About two years ago, a good friend called to tell me she had breast cancer. Stunned, I did the best I could at dealing with the shock while offering whatever verbal support came to mind. I also sent her coldfront. After thanking me, Sheri gently explained that she didn’t need a personal cooling system. I told her to hang onto it, because chances were that she would. While going through the treatment and healing process post surgery, her physical therapist asked her to bring in whatever she was using to make her feel better. Sheri brought in coldfront.
After her appointment, Sheri called to let me know that her doctor was intrigued and would be calling me later in the day. Ten minutes later, Dr. Nancy Roberge and I were talking. Since then I have come to understand and appreciate just how passionate Nancy is about her breast cancer patients, along with the importance of physical therapy as it relates to optimal healing.
I am delighted that she agreed to participate in this interview, and to introduce you to Nancy Roberge, Physical Therapist, Doctor of Physical Therapy and Master of Education.
Nancy J. Roberge, PT, DPT, M.Ed. has specialized in the care of women after breast cancer treatment since 1993. Her focus and emphasis has been on helping people get through their cancer journey in a more positive, more healthful way through manual physical therapy, exercise, use of the mind-body connection, and patient education. She believes that with Physical Therapy intervention, the cancer journey doesn’t have to be as difficult as she has seen it be for so many.
She is known nationally for her work in Physical Therapy for the patients who have undergone axillary node dissection and/or treatment for breast cancer. Dr. Roberge is focused on helping her patients regain the use of their arms, return to their maximal level of function, and minimize the after-effects of surgery, chemotherapy and radiation therapies. Educated in the LeDuc method of manual lymphatic drainage, she also teaches patients how to lower their risk of getting lymphedema.
Dr. Roberge is the director of Chestnut Hill Physical Therapy Associates and focuses her work on helping women move through breast cancer diagnosis, recovery, and beyond, achieving the highest quality of life possible. She has developed a two-day comprehensive breast cancer rehabilitation course and teaches nationally and internationally.
“Doctors will tell their patients, ‘If you can exercise, you don’t need PT.’ This is just not true.”
Q: How did you get into Physical Therapy (PT) for breast cancer patients?
A/NR: A dear girl friend, also a PT, was diagnosed with BC in 1992. We did everything we have been trained to do as Physical Therapists (PTs) and she had a speedy, quick and complete healing of her wounds and after effects from treatment. She worked through chemo and radiation therapy and her doctors were all amazed at her quick and full recovery and asked her what she had done. She looked at them and said, “You know I am a PT and I just did what I was trained to do…” It was a light bulb moment for me, realizing that we knew what to do to get her whole again. But not everyone diagnosed with breast cancer is a PT and they won’t know what to do. It was from that moment forward that I realized, this would be the rest of my professional career work, focused on those being treated for breast cancer.
Q: Who needs PT during recovery?
A/NR: Everyone. Not everyone needs long-term PT, but most women need some. Education is so important for these women. They thirst for the knowledge and information I bring to them. So PTs offer support, education or information, manual therapy to heal their wounds, and therapeutic exercise to remediate the effects of the treatment.
Q: What are your patients’ most common complaints?
A/NR: Not enough information for one. Cancer related fatigue is the most common complaint from most. Inability to function and do what their families need them to do. Low endurance.
Q: What are the most common misconceptions of PT for breast cancer patients?
A/NR: Doctors will tell their patients, “If you can exercise, you don’t need PT.” This is just not true. We offer support. We educate our patients about the short and long term after effects of treatment. We help them with lymphedema risk reduction strategies for those at a higher risk. We help them with their return to work schedules so they can be successful through pacing of their efforts, mindful of their energy.
Patients have told me that they are made to feel ‘inadequate’ because they ask for PT and are trying to advocate for themselves. No patient should be made to feel inadequate because they can’t exercise or need help getting through the rigors of breast cancer treatment! PTs help patients to advocate for themselves. A woman has a right to want to be whole again. A woman has a right to be as strong as she once was. A woman has a right to function as she wants to or needs to. She shouldn’t offer anyone an apology for advocating for herself by asking to be sent to PT!!
Q: How can PT help during the recovery process?
A/NR: PT can speed recovery in many ways. First of all, patients often don’t know when enough is enough. They may over or under exercise. PTs help them here. PTs are great about offering emotional support. I believe the first cheerleaders were PTs! We know how to get people to move or exercise even when it doesn’t feel good to do so.
Patients need to understand the differences between ‘acceptable’ pain and ‘unacceptable’ pain. This is difficult to judge and PTs help the patients to figure this out. After surgery, PTs do manual therapy (often during chemotherapy) to get the patients range of motion (ROM) as good as it can be for radiation (which follows chemo). If a woman doesn’t have enough ROM to get her arm up for radiation, she may have significant pain and difficulty and radiation can last 6-7 weeks. One of my patients said she couldn’t imagine that “…Medieval torture was any worse than what I experienced every day of 6 1/2 weeks of radiation. She had a torn rotator cuff that she had put up with for years, and came to diagnosis causing significant pain during radiation.
“PTs use the ‘F’ word every day. Function. Function. Function. This is what people want, their function back”
Q: How often is PT prescribed?
A/NR: PT is prescribed routinely in some centers, non-existent in others (sadly).
Q: What are the current standard protocols for treating breast cancer?
A/NR: Surgery, chemotherapy and radiation therapies. You’ll find an overview of each here.
There are no current standards of PT care. Some Comprehensive Cancer Centers have routine PT intervention and have since the 1950s (MD ANDERSON, Houston, TX). For others, it is non-existent or only exists “when the patient has a problem.” This is the paradigm shift I often talk about. PTs should be part of the critical pathway of professionals who see the patient being treated for breast cancer and NOT just for “problems only.” Most RNs and MDs think of PT when the patient has a problem that they can’t solve. We need to be there before a problem exists. Prevention is kinder to the patient than remediating a problem.
Q: Why and how are hot flashes associated with breast cancer treatments?
A/NR: A hot flash is a vasomotor response caused by the extreme hormonal shifts that breast cancer patients go through. Menopause is known for causing hot flashes. But for women who experience menopause as a result of chemo or certain medications, the hot flashes can be more intense.
Q: How can PT awareness be raised for breast cancer patients?
A/NR: Through people reading articles such as these. Through our in-service educational programs that we offer in hospitals. Through educating the public at large, so that women can be empowered to advocate for themselves and say to their doctors, “Please, I would like a referral to a PT.” and not feeling badly as they advocate for themselves.
Q: What resources do you recommend?
A/NR: You can find a list of resources here.
Q: Do you have some words of wisdom you’d like to share with those going through breast cancer treatment?
A/NR: “Damn the torpedoes. Full steam ahead!”
Treatment for BC or any cancer is a protracted journey and you will see just how strong you are. But don’t despair, soon, treatment will be in the past, like an object in your car’s rear-view mirror getting smaller and smaller as time goes on. You will be whole again and PTs will help make this happen. Your new normal may be different. But hopefully, you will be new and improved because you will be cancer-free and with a sense of how strong you really are.
Eleanor Roosevelt said it best: “A woman is like a tea bag; you never know how strong it is until it is in hot water.” This is the strength I see every day in women.
To learn more about Nancy, click here.
In honor of Breast Cancer Awareness Month, we’re offering coldfront at a 10% discount on our website. Use code: BCAM10 at checkout.
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