Getting your life back: Rehabilitation after breast cancer


Surviving cancer is a big deal, and so is getting your quality of life back after cancer treatment is over.

More women than ever are surviving breast cancer. With advances in early detection and treatment, we see patients living long, full lives after breast cancer.

These patients often are eager to get back to their normal activities, but side effects from treatment sometimes hold them back. Chemotherapy, radiation therapy, and surgery are effective treatments for breast cancer, but nerve damage, swelling, and soreness can sometimes occur.

Breast cancer rehabilitation can help resolve or manage these types of symptoms. As a physician who specializes in oncology rehabilitation, I’ve seen patients who were afraid they’d never be able to swim or play tennis again because of their post-treatment symptoms. After rehabilitation, these women were back in the pool and on the court doing what they love to do.

Nearly 25 percent of the cancer rehabilitation patients I see in Dallas are breast cancer survivors. Some come to me immediately after receiving treatment; sometimes, it’s years later. The three most common issues patients face after breast cancer treatment are neuropathy, lymphedema, and stiff, weak tissue.

Neuropathy: Nerve damage

One of the most common problems I see after chemotherapy is neuropathy – damage to the small nerves most often in the hands and feet. In cancer patients, it can result from chemotherapy, which is a systemic treatment, meaning it can also affect small nerves throughout the entire body.

If you have neuropathy, you may have trouble walking, typing, opening jars, or performing other tasks throughout the day. It can cause numbness, burning, tingling, or pain and also weaken the muscles and lead to falls, putting you at risk for further injury.

For most people, neuropathy gets better with time. But nerves heal very slowly – it can be weeks or months before neuropathy goes away. That’s a long time to just live with it and suffer.

Our physical and occupational therapists can provide therapy, medications, and other tools to help reduce symptoms. Regular exercise like walking or running has been shown to decrease symptoms of neuropathy. Strengthening exercises can help if you are having a hard time opening jars or typing.

Lymphedema: Swollen arm after a mastectomy

For breast cancer patients who’ve had a mastectomy, lymphedema is swelling in the arm on the same side of the body as the surgery. After a double mastectomy, patients may have swelling in both arms. Having lymph nodes removed may increase the risk for lymphedema.

Lymphedema is similar to having a clogged drain. Fluid wants to flow through the lymph vessels, but it gets blocked in areas where lymph nodes have been removed. The lymph fluid begins to back up, which causes swelling.

The arm will likely swell just a few centimeters, but that extra fluid makes a difference. For some people, lymphedema can feel tight and painful. The affected arm likely will feel heavier, making it more cumbersome to use.

The old thought was if you had lymphedema, you weren’t supposed to use your arm. Recent studies suggest that structured strengthening exercises actually can improve the condition.

Our breast cancer team works with patients to try to prevent lymphedema. For most patients who develop lymphedema, it’s a lifelong condition. If you develop lymphedema, we’ll help decrease it and teach you tools to treat yourself in the future through massage, prescribed compression sleeves, and potentially other therapies. For some patients with more severe lymphedema, we may suggest other alternatives, including surgical techniques.

Stiff, weak tissue in your chest and arms

Radiation and surgery can cause scar tissue to form in the chest area. Scar tissue is thick and not as flexible as normal tissue, so a patient’s range of arm motion may decrease. Breast cancer surgery can cause soreness or tenderness, so patients may be inclined to hold their arms close to their bodies and avoid moving them.

But restricting movement makes the affected tissues stiffer and weaker, which makes it harder for patients to use their arms later on. It’s better for patients to move their arms so their muscles remain strong and their skin stays flexible. Our physical and occupational therapists can help patients regain their range of motion through strengthening exercises and other methods.

A lot of my patients have good families that want to take care of them. But I encourage patients to try to perform as many of their normal activities as possible on your own – avoiding movement may decrease the flexibility of the tissues involved and make the arm weaker.

Who should seek rehabilitation?

If you feel like you’re unable to do your normal activities within a few weeks after breast cancer treatment, you may benefit from rehabilitation. Your treatment will be based on your symptoms. Depending on the severity of your symptoms, you may need to see me regularly or just a few times.

Rehabilitation can help prevent and address problems with neuropathy, lymphedema, and weakness later in life. Fixing your aches and pains helps you get back to your favorite activities, including exercise, which research has shown can help prevent you from having cancer again.

More people should seek rehab after breast cancer. It’s covered by most insurance providers and Medicaid in Texas. If you’re experiencing soreness, stiffness, swelling, or other uncomfortable sensations after breast cancer, make time to see my team. No symptom is too small to be looked at if it’s impacting your quality of life.

Many patients think, “I’ve gone through cancer treatment – I’m supposed to feel this way.” There’s this notion that recovering from cancer is just going to be bad. But it doesn’t have to be.