Cancer is one of the few diseases where a patient goes in feeling reasonably well and emerges from “successful” treatment feeling awful.
October is now here, so our awareness of breast cancer is at a yearly high. The truth of the matter, however, is breast cancer is a realistic everyday concern for over 2,900 women in Ireland each year and not just a month-long event we should consider every October.
Breast cancer is not confined to certain groups or demographics, it is indiscriminate in its invasion into a women’s everyday life. It is estimated by the year 2020 that 1 in every 2 people will be effected by a cancer diagnosis and it is fact that the incidences of breast cancer are continually on the rise.
Breast cancer is the most common malignant tumour diagnosis for Irish women and it is estimated, that on average, up to 1/3 of cancer diagnosis in Irish women are breast cancer related.
This may appear alarming but the rise in detection of breast cancer is a result of the improvement in technology and improved adherence to screening. Although the mortality rate is also the second highest, at a rate of 17%, of all cancer deaths in Irish women (690 deaths were attributed to breast cancer in Ireland in 2011/12) it is declining by an average rate of 2% per year since 1994.
The survival rate is also considerably high and is estimated at 82% after 5 years. Up to 85% of patients diagnosed with breast cancer have surgical treatment. In recent years the incidences of mastectomy are on the decline as breast conserving surgery (BSC, ‘Lumpectomy’) with associated radiotherapy now accounts for 2/3 of all surgical treatments for breast cancer (NCRI.IE).
As a shoulder specialist, I continue to see daily, the associated complications that survivors of breast cancer surgery. Early stage complications include the occurrence of Lymphedema at a rate of 20% of the surgical population, Seroma’s in up to 21-22% and phantom breast syndrome in 25% of post-surgical breast cancer patients.
Late stage complications tend to be more musculoskeletal in nature with the onset of Scapular dyskinesia, Impingement syndrome and adhesive capsulitis (frozen shoulder).
What should you do to be proactive if you are awaiting Breast cancer surgery and treatment?
The most current research is advocating complete rest for the first two weeks post treatment. This advice is often related to the increased chances of developing lymphedema with incidences reported to be as high as 20% post mastectomy. Associated research has, however, yet to prove the link between early onset exercise post-surgery and lymphedema.
The relevant research does support the fact that exercise / excessive movement in the initial two weeks post-surgery does cause increased wound drainage and volume. Research has shown it takes 7-10 days for the reconnective tissue & lymphatic connecting vessels to reconnect following breast surgery, thus excessive movement and exercise is not recommended whilst drains are in situ and for up to 3 days post drain removal.
Studies have proven that following these guidelines generally results in getting drains removed much quicker post-surgery, thus allowing the implementation of your exercise program.
Is there anything you can do to aid your recovery in this two-week period?
Yes – the most important thing and, often most demanding thing, to work on in this two-week period is postural awareness as it will help improve your long-term outcome. Your progression from two weeks on after your drain has been removed will depend on numerous factors as listed below.
Thankfully our management of patient’s post breast cancer surgery is improving thanks to amazing initiatives such as the Platinum Pink Ribbon Program. There is considerable evidence to support the implementation of physiotherapy and exercise rehabilitation after the initial acute phase of healing.
The time periods may vary from patient to patient and your progression after your drain has been removed will depend on numerous factors such as the need for chemotherapy / radiotherapy, your perceived pain and the surgery you have had.
For instance, if you are undergoing TRAM or DIEP Flap surgeries research has shown your recovery may be a little slower due to difficulty recruiting abdominal muscles and due to increased pain. It is, therefore, very important to have a review with your Physiotherapist or initial consultation when your drains have been removed.
Physiotherapy has been proven to speed up functional recovery after surgery, reduce chemotherapy-related fatigue and nausea, maximize active and passive range of motion, reduce swelling and pain, improve quality of life and help moderate weight gain.
Following your initial consultation and implementation of a very basic exercise program a designated date for the commencement of your Platinum Pink Ribbon Program will begin. This date will be discussed with your physiotherapist and will vary from patient to patient. We aim to begin our level one program 4-6 weeks post Op.
There is ample evidence that disuse of the effected limb post-surgery leads to muscle atrophy and decreased functional capacity of the arm and associated musculoskeletal tissue. The research does indicate that a supervised slowly progressive exercise program is essential.
The level one program will follow these recommendations and will start at a low level and will always be supervised by both our chartered physiotherapist and our Pink Ribbon Pilates instructors.
Although our level one program is performed in a small group environment your exercise will only increase according to your symptom response which will be monitored by our physiotherapist.
The level one program is a six-week program which will focus on building your range of movement, strength, proprioception, swelling/lymphedema management & control, pain management and a reduction in scar tissue tightness.
Following the successful completion of the level one program you will then be reassessed by our chartered physiotherapist and if appropriate you will be referred into our level two program. The aim of our level two program is to empower you and make you stronger and fitter than you were before your diagnosis through the implementation of more complex reformer Pilates based exercises. Our focus is to improve your functional postural control, strength, scapula thoracic mobility / stability and general cardiovascular fitness.
Through the implementation of this program we aim to give you the strength and confidence to take back control of your body in a safe, professional and friendly environment. A common feeling that patients have post breast cancer surgery and cancer treatment is the feeling that their body has betrayed them and that they no longer trust their bodies to help them recover.
The founder of the Pink Ribbon Program Doreen Puglisi is a breast cancer survivor and the quote below explains perfectly why patients should become proactive and take back control of their lives post Breast cancer diagnosis through initiatives such as the Platinum Pink Ribbon programme.
“We have no control over surgeries, chemotherapy, radiation. You’re part of a group you didn’t choose to become part of. Surgery, radiation, chemo doesn’t feel good. This program gives the patient control over doing something positive, and can gain control over some portion of their recovery…
Literally, the Pink Ribbon Program can make you feel better and improve your quality of life. I didn’t realize that until I went through it.
When you go through it, the diagnosis consumes part of your life for a while, so to be able to have something positive in the mix of all that…I can’t begin to explain how good that feels.”