Physical Therapy Services During Cancer Treatment

Deborah
This is Weekly Dose of Wellness, brought to you by Memorial Care Health System. Here's Deborah Howell. Welcome to the show. I'm Deborah Howe. Thanks for being with us. Going through cancer treatment is challenging, as anyone who's been through it can tell you. So how do you find the time and the strength to add physical therapy to your weekly routine, when maybe you're not feeling your best? To find out about what physical therapy can be like during cancer treatment, well turn to an expert in the field. Our guest is Mindy Kruse, a physical therapist and certified lymphedema therapist at Orange Coast Medical Center. Welcome, Mindy.

Mindy
Hi. Thank you for having me on today.

Deborah
Boy, do you do good work. So happy to have you. So how can physical therapy help a patient who's been diagnosed with cancer?

Mindy
Sure. Physical therapy during or after treatment for cancer can benefit a patient's quality of life significantly. We address losses of range of motion and strength that are limiting a patient's function and quality of life. Often with treatment for cancer, there can be side effects related to surgeries, radiation, and or chemotherapy. And physical therapy can help minimize these side effects. For example, after a mastectomy for breast cancer, sometimes the patients will have pain limited range of motion of the shoulder, swelling of the arm and trunk, and difficulty returning to their day to day activities. Some other impairments we can address are poor balance, postural dysfunctions that can occur after surgery, radiation, pelvic floor dysfunction is treatment for lymphedema and defining exercise programs to help with cancer related fatigue. We also can provide education and guidance for returning to work and or recreational activities. Sometimes with cancer treatments. Patients will be out of work for a period of time, and it can be very difficult to return, so we can incorporate some work retraining and exercises specifically to help prepare them for their job. Along the same lines. Often people will stop or significantly limit their exercise when they are going through treatment for cancer, and it can be overwhelming for them to return to a physical activity that may have been something that they really enjoyed in the past. It's very important for us to discuss what each person's specific goals are. For example, if they want to return to their job as a banquet server, we could design a strengthening program to mimic carrying a heavy tray. Or if they want to return to a specific type of fitness class such as yoga, Zumba, or whatever it was that they enjoy. We can incorporate exercises to gradually and safely return to whatever type of exercise they enjoy. As well as give them education on modifications if needed to make it safe and successful for them. For others, the focus may be on recovering their independence with activities of daily living such as bathing, dressing, whatever it is for them to help them live more independently.

Deborah
Got it. Now, what are some of the benefits of exercise for patients who have or have had cancer?

Mindy
Exercise has so many benefits for all people, but also for patients who have been through cancer treatment or are in the process of cancer treatment. Exercise can reduce muscle weakness associated with chemotherapy. Exercise reduces fatigue and helps maintain function and energy during chemotherapy. Exercise boosts immunity by increasing the number and effectiveness of the body's immune cells. Exercise prolongs independence. Walking and resistance training improves bone density, and it can decrease cancer treatment related pain as well. Also, exercise can help with maintaining a healthy body weight. And there's research that shows weight gain after breast cancer treatment is associated with a higher recurrence rate. So maintaining a healthy body weight is very important.

Deborah
Those are some incredible benefits. And what's the process like for a cancer patient to schedule an appointment with MemorialCare, Orange Coast Medical Center's outpatient rehabilitation department?

Mindy
They just need a prescription from any physician, preferably a physician who's involved in managing their treatment for cancer. We often get referrals from oncologists, oncology surgeons, radiation oncologist, but we also get referrals from primary care physicians. Once they have a prescription, they can call our office at (714) 378-5095 to schedule an appointment.

Deborah
Understood. Okay. Now your day is different every day. Mindy, how does a physical therapist initially become involved in a patient's cancer journey?

Mindy
I initially became involved in treating patients with cancer when I was working in inpatient on the oncology wing. I was able to see many of the patients had needs that can be addressed by physical therapy. So I started taking more continuing education courses to learn more about how to best serve the cancer population in the outpatient setting.

Deborah
And then at what point during a cancer patients treatment, does a physical therapist treat them?

Mindy
We do see patients while they're actively being treated for cancer during chemotherapy and radiation. Often patients are referred once they are cleared by their surgeons if they've had a surgery. We try to be flexible with managing this population because often they don't fit the traditional outpatient physical therapy model, where someone comes in 2 to 3 times a week. We treat every patient individually, which means sometimes we may discharge for a period of time based on what is happening with their cancer treatment and restart when it is appropriate. We also get patients referred who had treatment for cancer as much as 10 to 20 years ago, but never had treatment to address their impairments, and they have been living with it for all these years. We also occasionally treat patients during palliative care, where we focus on improving quality of life and training the family to assist the patient, if appropriate. The duration and number of treatment sessions varies greatly. Sometimes patients benefit from more extensive therapy, requiring many sessions, but other times patients may just need a few sessions focusing on education in a home program. Once again, it's very important to individualize that treatment plan for each patient.

Deborah
Well, I know what you do is just incredibly life changing. So what are some of the most common types of cancer that you see with physical therapy services at Orange Coast Medical Center?

Mindy
Breast cancer is the most common type of cancer we treat, but we do see many other types of cancers we've treated head and neck cancers, brain cancers, lung cancers, soft tissue tumors such as sarcomas, blood and lymphatic cancers, gastrointestinal melanoma, and urogenital cancers. Those are all some of the types of cancers that we have treated in our clinic.

Deborah
And what is lymphedema, Mindy, and how is it related to cancer?

Mindy
Lymphedema is an abnormal collection of high protein fluid just beneath the skin. The result is swelling of a part of the body. Lymphedema related to cancer is referred to as secondary lymphedema, and occurs when the lymph nodes have been removed or are affected by the cancer and or radiation to the lymph nodes. In this country, treatment for cancer is the most common cause of lymphedema.

Deborah
So somebody comes to you with lymphedema. Can you tell us a little bit about the treatment?

Mindy
Sure. Traditionally, lymphedema management consists of compression a gentle massage technique called manual lymph drainage, and some basic exercises. Often I will see patients who have been told they need to wear compression, and they either don't know what to get or they don't like what they've tried. So I will try to provide them information on different types of compression and find something that works for that patient. Most importantly, I always try to provide a lot of education regarding lymphedema because it's natural for someone to be more compliant with instructions if they understand the reasons behind the instructions.

Deborah
Sure. So after the massage, does a patient actually feel some relief from their drainage?

Mindy
Yes, often they do. Manual drainage can be very effective in decreasing the fluid and the swelling. And we also train the patient to do some self manual drainage at home as well.

Deborah
And I'm interested in all the physical therapy resources available to cancer patients at Orange Coast Medical Center. Can you speak to that?

Mindy
Yeah. And patients can always call our office once again at (714) 378-5095. And myself or the other oncology rehab therapists are happy to answer any questions. Sometimes I will just get phone calls from patients or family members wondering if their specific issue that they're dealing with, if it's something that physical therapy can be helpful for, so we can have a conversation about how our resources can help them.

Deborah
Well, thank you so much for your time and your expertise today. We really enjoyed having you with us and we really, really appreciate all the work you do every day for your patients.

Mindy
Thank you so much for having me on.

Deborah
For more information about physical therapy services during cancer treatment, once again please call (714) 378-5095 and to listen to any of our informative podcasts, please visit Memorial Care Dawgs podcasts. That's all for this time. I'm Deborah Howell. Have yourself a terrific day.