Eileen Pillitteri: Hi, I’m Eileen Pillitteri. I’m the Program Director at The Maurer Foundation for Breast Health Education. Today we’re diving into our topic that I don’t feel gets enough attention, and that’s the role of physical therapy during breast cancer treatment and recovery. And I’m thrilled to be joined by Melissa Thorp. She’s a certified breast cancer rehabilitation specialist. Melissa holds a bachelor’s degree in clinical sciences and a master’s degree in physical therapy from Ithaca College. She brings a wealth of experience working with patients who have complex medical histories. And today she’s here to share her expertise on how physical therapy can help support healing, mobility, and quality of life after a breast cancer diagnosis. Melissa, thank you so much for being here with us.

Melissa Thorp, MS PT: Thank you so much for having me, Eileen. This is a topic that’s certainly near and dear to my heart. So I appreciate the chance to speak with you about it.

Eileen Pillitteri: This is great. I think the best way to start off is just, can you explain what oncology rehabilitation is?

Melissa Thorp, MS PT: So, my job as an oncology rehabilitation therapist is trying to get people to improve their quality of life. So specifically with the breast cancer patients, I’m working with women who are coming either from a lumpectomySurgical removal of the breast lump and its surrounding tissue. or a mastectomyAn operation removing all or part of the breast., maybe none of the above. Some of them have had surgery and radiation, some have had chemotherapyTreatment with drugs to destroy or slow down the growth of cancer cells. Often referred to as systematic treatment, because it acts throughout the body, as opposed to localized treatments, like surgery or radiation. or are on any of the AI medications. All of these treatments are designed to save their lives and to keep them here. And some of those treatments do have some side effects. And my job is to help mitigate the effects of that.

Eileen Pillitteri: Can you go in a little more detail what some of those side effects are? Like, why are people coming to you for your service?

Melissa Thorp, MS PT: So, patients who have had surgery or radiation often times will have difficulty with their range of motion. So, they go to get something out of the cabinet they can’t quite reach. They might have trouble getting their arm behind their back to be able to hook their bra. They might be going to lift something up and realize they really can’t do that. So that’s one issue. The other issue that comes into play is a lot of the patients who are on the long-term medications, like tamoxifenA drug that blocks estrogen from affecting organs, such as the breast. or lestrizol, those patients are having difficulties a lot of times with joint pains and getting up and getting around is not something they want to do. And then we start to get into a cycle where they don’t move as much and then they have some more pain. So, we’re trying to really mitigate that and get them to the point where they can get out and start living their life again, get a little stronger.

Eileen Pillitteri: Now we know every patient’s journey is a little bit different depending on their stagingThe process of determining whether cancer has spread and, if so, how far. Although there is more than one system for staging, the TNM system provides three important pieces of information: T - referring to the size of the Tumor, N - describing how far the cancer has spread to nearby Nodes and M - showing whether the cancer has spread or Metastasized to other organs of the body. Letters or numbers after the T, N, and M provide a patient with more details about each of these factors. The TNM descriptions can also be grouped together into Stages labeled with Roman numerals. In general, the lower the number, the less the cancer has spread. The higher the number, the more serious the cancer is. and their type of cancer. And you certainly have mentioned several treatments that breast cancer patients can undergo. I’m just curious, can people start receiving rehab before these treatments begin?

Melissa Thorp, MS PT: I get patients who will have some therapy before. Oftentimes, I’ll get them after surgery, but before radiation, or I’ll get them during chemotherapy. I don’t often, at least in my practice, see patients who are having therapy before surgery.

It is something as oncology therapists that we’re looking to get our surgeons and our oncologists, medical oncologists, radiation oncologists on board that we’re here and we’re here to help. And if we can at least start with some exercises, start with a little program, then we can get you better. So, there’s certainly, we’re here for that. We’re just not utilized for that as often as I’d like to be.

Eileen Pillitteri: So, I’ve heard people talk about these different phases of oncology rehabilitation. So I guess that’s a little bit more on the preventative side. Can you describe some of those other phases that people may not be familiar with, whether it’s restorative or supportive?

Melissa Thorp, MS PT: So basically, we have our preventative exercises. The goal with that is for anyone and everyone to have a good program that’s building up their aerobic capacity, that’s building up their strength, that’s working on their range of motion, and basically keeping them doing what they need to before any type of treatment. Then we have restorative therapy. Restorative therapy is when we’re really looking to do just that. We’re looking to restore function to a patient.

And that usually happens after surgery, after radiation, and during or after chemotherapy, when people are experiencing side effects that are impacting their quality of life. For breast cancer patients, it’s usually in the form of fatigue and battling the fatigue factor, or in battling the things that they can’t do with their upper extremity, reaching overhead, getting into cabinets, that sort of thing.

