Physiotherapy following breast cancer surgery

Breast cancer affects nearly 10,000 Australian women each year. Because the treatment of the cancer is so invasive and aggressive, and there is insufficient rehabilitation, women often report the presence of symptoms such as stiffness, weakness, swelling and pain months and years after treatment. These symptoms can impact on the quality of life and interfere substantially with activities of daily living for the cancer survivor. We will investigate whether an early intervention program of daily stretching and strengthening for muscles about the shoulder prevents occurence of these symptoms. We will compare the outcomes of patients randomly assigned to either an exercise group or a usual care (control) group. Subjects allocated to the exercise group will perform exercises daily, and will be supervised by a physiotherapist once a week for 8 weeks. At the end of the 8 weeks, subjects will be given a home-based training program to continue indefinitely. Subjects in the 'Usual care' group will receive the same care as is now typically received, a vist by the physiotherapist and occupational therapist while an inpatient, and receipt of pamphlets. All subjects will be measured at baseline, 8 weeks, and 6 months intervals up to 3 years. The primary measure is arm symptoms, derived from a Breast Cancer specific questionnaire (BR32). In addition, range of motion, strength, swelling, pain and quality of life will be assessed. This study will determine whether the secondary problmes associated with treatment of breast cancer can be prevented by exercise, and provide the basis for successful rehabilitation. Additionally, it will identify whether strengthening exercises reduces the incidence of swelling.