daily activities, therapeutic exercise to increase strength and mobility, neuromuscular reeducation to improve posture and muscle coordination, and manual therapy to decrease pain, decrease soft tissue restriction, break down scar tissue, and improve joint mobility.

Lymphedema

Another area addressed by specially trained physical therapists is lymphedema. Lymphedema is an accumulation of proteins and fluid due to decreased functioning of the lymphatic system. In the United States, breast cancer treatment is the most common cause of lymphedema. Patients who have been treated for breast cancer are at risk for developing lymphedema in their arm, breast/chest or trunk on the affected side. While lymphedema is not curable or preventable, it is treatable and manageable. The ability to effectively manage lymphedema increases when it is diagnosed and addressed early.

Strategies to reduce risk of lymphedema

Treating lymphedema

Complete Decongestive Therapy (CDT) is the current gold standard in the treatment of lymphedema. CDT consists of two phases designed to decrease lymphedema and manage the condition over the course of one's life.

Phase 1: Treatment (acute)

Phase 2: Independent management (long term)

Training of lymphedema therapists

Certified Lymphedema Therapists (CLTs) are licensed medical professionals who have completed 135 hours of coursework in Complete Decongestive Therapy (CDT). The education must take place through an approved program and include both didactic and practical components. Each practitioner must pass written and practical examinations in order to obtain certification as a CLT.

Once a CLT has practiced for one year, he or she is eligible to sit for a national examination to be certified by the Lymphology Association of North America (LANA). Upon passing this examination, the therapist becomes nationally certified by the LANA. His or her credentials are then denoted as CLT-LANA. In order to maintain this certification, therapists must complete a number of hours of continuing education in lymphedema.

Community Health Network currently has five CLTs, two of whom have also obtained national certification (CLT-LANA). These therapists are all part of the outpatient Rehab & Sports Medicine team and serve patients in the north, east and south markets of Indianapolis. These therapists work with the rest of the medical team to help each patient with breast cancer achieve an optimal level of function as part of their treatment and recovery.

—Lori Feldmeyer, MSPT, CLT-LANA, physical therapist