Analysis: exercising has been proven to improve shoulder functions for breast cancer patients after surgery

Breast cancer accounts for 15% of all new cancer diagnoses in the UK at present. The survival rates of the female breast cancer population have also increased over the past four decades due to improved diagnostics, screening and treatment options. Currently nearly 80% of breast cancer patients survive at least a 10-year period, increasing to 20 or more years after diagnosis and treatment in 65% of these patients.

After initial treatment, many patients return to work and try to regain the lifestyle they had before the surgery, though the surgery sometimes results in the person having some shoulder and arm problems. Imagine not being able to reach up to the cupboard or really wanting to lift your child, comb your hair or scratch your back, but your shoulder and arm are too sore and weak to manage it. The good news is that exercising as part of rehabilitation after surgery for breast cancer is proven to effectively improve shoulder function and reduce the risks of long-term defects on the affected side.

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The most common treatment combination for breast cancer is surgery along with radiotherapy and hormonal therapy. Although very successful, these treatments have been linked to some physical and functional post-surgical complications: such as short-term reduction in the range of movement in the shoulder region, decreased shoulder, arm and/or hand muscle strength, lymphoedema (swelling) and pain. All of these are more common if the lymph nodes are operated on or removed.

When breast surgery is followed by breast reconstruction, there may be further shoulder and arm musculoskeletal problems, that, according to some women, still persist five years post-surgery, but are more prominent in the immediate post-surgical period. 

This support will enable even better outcomes for anyone who has had surgery for breast cancer. 

After surgery, patients are usually given exercises to carry out at home in order to prevent problems or reduce any shoulder and arm issues they might have. The most recent studies and guidelines about rehabilitation after surgery recommend that an upper-limb exercising programme be started possibly on the day after the operation. This programme should involve gentle exercises, performed three to five times a day, within pain limits and performed in two or three sets containing eight to 10 repetitions. After surgery, patients are encouraged to use their upper-limb on the affected side as normally as possible, though there are certain restrictions for the first week or so or until the drains are removed from the chest.

A longer-term, at least eight-week long exercise programme, performed two to three times per week, for 20 to 30 minutes, is proven to be effective in achieving (almost) full use and movement in the affected arm. This involves gradually increased strengthening and weight-training exercises. Immediate and long-term exercising after surgery for breast cancer has no reported serious long-lasting adverse effects. Neither, does it increase the risks or incidence of lymphoedema and sometimes reduces it.

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But the reality is that it is likely that many patients are overwhelmed with information about their cancer treatments during their short day-procedure or overnight stay for breast surgery. After the operation, patients often start other cancer treatments and shoulder exercising may not be prioritised. This is due to little emphasis being placed on preventing or reducing arm and shoulder dysfunction after surgery, which may have potentially short and long-term negative consequences. Instead, the emphasis after surgery is predominantly on patients' physical and psychological well-being and body image. Although important, this should not exclude the provision of tailored advice addressing the potential functional shoulder and arm issues.

Developments in digital technologies in the last decade have led to the advancement of web-based and non-face-to-face programmes in the field of healthcare and more specifically, cancer care and survivorship. Despite the relatively limited number of online programmes, web resources are becoming increasingly popular because they overcome such barriers as travel costs and time and distance subsequent. At the same time, they can provide autonomy, allowing patients to actively participate in achieving better health outcomes in their cancer care, by using the online resources independently and by managing their own care at a preferred time of the day and in the comfort of their homes. 

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To date, only a very small number of online programmes exist that relate to supporting breast cancer patients. Therefore, there is a need for the development of easy-to-use engaging exercise programmes for patients that are available to them at any time and as soon as possible after the breast surgery.

A team of researchers at Ulster University are currently working towards the development and testing of an online resource for self-exercising to improve shoulder function and mobility. This is being designed by and for the patients so that it gives specific, relevant and encouraging advice based on their needs and preferences. 

Programmes like this are low cost, will support people after surgery and will encourage safe exercising in an engaging and timely manner. This online support will enable even better outcomes for anyone who has had surgery for breast cancer. 

The views expressed here are those of the author and do not represent or reflect the views of RTÉ