Occupational therapy’s unique value in breast cancer care
October 31, 2017
Assistant Clinical Professor Michelle Lee Hsia discusses the unique value of occupational therapy services during October's Breast Cancer Awareness Month
Clinical Events Faculty Health and Wellness
By Michelle Lee Hsia / Photo by Ted Fu
Breast cancer is the second leading cause of cancer death among women, claiming the lives of more 40,500 people each year. Thanks to improvements in early detection and advances in medical diagnostics and treatments that have improved survival rates, more than 3.3 million breast cancer survivors in the U.S. are alive today. And while a cure is the ultimate future goal, current treatments have irreversible side effects that can turn into long-term problems with significant impacts on quality of life.
Current guidelines for breast cancer treatment recommend surgery, radiation, chemotherapy and/or hormonal therapy, and women often have narrow treatment options due to their tumor grade and genetic testing. Breasts are a symbol of femininity and sexuality, and changes to the body and body image can cause anxiety and even depression and threaten intimate relationships and sexual functioning. This doesn’t even begin to address physical impairments, functional capacity deficits or social impacts.
According to the Institute of Medicine report From Cancer Patient to Cancer Survivor: Lost in Translation, more than 11 million cancer survivors in the U.S. have not received oncology rehabilitation services. The National Health Interview Survey reports that general cancer survivors are significantly more likely to report fair or poor health, psychological impairments and three or more chronic comorbid conditions.
Occupational therapists should be — need to be — treating breast cancer patients. A first step toward doing so is to build better relationships with the oncology team, educating them about occupational therapy’s distinct value, providing them with resources on where to refer patients and collaborating with them on optimal timing for therapy. There is so much that occupational therapy can offer these patients, such as:
- Activities of Daily Living (ADL) Limitations: Directly after a mastectomy or axillary lymph node dissection, patients will usually have some limitations due to pain and surgical discomfort. Occupational therapists can address these issues on post-op day-zero or day-one with education about getting into and out of bed independently to minimize pain, discussing clothing options that limit overhead range of motion and encouraging participation in daily activities to reduce range of motion limitations, build up endurance and return to a daily sense of normalcy.
- Physical Impairments: It could be days or weeks after surgery, or during radiation, that patients report limitations to shoulder and elbow range of motion. Signs include guarding the affected arm(s), not using their arm(s), developing axillary cording, or pain and discomfort from nerve impairment. When patients are not referred to therapy for these physical impairments, they risk exacerbating their severity. Through manual stretch and massage, axillary cording techniques, myofascial release and sensory re-education, occupational therapists can teach patients how to manage and improve their range of motion and strength.
- Functional Capacity: Surgery, chemotherapy and radiation all can impact functional capacity. Bed rest risks muscle atrophy, and occupational therapists can help patients incorporate physical activity into their routine to limit time spent in bed. Chemotherapy side effects include but are not limited to fatigue, headache/muscle/stomach pain, mouth or throat sores, nausea and vomiting, constipation or diarrhea, nervous system effects and sensitivity to light. Helping patients figure out the best routine for activity and rest is key to maintaining strength and spirit.
- Psychosocial: Acceptance and coping with a cancer diagnosis will impact everyone differently, and sometimes age, ethnicity, marital status and support systems factor into this process. Helping patients identify what’s most important to them at different times during treatment will help create an individualized treatment plan to keep their goals at the forefront. Sometimes occupational therapists are the only health care providers that offer an outlet for expressing their feelings and concerns. Having a supportive provider to advocate for their needs, communicate with their family and give strength when they are afraid to ask for help can change how they respond to and sustain their treatments.
- Sexual Health: All treatments for breast cancer can impact sexual health. Whether it’s addressing body image after surgery, hair loss and fertility concerns from chemotherapy, menstrual changes and scarring from radiation or vaginal changes and mood swings from hormone therapy, sexual health is an area often overlooked by health providers. While survival is the ultimate goal, occupational therapy can focus on quality of life and the perception of what is really important to patients in order to be a “whole” person.
- “Chemo Brain” and Lifestyle Modifications: Survivors often complain that, “I used to remember this, but my “chemo brain” has really gotten to me.” Examples of “chemo brain” symptoms include disorganized thoughts and activities, confusion, difficulty concentrating, fatigue, decreased attention span, taking longer to complete routine tasks and trouble with visual/verbal memory.
- Lymphedema: Lymphedema is not predictable or preventable as our bodies all respond differently to surgery and treatments. The best way to “prevent” lymphedema is to educate patients about the potential for developing it and what symptoms to look for so that it can be managed as early as possible. As occupational therapists, we advocate for lymphedema risk reduction education before and after surgery by recommending a compression sleeve. Not all patients will need a sleeve but if they notice one day that their arm appears larger or heavier, they need to wear a sleeve to minimize exacerbations while they follow up with their oncologists and surgeons. If patients have already developed lymphedema, an occupational therapist certified in lymphedema management can assist them with decreasing its severity, recommend compression garments or other devices and educate and implement a self-management program to improve independence with lymphedema and functional activities.
The American Occupational Therapy Association strongly advocates for the importance of occupational therapy services during the continuum of cancer care. We help our patients resume valued roles more quickly, address their fears and anxiety with activity and movement and educate them about short-term strategies to minimize lasting effects from oncology treatment.
In their 2016 article published in the American Journal of Occupational Therapy, USC Chan alumnae Alix Sleight MA ’12, OTD ’13, PhD ’18 and Assistant Professor of Research Leah Stein Duker MA ’06, PhD ’13, Postdoc ’15 concluded that occupational therapy interventions that address both physical and psychosocial impairments may demonstrate greater impact on functional outcomes.
We all have somebody — family or friend — that has been impact by cancer; wouldn’t you want the very best for them? In not only October, but also year-round, we need to advocate for occupational therapy as a needed and proven therapy service for all oncology patients.
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