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Originally published October 28, 2024
Last updated October 29, 2024
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Reaching the end of breast cancer treatment is always worth celebrating. It’s when a patient can say goodbye to chemotherapy, radiation and surgeries. It’s worth noting, however, that after breast cancer, patients can experience some lingering side effects. Some of these side effects can impact a patient’s strength, range of motion, independence or quality of life.
“Patients are often surprised by how long the recovery process is, especially after treatment,” says Christina Shin, OTD, OTR/L, CLT-LANA, an occupational therapist specializing in oncology at Keck Medicine of USC. “Many people experience ups and downs, good days and bad.”
That said, patients can mitigate symptoms of long-term side effects by taking action as early as the day of their diagnosis — and receiving the right multidisciplinary care, including physical therapy and occupational therapy.
“At the time survivorship begins, it’s ideal to start a relationship with an occupational therapist and a physical therapist,” says Kimiko Yamada, DPT, a physical therapist specializing in oncological therapy at Keck Medicine. “They will have been able to provide preventive care to mitigate lasting side effects or symptoms.”
Even when breast cancer–related conditions can’t be prevented, they can still be treated. Drs. Shin and Yamada discuss symptoms common among breast cancer survivors and how to manage them.
Breast cancer survivorship, like treatment, is easier to face with the help of multiple specialists working together.
Oncology physical therapy specialists can help restore the strength, range of motion and cardiovascular endurance that’s often lost with surgery and radiation. They can also help a patient manage their balance and find ways to stay active when fatigue and cardiopulmonary symptoms are at their worst during and after chemotherapy treatments.
Oncology physical therapy specialists provide manual therapy and prescribe appropriate exercises to enhance mobility and activity participation. Dr. Yamada adds that every patient is different, so breast cancer survivors are encouraged to get a thorough physical therapy evaluation. All cancer survivors will receive a personalized treatment plan.
“Many patients can return to the same levels of strength and mobility they had before, especially if they stay active and seek physical therapy during the treatment process,” Dr. Yamada says.
Occupational therapists help breast cancer survivors regain independence with their activities of daily living (ADLs), such as getting dressed, performing housework and returning to work, through remedial and compensatory strategies. They may recommend environmental modifications and assistive devices to help survivors achieve their goals for recovery. Occupational therapists may also help patients with psychosocial adjustments, including coping with body image changes.
Both occupational therapists and physical therapists specializing in oncological therapy are experts in lymphedema — a condition characterized by swelling, stiffness and pain that can occur when lymph nodes are surgically removed or damaged by radiation therapy. Occupational therapists and physical therapists can help monitor for symptoms, advise on flare-up prevention and prescribe therapies like pumps and compression sleeves.
Fatigue and brain fog resulting from chemotherapy can take a major toll on a breast cancer survivor’s day-to-day life. Dr. Shin recommends approaching these issues by being kind to oneself and learning to live with them until they diminish.
One approach is commonly known among the chronically ill community as “the spoon theory.” Each task that must be done over the course of a day requires a set number of imaginary spoons, each of which represents a unit of energy. Getting dressed may take two spoons, while cleaning the house could take 12. Patients pay attention to how they feel at the start of each day and budget their spoons for the most important tasks.
Dr. Shin also tells patients to track when they have the most energy — whether it’s in the morning or evening or a certain day of the week. Those are the days to plan on doing what’s important.
For brain fog, an occupational therapist can offer tips and tricks to help patients remember or process important information. Every brain is different, so the process can involve some trial and error, but there’s a wide range of lifehacks, tools and apps that can help.
“Survivorship can come with a unique set of challenges,” Dr. Shin says, “so it’s important to remember that recovery is a marathon, not a sprint.”
Dr. Yamada adds that the breast cancer journey, including survivorship, can take a toll on one’s mental health, so finding support early on is crucial. Many patients report that support groups and counseling are incredibly valuable resources.
Dr. Yamada adds that self-advocacy might be the most valuable tool a breast cancer survivor has.
“Don’t underestimate the amount of recovery support you can get,” she says. “The side effects of treatment won’t go away on their own. There are a lot more options to explore and a lot more research on addressing cancer treatment side effects, so self-advocacy for the care you need and starting physical and occupational therapy early is key.”
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