Effects of Oncology Rehabilitation on Fatigue, Chemobrain, Function, and Pain in Women with Breast Cancer: A Systematic Literature Review

Effects of Oncology Rehabilitation on Fatigue, Chemobrain, Function, and Pain in Women with Breast Cancer: A Systematic Literature Review

Emilee R. Bohde, Pre-PT Student
Deborah J. Doherty, PT, PhD, CEAS
Oakland University, Rochester, MI

Introduction: Due to medical advancements and knowledge in the health field over the last several years, many more oncology patients are now becoming survivors and therefore are living longer than those diagnosed with cancer in the past.  According to the International Agency for Research on Cancer, a faction of the World Health Organization, cancer is on track to become the leading cause of death by 2020, dominating over cardiovascular disease.   Survivors of breast cancer struggle with a variety of functional deficits; this study will focus on the following four deficits: fatigue, pain, chemobrain (memory fog associated with cancer treatments), and loss of function, all hindering daily tasks.  Often times, those who undergo oncology treatments such as chemotherapy and radiation, suffer from side effects on a daily basis; however, very few patients complain to their physicians because they assume it is normal to live with pain.  For this reason, it is critical to have oncology rehabilitation programs as an option for individuals suffering from treatment side effects.  “Currently there are over 2 million breast cancer survivors in the U.S. alone” (Smoot et al.). Furthermore, it is crucial to improve cancer patients overall quality of life through radical research interventions and/or comprehensive cancer rehabilitation.

Purpose: First and foremost, physical therapists can improve cancer survivors overall quality of life through education--easing fears of the unknown, empowering individuals to take responsibility for their care, and expanding patients’ knowledge base of cancer and its related treatments and symptoms.  Each rehabilitation program is personally tailored to suit the needs of every individual, be it through an extended support system, manual therapy, exercise regimes, lymphedema (swelling in arms and trunk) treatments, and/or pain management.  These programs are in their early stages and there has been little evidence to support their efficacy.  The primary purpose of this study is to examine current research on the effects of Comprehensive Oncology Rehabilitation (COR) on fatigue, pain, chemobrain, and loss of function in women with breast cancer.

Method: A variety of educational databases were consulted in the preparation of this literature review.  Search engines included Medline, PubMed, CINAHL/FirstSearch, Cochrane, SPORTDiscus, PEDro and Science Direct.  Keywords used were: oncology, cancer, neoplasm, rehabilitation, chemobrain, fatigue, pain, function, and physical therapy.  Studies included were those that discussed rehabilitation programs specifically aimed at improving fatigue, pain, chemobrain, and/or loss of function in breast cancer survivors.  Studies excluded were those that did not use a structured rehabilitation program or were not comprised of primarily breast cancer survivors (60% minimum and only if the article separated breast cancer results from other types of cancer).  A functional deficit is a defined loss of range of motion, strength, endurance, cognition,  as well as pain, fatigue, cardiopulmonary deficits and its’ impact  on a survivors’ activities of daily living.

Results: This study determined that breast cancer patients’ functional levels increased after a course of COR (13 out of 14 articles presented positive results).  In addition, fatigue levels decreased in patients who utilized rehabilitation (13 out of 15 articles supported this finding).  Being that chemobrain is a new field of study, there was no research supporting the effectiveness of COR on chemobrain; however, one study suggested that rehabilitation could be successful in reducing cognitive deficits.  Lastly, studies on COR related to pain were very few, yet numerous articles recognized pain as a typical symptom of breast cancer treatments.  In the articles gathered and dissected, our team determined that Oncology Rehabilitation has positive effects on breast cancer survivors’ overall quality of life.

Conclusion: This study promotes comprehensive oncology rehabilitation as an essential tool at any stage of breast cancer diagnosis--relieving pain, reducing fatigue, and increasing one’s functional and cognitive levels--all while preventing scapular dyskinesia (a movement disorder of the shoulder that may result from tightness from surgery or radiation) and diagnosing disorders such as lymphedema and axillary web syndrome (a cord like structure that may develop after lymph nodes have been removed from under the arm).