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| Division of Occupational Therapy - OT Connect Breast Cancer
Breast cancer first appears as a lump or thickening in the breast. It originates when the processes that control normal cell growth break down, which allows a single abnormal cell to multiply at a increased rate and form masses (tumors). These masses can be either malignant or benign. Malignant tumors are cancerous while benign tumors are not (American Cancer Society, 1998). Common Symptoms/Course of disease
A tumor that is malignant (cancerous) may have cells that move throughout the body. From the breast, these cells can spread to the underarm, lungs, liver or other parts of the body. If these cells form other tumors, this is called metastasis (American Cancer Society, 1998). Usual Age or Common Age of Presentation: Adult years, usually after 40, (risk increases after age 50). This is why it is important to start having yearly mammograms around the age of 35 (American Cancer Society, 1998). Risk Factors:
Sex Biases (Men vs. Women): Breast cancer accounts for 30% of all cancer in women. In 1998, it was projected that 180,000 American women would get breast cancer and that 44,000 of them would die. In contrast, it was only projected that 400 men would die of breast cancer (American Cancer Society, 1998). Cultural Biases: Cultures that have high fat diets may be more likely to have a higher incidence of breast cancer. Research published in the Journal of National Cancer Institute (2003;95:132-141) looked at the diets of adolescent girls and the relationship between their diets and their levels of estrogen. Estrogen is a sex hormone that has been linked to breast cancer. In the adolescent girls who had higher fat diets, higher estrogen levels were found. However, there is still need for evidence that shows there is an ultimate relationship between the two (BBC News, 2003). Stages of Breast Cancer:
Current Medical Treatment: After one is diagnosed with breast cancer, the treatment focuses on surgery to remove the cancerous tumor. Lymph nodes in the underarm may be removed to detect if the cancer has moved. The surgeries that may be performed are:
The choice between these different types of treatment varies due to the type of breast cancer, the stage of the disease, the age of the patient and the patient’s overall health. Listed below are a couple of the most common treatment approaches:
When the treatment is successfully completed, many women wear a breast prosthesis, which serves a cosmetic as well as emotional purpose. However, others take a step further and look into breast reconstruction. (American Cancer Society, 1998). Occupational Therapy Involvement Occupational therapy is prescribed to address therapy goals post-surgery. Occupational therapists can address the range of motion in the effected arm, lymphedema (if present), and any psychosocial needs due to the cancer. Occupational therapy also looks at the need for adaptations of home, work or leisure activities that may be beneficial to utilize until the patient has full movement of the affected arm. After surgery for breast cancer, arm limitation is common secondary to the motion of the shoulder joint. This is why it is important to have an occupational therapist provide you with the proper exercises and stretches to achieve full motion, usually within two to three months (American Cancer Society, 1983). While the motion is coming back occupational therapists can work with the patient to help them find ways to adapt past activities so that they may still engage in them. Lymhedema is another problem associated with breast cancer that occupational therapy services may help. “Removing axially lymph nodes and muscles of the chest wall under the breast may produce lymphedema, loss of range of motion, and referred pain that adversely affects activities of daily living (McCormack et.al., 2002).” When the lymph nodes of the underarm are removed, there is a chance of lymphedema; when the arm holds fluid and swells. It is important to keep the lymphedema in the arm to a minimum and address pain management techniques so that the patient may return to their previous quality of life. Breast cancer often brings emotional changes in addition to the physical ones. Emotional changes may cause the person to become less motivated to engage in normal activities and there may be a decline in the value a person holds in completing activities such as grooming, home management and leisure activities (McCormack et.al., 2002). In addition, other psychosocial issues that may exist are depression, loss of self-esteem, fear of rejection and loss of appetite or interest in sex (American Cancer Society, 1998). Occupational therapists are trained to help people address and overcome these feelings and return to a productive life. An intervention commonly used is stress management, which can be addressed in many ways. Examples include breathing exercises for relaxation and support groups (McCormack et.al., 2002). Overall, the main goal of occupational therapy is to “help the client regain independence and function in valued occupations and activities of daily living through compensation or adaptation interventions (McCormack et.al., 2002).” Occupational therapy is a profession that looks at all aspects of the person, which is a necessity for someone with breast cancer. References
How OT Makes a Difference: Evidence-Based Practice Breast cancer is an emerging area for occupational therapy. Recently, in a study by McCormack et.al., occupational therapy included complementary techniques in addition to the normal practice in the treatment of breast cancer patients. The Clinic for Complementary Therapy provided holistic treatment, based on all areas of occupational performance. The clients come in on an out patient basis, which allows them to continue with their lives in their home environment. “The primary purpose of the Clinic for Complementary Therapy is to provide and facilitate ways for clients with breast cancer to relax, which better enables them to participate in valued occupations. The secondary purpose is to alleviate the side effects of medical intervention, which enhances performance of ADL and a productive and positive lifestyle. (McCormack et.al., p. 13, 2002).” A normal treatment started with active range of motion activities and breathing exercises to provide relaxation. The environment is set-up to provide further relaxation through soft lights, aromatherapy, and relaxing music. Guided imagery and visualization were also implemented. The clients then receive one-on-one treatment, specific to their particular needs. An example is their acupressure protocol that assists in reducing fatigue, perception of pain and gastrointestinal discomfort. Looking at all occupations of the client, activities and adaptations are graded to provide appropriate treatment. Last, the clients received a foot massage, which for many was the most relaxing. The Clinic also provided an emotional support group; many clients stayed after treatment to have group discussions. In concluding, over two years they found observed improvements in the general outlook, coping abilities and ability to engage in activities of daily living in their clients. “Most of the clients report that they experience a deep and profound relaxation response during the 50 minute treatment. Pain and discomfort diminish, and most feel more energized and better able to cope with their condition (McCormack, et.al., p. 15, 2002). S is a 37-year-old female status post right lumpectomy with subsequent chemo and radiation. She was referred to Occupational Therapy secondary to her right upper extremity lymphedema (swelling of lymph nodes). She had her surgery in September 2002 and developed swelling that was diagnosed in November. She first went to a local physical therapist with poor results, and was then referred to occupational therapy for decongestive therapy. She was seen for 6 visits beginning March 10, 2003. Her treatment consisted of Manual Lymph Drainage, Meticulous Skin Care, Semi-rigid Compression Bandaging, Muscle Pumping Exercises and just recently she was issued an elastic sleeve to be worn daily for maintenance of reduced limb size. S is thoroughly satisfied with the occupational therapy she has received. She states that she is right hand dominant and could not use her right hand due to the swelling, prior to receiving occupational therapy. She couldn’t make a fist. She is the mother of a toddler and now she is able to help carry her toddler and put her in her car seat. Looking at her progress of decreased lymphedema, with circumferential measurements (around the part of the body), she has lost 2.4 inches (6 cm) around the base of her fingers and 3.2 inches (8 cm) around her wrist. She has maintained this at home for over a week with self-massage and bandaging. In closing, due to the occupational therapy interventions S has received, she is able to meet the occupational challenges of her life roles, such as mother and worker.
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