Physical Therapy A Critical Component in Breast Cancer and Secondary Lymphedema: A Rehabilitation Perspective
Abstract
Purpose: The main purpose of the methodical review is to obtain the importance of Physiotherapy Rehabilitation in breast cancer-related lymphedema in order to elucidate the role of Physiotherapy in these patients.
Methods: A systematic data search was performed using Google scholar, PubMed (from February 2001 till August 2020) and is focused on the rehabilitative aspect of breast cancer related secondary lymphedema and undertaken according to the PRISMA statement with Levels of Evidence (LoE) assessed.
Results: 14 randomized controlled trials that included 158 women with breast cancer in after care were included. The included for articles studies of effect different types of physiotherapy regimens like exercises that consisted of lymph training, swimming, resistance exercise, gravity-resistive exercise and aerobic exercises. The mentioned articles were thoroughly analyzed and included in the review.
Conclusion: The evidence indicates that Physiotherapy can improve subjective and objective parameters in BCRL patients although it is found to be helpful in improving the quality of life of these patients.
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Introduction
As per the recent data breast cancer is most common cancer in women worldwide. There is been satisfactory improvements in early detection, diagnosis, treatment and reduction of complications, side effects which includes fatigue, weakness, loss of muscle extensibility, limited shoulder range of motion, upper-body pain, pulmonary complications, neuropathy, decreases in lean mass and concomitant increases in fat mass,. The BCRL arises as a result of fluid accumulation in the interstitial tissue due to damage of the lymphatic system, induced by surgery and/or radiation, or tumor-induced neo-lymph angiogenesis. Maximum proportion of women undergoing axillary intervention develops swelling upto 2 years. Chances of breast cancer related lymphedema is further increased by some risk factors like extensive surgery, obesity, axillary lymph node procedure, and radiotherapy to the regional lymph nodes. Patients with BCRL typically suffer from a swollen upper limb, with concomitant feelings of weakness, heaviness, discomfort, and pain. Furthermore, there is an increased risk of infection and a chronic, progressive course of disease, leading to psychosocial distress and impaired quality of life (QoL). Treatment of BCRL typically consists of a multimodal therapy approach, including complex decongestive medicine, physiotherapy, and skin care. Although previous studies have indicated numerous positive benefits of exercise in breast cancer treatment such as improvements in physical performance, body composition, and quality of life along with an acute and chronic reduction in fatigue.