Breast Cancer Call to Rehabilitation & Exercise Action

A concert pianist was told not to play the piano after breast cancer surgery because it could cause lymphedema.

A young mother couldn’t lift her baby because of shoulder weakness two years after treatment.

“It’s a travesty,” says physical therapist Jill Binkley, founder of TurningPoint Women’s Healthcare, a nonprofit breast cancer rehabilitation clinic in Atlanta. “We are seeing 300 women a year in our clinic, and it’s the tip of the iceberg. These are all women who have breast cancer and have ongoing issues because of surgery and other treatments.”

Binkley, who is a 12-year survivor of stage 3 breast cancer, joined other researchers who recognized women’s unmet physical needs and the increasing evidence for an expanded rehabilitation approach for breast cancer patients. As a result she became part of the planning committee of an early 2011 meeting of leaders and stakeholders in the area of breast cancer rehabilitation and exercise that was supported by the American Cancer Society. The result of the meeting is a special supplement published in April in the journal Cancer??: “A Prospective Surveillance Model for Rehabilitation for Women with Breast Cancer.” The articles explore rehabilitation and exercise as they relate to ongoing efforts to devise creative, multidisciplinary solutions to address the physical and functional needs of the growing population of breast cancer survivors. (You can read the supplement here.)

“A prospective surveillance model means each woman receives a pre-surgery baseline, post-surgery assessment and ongoing surveillance for the physical side effects of treatment,” says Binkley. The model is a proactive approach to periodically examining patients during and after disease treatment, in an effort to enable early detection of and intervention for physical impairments known to be associated with cancer treatment. Women are educated throughout the process of surveillance about the benefits of exercise and the importance of early rehabilitation intervention when physical or functional impairments are identified.

There is a compelling body of evidence that rehabilitative and exercise interventions benefit breast cancer survivors.

“There has been broad agreement that there is a compelling body of evidence that rehabilitative and exercise interventions benefit breast cancer survivors and that establishing better ways of connecting survivors with these interventions is warranted,” says Kathryn Schmitz, PhD, of the Abramson Cancer Center of the University of Pennsylvania, Philadelphia. Recommendations in the supplement include:

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 Promoting surveillance for common physical impairments and functional limitations associated with breast cancer treatment;

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Providing education to reduce risk or prevent adverse effects and facilitate early identification of physical impairments and functional limitations;

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Introducing rehabilitation and exercise interventions when physical impairments are identified; and

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 Promoting and supporting physical activity, exercise and weight-management behaviors through the trajectory of disease treatment and survivorship.

Additional articles in the supplement address the challenges of integrating the model into survivorship care delivery, as well as exploring the model in relation to long-term issues of follow-up; post-reconstructive issues; upper body and lymphedema issues; treatment’s impact on the development of chemotherapy-induced peripheral neuropathy; cancer-related fatigue; cardiac toxicity; weight management; bone health; physical function; clinical practice guidelines; cost considerations and stakeholder perspectives. Binkley says she hopes the supplement will draw attention to the unmet needs of women with breast cancer, make rehabilitation and exercise a routine part of their care and offer hope for improved quality of life.