In the moments after a patient learns she (or he) has breast cancer, trying to take in treatment and surgery information is difficult enough. Then there’s the post-surgical rehabilitation plan to consider. But a new approach at Allegheny Health Network is helping breast cancer patients do some “prehab” before surgery that will help them combat one of the biggest post-surgical problems.
After breast cancer surgery, patients sometimes develop lymphedema, which is swelling in the arms, chest wall or other parts of the body. It’s caused by a disturbance, damage or removal of lymph nodes, which is often part of the surgery. The lymphatic system can also be damaged by radiation treatments after surgery.
“We developed this population of breast cancer survivors with lymphedema,” said Dr. Judith Schaad, director of Allegheny Health Network’s Oncology Rehab program.
New research shows promise in consulting with patients about lymphedema prior to surgery, and keeping a keen eye on its possible development after surgery.
The “prehab” program includes taking baseline measurements of both arms before and after surgery, and watching for any swelling.
“If we detect any slight change then that would indicate that there was an early development of swelling,” said Schaad.
Therapists fit patients with a compression sleeve to wear for about a month to reduce swelling. Since lymphedema is a chronic condition that will not go away on its own, the key to combatting it is being proactive and trying to prevent it from the start.
“Once a patient develops lympedema, they’re always susceptible to that swelling,” said Schaad. “In the old days, before we had this protocol, patients would develop swelling and it would already be significant by the time they got to us, and they needed much more extreme treatment.”
Now, rehabilitation specialists see patients every few months during the first year after their breast surgery, measure both arms to check for signs of swelling and watch for any other early signs of lymphedema such as tingling, numbness, achiness or a sense of heaviness.
Patients not only consult with their oncologist and breast surgeon, but they also meet with rehab specialists like Nicole Reilley Dosey, regional manager of outpatient therapy services for AHN, to learn about lymphedema and what symptoms to watch for on their own.
“The input we’re getting back from patients is amazing,” said Dosey. “They love the fact that we’re showing them the exercises, telling them what they’re supposed to do and giving them some guidelines on what they’re not supposed to do, doing some of the measurements to assess whether they’re presenting with any form of lymphedema.”
Learning about the early warning signs of lymphedema is just part of the education and “prehab” process now.
Dosey said, “So many people have this type of surgery and then they wonder, ‘Can I travel? Can I lift things? Can I exercise?’ We’ve gotten such positive feedback on empowering them.”
Dosey remembers seeing many breast cancer surgery rehabilitation patients walk in with shoulder problems and she wondered why.
“They weren’t sure how much they should move their arms,” said Dosey.
Now, she’s teaching them them what to do and what not to do even before they have their surgery.
At first, Dosey worried the extra “prehab” appointment would overwhelm patients or that they would see it as just another doctor’s appointment and obligation during a very stressful time. However, the positive feedback she’s getting from patients is encouraging, and she enjoys seeing them walk away with information and guidance.
“I feel like the patient knows they have someone outside of their physician that they can call,” said Dosey. “The patients are seeing it earlier, they are reporting it earlier if something doesn’t seem right and they’re getting back in to see us. The good news is we’re not seeing those advanced stages. We’re catching it early enough that they’re not hitting stage two and stage three.”
Schaad is also encouraged by the “prehab” program and its encouraging results.
“My goal is to get them back to all of their prior functions,” said Schaad. “In the old days, the myth was that these patients should not lift anything more than ten pounds the rest of their lives. I see a lot of women in the prime of their lives, they have their job, their family, they want to travel and get back to the gym, and we can help them safely resume that and get them get back to what they did before.”