Physical Therapy Implications for Complications of Breast Cancer Treatment

Megan Schilter, SPT

 

Background & Purpose

The topic of my capstone was inspired by personal interest, following my mom’s diagnosis of breast cancer last year. Immersed in physical therapy coursework and a constant clinical mindset, my immediate thought upon hearing this news was, “What functional impairments might she encounter in light of this diagnosis?”

I began to independently research the physical and functional deficits that might accompany typical course of treatment in a breast cancer patient. In turn, this opened the door to many more subjects in the realm of breast cancer management: myocutaneous reconstruction, shoulder dysfunction, axillary web syndrome, and lymphedema. While there is a wealth of evidence supporting physical therapy intervention on reducing and managing these pathologies, it seemed that patients and even our fellow clinicians are not fully aware of PT’s beneficial role in this field. Discussion with practicing physical therapists and a Certified Lymphedema Therapist confirmed this notion that perhaps the general patient population and fellow medical professionals (i.e. oncologists, vascular surgeons, and plastic surgeons) are under-informed on physical therapy management for breast cancer.

Thus, this capstone presentation was developed to better inform physical therapists and other clinicians about the beneficial role of physical therapy in reducing breast-cancer related impairments. In addition, a patient education pamphlet was created to provide brief overview of these potential side-effects of treatment and to inform this patient population on physical therapy intervention during and after breast cancer treatment.

Relevant Coursework & Gathering Evidence

In a 52 yo F with breast cancer, is regular physical exercise beneficial in decreasing severity of the negative side-effects (i.e. fatigue, nausea, loss of appetite, chronic pain, and myalgia) of chemotherapy and radiation treatment, versus traditional symptom management (i.e. medication, rest, “usual care”)?

•  The P.I.C.O. question above guided my review of the current and best evidence in Evidence Based Practice II. Current literature supports use of both aerobic and resisted exercise for reducing chemo-induced fatigue in the breast cancer patient population. However, quality of literature varied widely, with statistical results that ranged from very thorough to almost non-existent. Further discussion can be read in my Critically Appraised Topic, linked below.

•  Our Advanced Orthopedics Elective presented the opportunity to further explore breast-cancer related impairments from a musculoskeletal standpoint. I assessed musculoskeletal complications stemming from breast cancer treatment and surgery, as well as the osteoporotic changes that accompany chemo and hormonal treatments of breast cancer.

•  The aforementioned learning experiences in past coursework prompted my desire to gain more in-person clinical experience with this patient population. Specifically, I wanted to improve my understanding of lymphedema management, a common complication of lymph node biopsy or dissection. I spent several sessions throughout this past semester independently observing a Certified Lymphedema Therapist in an outpatient setting who practices Manual Lymphatic Drainage and its accompanying wrapping techniques.

Critically Appraised Topic Breast Cancer Schilter

Advanced Orthopedics Breast Cancer MSK Schilter

Products

I intended to educate physical therapists and other medical professionals on the benefits of physical therapy intervention for improving a variety of breast cancer-related symptoms. As such, I created a Powerpoint presentation and audiovisual presentation that could be more easily dispersed to other professionals through electronic communication.

PT Interventions for Breast Cancer and Lymphedema Management

I also hoped to inform current breast cancer patients about physical therapy management and created an educational brochure for this purpose. The paper pamphlet is meant to provide a “snapshot” of potential complications from treatment and to simultaneously inform the patient of PT’s role in managing those very complications.

Schilter_Patient Education Brochure

Evaluation & Self-Assessment

Evaluation of material was initially assessed independently after viewing the capstone course’s voicethread about patient health literacy. After personal review of my initial rough drafts, I realized that there was a wealth of evidence and citations in my material, but all that information had not been synthesized in an easily-understood many. In short, the educational material was much too dense. Both the presentation and patient brochure were tailored to be more easily understood and less “bogged down” with statistics. Furthermore, I found that language in the patient brochure was too clinical and perhaps even a bit dry. I edited the patient brochure to be understood and more easily-read by the general public, keeping in mind that the average American has a 4^th-6^th grade level of literacy.

I then had the privilege of presenting this material to a group of outpatient physical therapists, of which two specialize in women’s health. I utilized a feedback form, attached below, which asked for their response on various categories in the presentation. Discussion with my committee members and face-to-face conversation with the PTs to whom I presented resulted in further revisions to the presentation, including more streamlined information and more pictures illustrating concepts. Feedback from the presentation is summarized in the link below.

This led to production of my final product, which will be used once again at the Portsmouth Naval Medical Hospital as part of an educational in-service for clinicians during my final rotation.

Response Form and Feedback Summary

Acknowledgements

I would like to thank Rebecca Neal, PTA, CLT for her guidance throughout this process. Not only did she provide incredibly helpful feedback throughout development of the capstone, but she also provided me with an invaluable opportunity to observe and learn through first-hand experience about lymphedema management. Furthermore, her insights regarding physician referrals and patient education were very helpful in creating a product that other medical professionals could utilize.

I would also like to thank Molly Fostek, MSPT, CMTPT for prompting great discussion about this patient population from an outpatient clinical standpoint. Her clinical expertise and personal experience with this patient population guided my final product toward one that is more easily understood and highly relevant to any practicing physical therapist.

I must also thank Karen McCulloch, PT, PhD, NCS for her assistance in shaping this capstone. Kmac, you have been so helpful in providing feedback on my various ideas and the eventual final product. Thank you for your enthusiasm and patience in my development of this idea.

A special thank you to the physical therapists at Tidewater Physical Therapy in Chesapeake, VA, who provided their time and feedback during presentation of my materials. Not only was their insight very helpful, but their words of support and advice were greatly valued and taken to heart. Furthermore, they have been role models to me in these past seven months of working as an aide at their clinic. I am so grateful for all their assistance.

Finally, I am incredibly thankful for my friends and classmates who have been a source of fellowship, inspiration, and learning throughout these past three years. I cannot think of a better group of future clinicians.