And then supportive therapy is what we’re here for across the board is the idea that while you may continue to go through treatment, you may have ups and downs. And if we bring in, you know, the idea of lymphedemaA condition that is caused by damage to the lymphatic system’s capacity to move lymphatic fluid, often a result from having the axillary lymph nodes sampled or removed at the time of lumpectomy or mastectomy, or having had radiation to the axillary area. Symptoms include the hand, arm and tissues of the upper chest becoming swollen and painful. While it can be controlled with the use of compression sleeves and a massage technique called manual lymphatic drainage, it cannot be cured. Lymphedema can also occur in the feet and legs as a result of node removal in the groin or pelvic area. that can come and go and not everybody’s going to get it and not everybody needs therapy for it. But if you do, we can work with you on that. Again, it’s all about the quality of life during each of those phases, as people like to call them.

Eileen Pillitteri: It sounds like a really important part of what’s become very personalized medicine. And it sounds like you can really adapt the treatment and rehab, depending on what the patient needs. Are there times where maybe they could be discharged for a little while, but if something tends to kind of flare up for them, then they can come back to you to be able to address that?

Melissa Thorp, MS PT: Without a doubt. Look, my first goal when somebody walks in is always planning for discharge. I don’t want, you’re not staying with me forever, I may love you, but you have to go out in the real world. And just because you finish up now doesn’t mean that something’s not going to crop up down the line. And if it does, I always tell my patients when they’re leaving me, just because you’re not seeing me right now, first of all, doesn’t mean you stop your home exercises, you have to keep doing them. But you can also always ask your oncologistA doctor who specializes in the diagnosis and treatment of cancer., your surgeon, your primary physician and you tell them, I’m having this, I’m feeling that pain again, I’m feeling that heaviness, I’m having trouble with and ask them to come see me again, come back for physical therapy, let’s see what we can do, let’s see how we can make it better. And everyone laughs, I always say, we’re really good about taking our cars in for a tune up, we’re really bad about forgetting that we can take our bodies in for a tune up also.

Eileen Pillitteri: It’s true. And you know what, you really started answering one of the other questions I had is like, how do people find you? How do people get referred to you? So, it sounds like there’s a couple of different avenues, whether it’s their general practitioner or maybe their oncologist would refer to you.

Melissa Thorp, MS PT: So, I get referrals from my breast cancer patients, predominantly from either the breast surgeons, the medical oncologists, and our radiation oncologists. I’ll also get referrals from an orthopedic surgeon, because if you’re not really moving your shoulder, if you’re not reaching over, we get a lot of adhesive capsulitis going on or that frozen shoulder pain. So a lot of times we can work with them on that.

Sometimes I get it from a primary physician. Somebody went in and that’s the doctor who just heard them the longest or hadn’t seen them in the longest time. And they’re like, this is bothering me. They’re like, okay, here I go for physical therapy. The other thing is most of my patients will tell me I didn’t know you existed. I didn’t know it was here. I didn’t know I could. So, if there’s anything that anyone hears from this, I want you to know that therapy is out there. Oncology therapists are out there, but any physical therapist is qualified to treat you with any functional impairment, meaning if you can’t do it, we can treat you and help get you better. And asking your doctor for that referral is the best thing that you can do.

Eileen Pillitteri: Definitely raising awareness to the service is so important and I love that we have this opportunity to connect and kind of spread the information and get it out to folks because we don’t want people suffering if there’s things that we can do to help alleviate that. I’m just sort of curious, what’s your experience with getting your services covered by insurance?

Melissa Thorp, MS PT: We’re very lucky with the breast cancer population in that most of our insurances will cover treatment. They’re looking at functional goals. So, the moment that you don’t have the ability to perform a task, we can put in what your range of motion is, your strength, and we submit. And insurance is really pretty good about reimbursing for that, about covering for that. It will vary person to person.

There’s so many insurances out there. I can’t guarantee that anybody’s is absolutely perfect, but it’s really no different than the way we would go about getting visits for someone who has a total knee replacement or a total hip replacement.

Eileen Pillitteri: That’s great. So, I guess, you I know you mentioned, you know, people aren’t going to be with you forever. So, what are the steps when somebody’s when you’re ready to discharge them? What happens after rehab?

Melissa Thorp, MS PT: So, after rehab is over, starts on the day that you walk in to see me. And that’s with a home exercise program. And what we do with those exercise programs is that I tailor them to what you need. Not everybody is getting the exact same thing. It’s based on where you’re at and what you need. And we progress those programs so that the more you can do with me in the clinic, the more you can do outside. And we talk about all different programs. Here in the Long Island metro area, we have a couple of programs for exercise for people who have cancer. So, we’re able to give referrals to those programs. I know there are some across the country depending on where you’re living. So that’s a great option. We talk about gyms, what equipment you can use in the gym. I get you out into the gym with my orthopedic patients who are there and we work on machines. We work on anything that you can do that’s gonna help you return to the activities you wanna do. If you wanna go play pickleball or you want to play tennis, or you’re a bowler, whatever it may be. My whole goal is to get you back to doing all that.

Eileen Pillitteri: Great. And I think that’s the goal, right? Quality of life, to be able to restore some of that function and people make sure they have that independence that they had before treatment is really just so important. Melissa, I really want to thank you again for sharing all this valuable information with us. I think there’s so many people who can really benefit from what you’ve shared today. So, thanks again for joining us.

Melissa Thorp, MS PT: My pleasure. Thank you so much for having me.