Lymphedema therapy helps graduate student manage serious side effect of cancer treatment
Amanda Shopa has been knitting a scarf for nearly three years. She began it when she completed her doctoral coursework and, every day, it grows one row longer. Colored stripes symbolize how Shopa’s days were spent: blue for interviewing, purple for writing, white for rest, and a section of tan in the middle for her days of radiation therapy for breast cancer.
The scarf continues to grow as Shopa nears graduation. Just as its colors blend into one design, her diagnosis shows how each day affects the following one. Shopa wants others to know that life is not as simple as it may seem for those who finish treatment.
Chronic swelling after treatment
Shopa was 40 when her first-ever mammogram led doctors to discover stage 1 breast cancer. She had surgery to remove the cancer and then underwent radiation therapy. She’s now working to manage lymphedema, which affects an estimated 40 percent of people who have undergone breast cancer treatment.
“The main symptom of lymphedema is swelling, which can cause discomfort and worsen if not treated. In patients who have undergone breast cancer treatment, it often occurs in the arms and chest,” said Megan O’Connor, DPT, CLT-LANA, a physical therapist and lymphedema specialist with M Health Fairview. “It also increases the risk for infection in those areas. Untreated lymphedema can progress and cause a loss of elasticity in the skin, and the tissue can harden.”
Proactive management through multidisciplinary team
Shopa began meeting with O’Connor last November, as she was finishing radiation therapy, to start taking proactive measures to control lymphedema. O’Connor taught her self-massage methods to help drain the extra fluid that causes swelling. They also began a strength training regimen to support the lymphatic system.
O’Connor is part of a team of lymphedema specialists who see patients at our rehabilitation clinics throughout the Twin Cities and beyond. She also works closely with Florence John, MD, MPH, a physical medicine and rehabilitation physician. John partners with therapy teams to support patients before, during, and after breast cancer treatment.
“We sometimes see patients before surgical intervention or at the beginning of chemotherapy, radiation, or hormonal treatments,” said John. “We call this the prehabilitation phase, in which we can educate patients about potential side effects of these treatments – like lymphedema – that can develop and affect their function. We also help optimize their mobility through therapies to help maintain strength and range of motion.”
Patients then meet with the rehabilitation team after surgery or other treatments to address functional needs and help manage any complications that arise.
Feeling secure in the return to activity
When Shopa began experiencing lymphedema this spring, O’Connor worked with her to get a compression sleeve and a pump covered through insurance. These supports, in addition to Shopa’s self-massage and strength-training routine, help keep fluids moving and manage swelling. When Shopa experiences swelling, this at-home regimen helps her control symptoms, allowing her to pursue her graduate degree and get back to the activities she loves – like working with her hands.
“I enjoy gardening and hiking, and I’m an artist. I do a lot with knitting and sewing. We don’t think of them as physical activities, but they are — especially gardening and spinning my own yarn,” said Shopa. “Strength training makes me feel secure in doing those activities safely to help prevent a lymphedema flare up.”
Living longer with breast cancer requires access to dedicated follow-up care
Shopa is one of more than 26,000 women under 45 who are diagnosed with breast cancer annually in the U.S. While many people are living longer after cancer diagnosis thanks to advances in care, their medical needs aren’t over when treatment ends. This makes it critical to have comprehensive, multidisciplinary follow-up.
Common complications after breast cancer treatment besides lymphedema include a limited range of motion and the buildup of scar tissue. Lymphedema can have other serious side effects beyond discomfort and the potential for infection. The buildup of fluid in the arms can put stress on shoulders that can lead to pain, inflammation, and even injury.
While physical and occupational therapists help patients manage lymphedema, improve range of motion, and regain strength, a physical medicine and rehabilitation physician like Florence John helps monitor progress over time and diagnoses and treats medical conditions that affect a patient’s function.
“Our team can help tease out the root cause of particular symptoms like pain or limited range of motion that are sometimes associated with lymphedema – is it nerve damage after surgery or radiation, scar tissue, or joint pain due to shoulder ailments or stress from swelling?” said John. “We have a variety of options including medication and interventional approaches to help provide symptom relief.”
John also monitors for cellulitis, a potentially serious infection that can occur due to excess fluid buildup, and helps treat these infections when needed.
Close collaboration between our therapists and John, as a physical medicine and rehabilitation physician, allows patients to receive holistic care for lymphedema and other functional effects related to breast cancer and treatment.
“While there’s no cure for lymphedema, our lymphedema therapists can provide very good management options which can significantly reduce swelling and other related symptoms,” said John. “Even though lymphedema is a lifelong condition, with the appropriate treatment it can be very well controlled for many patients, which helps them maintain a great quality of life."
