After the final infusion, when the hair is growing back and treatment has ended, life carries on. Regardless of how things went we all carry a little more weight on our shoulders than before. I guess you could call it survivors’ baggage. For me it’s health anxiety! I can snowball the tiniest symptom into the most catastrophic illness in less than 60 seconds! I joke about it, but I sometimes struggle and fixate on the tiniest things. 

Did you know, chemo shuts down your ovaries, so your body is forced into early menopause? That’s infertility, hot flushes, weight gain, fatigue and sweating to name a few. Mastectomies can cause chronic pain, shoulder stiffness and again, fatigue! Lymph node removal can potentially cause lymphoedema. Radiation, fatigue, oral chemo, fatigue, the more drugs…. the more symptoms. Everything has side effects that remain after the cancer has gone. 

This isn’t a complaint! Believe me, I’m very happy to be here and grateful for the treatments I’ve received. I’m proud to have come out the other side relatively unscathed, but occasionally I’m just tired! 

Fortunately, I have found support in a local occupational therapist called Kate who specializes in cancer rehabilitation that I didn’t know I needed! She believes exercise is medicine. Here’s what she had to say when I asked her a couple of questions… 

What are the most common issues you hear from women following breast cancer treatments? 

You have pretty much covered many of the issues that women may face, but I can elaborate on some of those.  

Restricted shoulder range of movement, strength and function can reduce a person’s ability to return to doing day to day activities, or the things they love…or maybe picking up their children. This restriction can be caused by tight surgical or radiation scar tissue, and muscle tightness due to altered posture, causing weakness. 

For women who have not had scar tissue management treatment following surgery or radiation treatment, scar tissue can form due to the body’s healing process, leading to thickening of the skin and tissue in the breasts, over mastectomy scars, and under the arm/s, which can also cause swelling and pain in those areas.  A common statement I hear from women suffering these outcomes is, “I just thought this was normal following treatment”. So many women put up with this ‘new normal’, and they don’t have to. Shortening or thickening of scars can also affect posture, breathing and movement patterns, causing weaknessesand compromised lymphatic drainage function.  Scar tissue management techniques help mobilise, reduce, and stretch scars, helping to increase movement, as well as reduce pain and swelling.  

Fatigue 

Fatigue is definitely a major issue, and very common in many, if not all women I see during and following cancer treatment. Cancer related fatigue is a fatigue like no other. What I often hear from my clients, is that no one else understands this type of fatigue they are experiencing, a feeling like they have been hit by a bus. This can be terribly frustratingand have a massive affect on a person’s motivation and mood.  

Extreme fatigue can have a carry over effect too….low mood, lack of motivation to return to the same job, to socialise, to exercise.  Not because you don’t want to…just because you’re bloody tired!  

Here are five top tips to manage cancer related fatigue: https://lymphaticsolutions.com.au/5-top-tips-for-overcoming-cancer-fatigue-a-tiredness-like-no-other/#more-2588  

What is lymphoedema?  

If we start with “What is the Lymphatic System”, it will make it easier to understand what lymphoedema is.  

The lymphatic system is our ‘sewerage’ system, filtering out the debris – bacteria, foreign cells, water molecules, protein molecules,from the blood system that our body doesn’t need. It is also our immune system, where the lymphatic system also fights infections.  

Lymphoedema can occur from cancer diagnosis, surgery, removal of lymph nodes, Taxane based chemotherapy treatment, and/or radiationLymph fluid is transported via the superficial and deep lymphatic vessels, filtered by the lymph nodes and deep lymphatic organs filtering out the debris. Lymphoedema is a back up of protein rich lymph fluid causing swelling (oedema) in an at risk limb or limbs (dependent on which side there has been surgery or removal of lymph nodes). If not detected early, lymphoedema can become a chronic, lifelong condition.  

Early monitoring for Breast Cancer Related Lymphoedema (BCRL) is recommended protocol by the Australasian Lymphology Association (ALA). This involves establishing a baseline L-Dex (lymphoedema index) reading of a healthy at risk limb/limbs prior to neo-adjuvant chemotherapy, surgery, and radiation treatment, using bioimpedance spectroscopy (BIS) technology. The protocol for monitoring is to complete an LDex reading every 3 months for 2 years post cancer treatment, then bi-annually from 3 to 5 years post treatment.  

Prospective monitoring for BCRL can detect changes in the development of fluid build up in the tissue of an atrisk limb before a person can feel or see symptoms. Symptoms include: feelings of heaviness; tired, aching limbs; pain; tightness of clothes or jewellery. If there is an increase of 6.5 units from the baseline, this can indicate the early development of lymphoedema. Self Manual Lymph Drainage (MLD) massage, preventative compression therapy, exercise, and skin care are all risk minimisation strategies to reduce the development of lymphoedema.  

If you haven’t had a baseline LDex reading prior to treatment, getting a baseline score at some point is better than none at allGo to the National Lymphoedema Practitioner Register https://www.lymphoedema.org.au/the-register/national-lymphoedema-practitioners-register/ to find a therapist who is able to complete an LDex measure 

How’s does exercise help with recovery? 

Exercise is beneficial in so many ways, even throughout treatment for cancerIn recovery, exercise increasesstrength; range of movement; and energy, enabling people to get back to normal day to day activities, or things they love doing. With specialised guided exercises by a trained cancer rehabilitation practitioner, specific exercises help to regain shoulder function, core stability, and endurance levels.  

Exercise also plays a role in improving functional efficiency of the lymphatic system. When participating in moderate exercise, a person’s breathing rate increases, which engages the diaphragm and in turn stimulates the deeper lymphatic organs, improving the lymphatic uptake.   

Increased muscle mass also helps increased lymphatic function. Studies have shown that exercise is known to reduce the likelihood of developing BCRL by 50%, and reduce the likelihood of lymphoedema becoming worse by 70% for those already with the condition.  

Participating in exercise during chemotherapy and radiation therapy is known to reduce the adverse affects of treatmentincreases energy levels, increases bone densityIn 2018, the Clinical Oncology Society of Australia (COSA) advocated for exercise to be standard practice in cancer care and viewed as adjuvant therapy to counteract the adverse affect of cancer and it’s treatments”.  

love seeing the women who come into the clinic for rehabilitation, nervous about exercise, leave feeling energised, stronger, moving better, full of confidence and with the biggest smiles across their faces.  

What’s the best piece of advice you can give to breast cancer survivors and patients? 

My best piece of advice would be, if you haven’t already connected with a cancer rehabilitation OT or physiotherapist, preferably with lymphoedema training, make that connection! They will help guide you through an exercise and rehabilitation program that will focus on regaining your strength, movement, and energy. Don’t be afraid of exercise! They will also provide education regarding fatigue managementscar tissue management, posture, breathing techniquesself manual lymph drainage (MLD) massage, and so much more.  

A lymphoedema trained therapist will also be able to monitor lymphoedema symptoms, provide education on risk minimisation and management strategies.  

If you have any questions please feel free to contact Kate at Cancer Rehabilitation & Lymphatic Solutions on 4312 7033 or visit the website https://lymphaticsolutions.com.au