Physiotherapy poses no risks for breast cancer patients

A study carried out by the José Alencar Gomes da Silva National Cancer Institute (Inca) with 461 women operated on for breast cancer over a year confirmed that there are no risks for performing free exercises above the shoulder in the postoperative routine for these patients. Researchers claim that shoulder exercises are safe and beneficial to patients’ lives. The study results were published in the journal Breast Cancer Research and Treatment.

The research was conducted by Inca physiotherapist and doctoral student Clarice Gomes Chagas Teodózio, under the supervision of researcher and physiotherapist Anke Bergmann and researcher Luiz Cláudio Santos Thuler.

“With this study, we confirmed that movement above shoulder height, which we called free movement, does not mean that it is complete. It means that the patient will exercise to the limit of her discomfort”, said Erica Alves Nogueira Fabro, responsible for the Physiotherapy Service at Hospital do Câncer III, from Inca.

Erica Fabro clarified that the patient’s own organism will provide a sense of what is uncomfortable for her. Exercise starts the day after surgery. Physical therapists take the patients out of bed in the morning and advise them to do the exercises several times a day, but with few repetitions, in order to maintain the natural lubrication in the shoulder, so as not to have any future restriction of movement.

“Because, theoretically, we don’t know what the treatment will be. There are some patients who will need radiotherapy and our concern is that they have full movement. We don’t want to delay the patients’ healing process, but rather advance their return to normal life, to work, that is, to make patients return to their daily activities and feel independent”, said the head of the Physiotherapy Service of HC 3.

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According to the expert, exercises at shoulder height correspond to 90 degrees. Above, it may be that one patient can go up to 120 degrees and another up to 180 degrees, which would be the full movement.

Domestic activities

Erica reported that the average is five patients operated on a day at Hospital do Câncer III, from Monday to Friday, which results in between 25 to 28 breast cancer surgeries in the unit, per week. Before the pandemic, the average was around seven patients a day.

Patients who undergo surgery approaching the lymph nodes in the armpit or removing the entire breast perform this new routine with the Inca team. The only patients who do not start exercises above the shoulder are those undergoing breast reconstruction and plastic surgery. “These [pacientes que passaram por reconstrução de mama] we don’t release it immediately. Only after it’s healed. For these, we still maintain 90 degrees”. These patients were not part of the research and, therefore, the new routine cannot be extended to them.

Erica pointed out, on the other hand, that actions such as sweeping, picking up weight, and cleaning the pan are not released. “No sudden or repetitive movements. We just want a movement for her to have independence to take a shower alone, do her own personal hygiene, feed herself”. Only after thirty days, the physiotherapy team gradually releases the patients’ return to domestic activities.

The president of the Brazilian Society of Regional Mastology Rio de Janeiro (SBM-RJ), Rafael Machado, confirmed that physiotherapy in the postoperative period and regular daily exercise after treatment give women operated on for breast cancer greater survival and better quality compared to sedentary women. “It’s fundamental,” he said.

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Rafael Machado highlighted that breast cancer is a public health problem in Brazil. Therefore, he defends that the theme be debated continuously and not only during Pink October, when the whole world talks about raising awareness about the disease. According to Inca, 66,280 new cases of breast cancer are estimated for each year of the 2020-2022 triennium. This value corresponds to an estimated risk of 61.61 new cases per 100,000 women.

new treatments

New treatments for breast cancer include so-called targeted drugs – targeted at specific tumor subtypes. These drugs allow for the so-called precision oncology, which results in individualized treatments for the patient, given the tumor subtype she has.

The president of SBM-RJ also defended that the approach to patients with breast cancer should be multidisciplinary, involving from a gynecologist, breast cancer specialist, psychologist, physiotherapist, nutritionist, among other professionals.