The breast cancer treatments are over. Now what?

When talking about cancer usually problems related to prevention, diagnosis and therapy attracts the discussions as the attention of the media and the majority of the available – human and financial - resources.

But are these the only problems of the complex oncological disease, especially for patients who live this experience in first person? Once the treatment cycle is over, is it possible to get back to a normal life?

From the experiences we have acquired in about twenty years in the oncological rehabilitation field, we are more and more convinced that the problems, the big problems, the ones that condition patients’ life, arise right when the so-called official treatments, surgical therapy, chemo and radiotherapy are over. Once completed these treatments, generally patients resume their working activities, family management, relationships with the partner that also involve a particular intimate and sexual sphere; in short, we get back to life!!

We believe that “BACK TO LIFE” sentence fits more to this context rather than the general term – used by both the scientific community and the general population – “survivor”. The term “survivor” does not express the inner process a person after a disease has to go through; the person wants to get back to life and not survive. Two different concepts, two different approaches to this very delicate phase.

Those who live in this particular situation should not be afraid or reluctant to ask for help because it is essential to rely on people who, by human capacity and professional experience, can offer and assure such help.

For many years we have been fighting on the recognition of the importance of Oncological Rehabilitation as a next stage to the oncological therapies just to offer support, a help from the physical and psychological point of view to patients who present disabilities resulting from cancer pathology in all various stages of the disease.
The rehabilitation environment is the most suitable to take care of patients who have these disabilities, understood in the broadest sense of the term, deriving from the oncological pathology, therefore both physical and psycho-relational disabilities that limit and strongly condition their quality of life.

The oncological rehabilitation is a team work; different professionals get involved and engaged according to the needs of the patient. The team work ensures the sharing of knowledge and skills for the specific rehabilitation goal (Individual Rehabilitation Project) developed for each patient.

The rehabilitative team key figures are the physician experienced in this discipline and who therefore has oncological and rehabilitative skills, who will perform the initial assessment of the patient – to make emerge the rehabilitation problems to be addressed - and a properly trained physiotherapist who will take care of the patient and that after a specific assessment and formulation of the Individual Rehabilitation Project will start the treatment with the different rehabilitation techniques necessary and specific for that patient.

For example, in the case of a lymphedema - a condition of localized fluid retention and tissue swelling of the upper limbs caused by a compromised lymphatic system – different treatments can be done: manual lymphatic drainage, elastocompressive bandage, pressure therapy, shock waves, lymphotaping, prescription and testing of an elastic brace. However, these interventions should not only be limited to the upper limbs but should consider the whole person in a holistic approach to the patient. This is the reason why, in the Rehabilitation Team there are always a Psychologist and a Nutritionist.

What are the problems that can be faced in an oncological rehabilitation path?

In addition to lymphedema, as mentioned above, the other most frequent disabilities are shoulder joints problems, scar tissues due to surgery and radiotherapy, neurological complications such as the winged scapula, postural alterations, the consequences of reconstructive surgery (mobilization of the limb during expander filling, encapsulation of the breast implant, secondary alterations to the removal of muscle-cutaneous or cutaneous flaps), the overweight, very common especially after the cycle of chemotherapy.

Another important aspect addressed within a rehabilitation process is the patient's Therapeutic Education, a relational communication process aimed at making understand and know all aspects of the disease and enhance the patient's participation in the management of her disability, with a great attention to the adoption of particular lifestyles that now are recognized having a fundamental role in both primary and secondary prevention of oncological diseases.

Our rehabilitation protocol needs to include educational interventions aimed at supporting this aspect, proposing both a proper diet, but above all an adequate physical activity. This is a particularly important aspect that requires assessment and specific skills as not all physical activities are recommended for a patient suffering from cancer pathology; the physical conditions, may be different from person to person and above all extremely variable in relation to the severity of the disease and the stage of oncological treatments that are being undergone (chemo, radiotherapy) and to any possible outcomes and disabilities.

We, thus, refer to the Adapted Physical Activity (APA) and then, to the Adaptation Theory, in order to tailor a certain physical activity, appropriately selected, both in terms of equipment to be used, frequency and duration of the training sessions, intensity of the activity, environmental context, monitoring of the activity, surveillance of adverse effects etc ... all aspects that have to be chosen and "adapted" by skilled and trained personnel. A physical activity carried out not in the correct way can cause serious damage.

The APA is indicated during the rehabilitation process to support it or at its completion to maintain the results achieved and - where necessary - to promote a healthy lifestyle.

But in the "after" of oncological therapies, we have to pay attention also to the so called “unconventional” therapies, which we underline in a clear and precise way cannot replace conventional cancer treatments, but that can help to recover the psycho-physical well-being during and after this particular experience.

Oncological Rehabilitation, Adapted Physical Activities and Unconventional Therapies can provide a concrete and valid support to patients with cancer pathology because we do not have to consider a patient as a survivor but as a person who has to get back to life and smile!

MD. Antonio Mander

Head of the Vascular and Oncological Rehabilitation Centres

C.A.R. e V.VOJTA Roma

Trainer at the Italian School of Nordic Walking

A.S.D   SALUTE in MOVIMENTO