Patients with breast cancer whose lymph nodes have been disrupted during surgery have an increased risk of lymphedema. Providing education to pre and post-mastectomy patients is an important service for physical therapists to provide.

Rehab Director and lymphedema specialist Jennifer Fuentes, PT believes there is opportunity for therapists to be more aggressive in establishing relationships with therapy and oncology teams at treatment centers to reach patients earlier in the treatment timeline.

She recommends the National Lymphedema Network for physician papers, best practices and patient-friendly resources on what the role of exercise is, proper use of compression garments, and other important risk-reduction practices to cover.

“Education is a huge part of what we do as therapists,” she said. “Even if a therapist is not lymphedema-certified, they could read this website and be able to educate a patient on those risk-reduction practices, because they can interpret the information with the skills and knowledge of a therapist.”

NOT ALWAYS EASY

Physical therapists aren’t always provided the opportunity to evaluate or educate pre-mastectomy patients before their surgical procedure. In some of the areas where we practice, patients with breast cancer are sent to larger centers for their diagnoses, radiation therapy, surgical treatments and other services; never knowing there is a local provider available who can provide therapy services.

“I’ll often see patients who had a majority of their care at a major medical center and didn’t know there was a local center that could have provided therapy services and education. We aren’t getting these patients until much further down the road,” she said. “Physical therapists should be more proactive about this group, as part of their pre-mastectomy treatment could be done locally.”

REFERRAL OUTREACH

There may be multiple major medical centers or cancer treatment centers within two hours of your facility, so Jennifer suggests focusing on one medical group first. It’s a short time commitment to send a note introducing yourself, your team and services–and mentioning the specific areas where physical therapists would be most effective in pre-mastectomy and early post-mastectomy treatment and education.

Jennifer recognizes that pre-mastectomy patients sometimes have several weeks ahead of them before surgery. “If we could see them ahead of surgery and gather baseline range-of-motion (ROM) and strength measurements, we could identify and then address their deficits right away,” she said. “Their surgical outcomes will be better for it.”

As a follow-up strategy, send a thank-you note to doctors when you receive unexpected referrals to encourage more patient care opportunities.