Cecilia de Villiers Lead Oncology Physiotherapist Cancer Centre London/Parkside Hospital

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1 Cecilia de Villiers Lead Oncology Physiotherapist Cancer Centre London/Parkside Hospital

2 Why Physiotherapy?? Consider the effects of the cancer itself. Consider the possible physical and emotional effects of the treatments for breast cancer. Consider the recovery and late onset of symptoms post treatment. Survivorship.

3 Possible physical effects post surgery Scars and skin adhesions Axillary web syndrome /cording with reduced flexibility, pain and weakness of the upper limb Swelling and seroma with possible infection risk Upper limb, trunk and abdominal weakness after Lattissimus dorsi and abdominal flap reconstructions Posture changes Harris, 2004

4 Axillary web syndrome/cording

5 During chemotherapy General deconditioning and weakness of the skeletal muscle Cancer related fatigue (CRF) Breathlessness Joint stiffness and pain/arthralgia Early menopausal symptoms Infertility Bone marrow suppression Cardio myopathy

6 During radiotherapy Soft tissue and connective tissue fibrosis Unable to reach radiotherapy position Fatigue Radiation related capsulitis Skin reactions Lymphoedema Postural changes

7 Endocrine therapy Hot flushes Weight gain Joint pain/arthralgia Loss of bone health with early risk of osteopenia and osteoperosis Biological therapy Herceptin-possible cardiac failure

8 Possible emotional effects Anxiety Fear Depression Social isolation Body image problems

9 Post treatment:late onset of symptoms Post mastectomy pain syndrome Lymphoedema Tissue tightness and capsular contraction post radiotherapy Radiotherapy induced brachial plexopathy Fatigue Inability to return to work or sport or other daily activities

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11 Physiotherapy at CCL/Parkside individualised graded exercise programmes, pacing, planning and energy conservation breathing and relaxation techniques massage and soft tissue mobilisations, acupuncture, TENS machines hydrotherapy and Pilates classes Kinesiotaping, fascial release advice on diet, exercise, emotional wellbeing, MDT approach

12 Survivorship 1.2 million long-term cancer survivors in the UK (Maddams et al., 2009) Earlier detection, better treatment What is their quality of life?? The National Cancer Survivorship Initiative (NCSI) originated from the Cancer Reform Strategy (2007). The aim: to ensure that those living with and beyond cancer get the care and support they need to lead as healthy and active a life as possible and for as long as possible.

13 Benefits During cancer treatment: significant small to moderate benefits for aerobic fitness, muscular strength, body fat percentage and anxiety. After cancer treatment: significant small to moderate improvements for aerobic fitness, body weight and body fat, quality of life and fatigue and large effects for muscular strength (Speck et al., 2010) preliminary evidence that physical activity performed after diagnosis may be associated with improved survival

14 Wellbeing o43% of all UK cancer cases in 2010 were attributed to largely preventable causes (Cancer Research, UK) olifestyle odiet and alcohol oexercise osmoking ooccupation

15 References Cancer Research, UK, 2012, wsletter/cancerstats-newsletter-sept2012.html Harris SR, Campbell KL, MnNeeley, L. Upper extremity rehabilitation for women who have been treated for breast cancer. Physiotherapy Canada 2004;56: Maddams J, Brewster D, Gavin A, Steward J, Elliott J, Utley M, Møller, H: Cancer prevalence in the United Kingdom: estimates for Brit J Ca 101: , 2009 National Cancer Survivorship Initiative, 2012, Speck, R., Courneya, K., Mâsse, L., Duval, S. & Schmitz, K. (2010). An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. Journal of Cancer Survivorship, 4,