Physical Therapy Guide to Cancer
Cancer is the growth of abnormal cells in the body that causes destruction of normal, healthy cells. This process affects the health and function of the body or body parts, and can cause death. Cancer affects 39.6% of people in the United States (US) at some point in their lives, with more than 1.5 million new cases diagnosed each year. Cancer deaths are higher among men than women in the US—highest in African-American men, and lowest in Asian/Pacific Islander women. Worldwide, approximately 14 million new cancer cases are diagnosed each year, and 8.2 million deaths from cancer are recorded.
Cancer, and the treatments for it, can cause physical problems such as pain, numbness, swelling, weakness, loss of balance, and difficulty moving or walking. Physical therapists help people manage cancer-related problems, improve their health and functional abilities, and return to work and other activities.
What is Cancer?
Cancer is an uncontrolled growth of abnormal cells in the body. The abnormal cells interfere with normal cells, and can spread throughout the body.
Cancer is diagnosed in adults and children. It can affect any part of the body, including organs, bones, and muscles. The most common types of cancer diagnosed in the US (in descending order) are:
Cancer death rates in the US have declined since the early 1990s; more Americans are surviving cancer than ever before.
Conventional treatment for cancer includes surgery, chemotherapy, radiation, and gene therapy. Cancer and the side effects of treatment can cause physical problems, such as:
- Numbness in feet and hands
- Swelling of lymph nodes (lymphedema)
- Swelling of arms, legs, torso, or face
- Muscle weakness
- Joint stiffness
- Loss of endurance
- Loss of bone density (strength)
- Difficulty walking
- Loss of balance
- Weight gain
- Brain fog
- Heart problems
Signs and Symptoms
Sometimes cancer does not cause any signs or symptoms, and is discovered during a medical examination or screening.
Common signs and symptoms of cancer can include:
- Unexplained weight loss
- Unexplained bleeding
- Skin changes
- Nagging cough
- Vision problems
More information on the signs and symptoms of cancer can be found at the American Cancer Society’s website.
How Is It Diagnosed?
Cancer is diagnosed by a physician. A physical therapist can examine a person who has been diagnosed with cancer for physical problems that cause discomfort or difficulty with movement. The physical therapy examination tests a person’s strength, flexibility, balance, sensation, coordination, endurance, and ability to walk and get around. Physical therapists create specialized treatment plans to address the needs and goals of people affected by cancer.
How Can a Physical Therapist Help?
Physical therapists are trained and educated to understand all of your health conditions, including a cancer diagnosis. Your physical therapist will work with you to develop a specialized treatment program to address your specific needs and goals.
The American Cancer Society recommends people undergoing cancer treatment, and cancer survivors, perform consistent physical exercise to decrease fatigue, and improve the ability to perform normal daily activities. Studies show that exercise can improve an individual’s chances of surviving cancer. Physical therapists can design individualized exercise and treatment programs to reduce or prevent many cancer-related problems.
Physical therapists help people diagnosed with cancer before and after surgery. Before surgery, they evaluate individuals for any of the problems listed above, and help address them. After surgery, they can help with the healing of the incision site, improve circulation, reduce pain, and minimize scarring. They evaluate individuals for any physical therapy treatment needs, and, by designing individualized treatment programs, help them recover and heal faster than they would on their own.
Your physical therapist may work with you to improve your:
Comfort and well-being. Cancer and cancer treatments can cause symptoms such as pain, burning sensations, numbness, tingling (neuropathy), cramps, spasms, and weakness. Your physical therapist may apply hands-on techniques (manual therapy) or technologies like electrical stimulation to help decrease your pain and alleviate your symptoms. The physical therapist may teach you gentle exercises or techniques to perform at home to aid your recovery. All of these options may reduce or eliminate the need for opioid pain medication.
Aerobic capacity. Cancer or cancer treatment may have decreased your ability to process oxygen (aerobic capacity), causing fatigue. Research shows that aerobic exercise, such as walking on a treadmill for at least 20 minutes 3 times per week, may help improve aerobic capacity, reduce fatigue, and optimize healing. Your physical therapist can assess your aerobic capacity and determine the best aerobic activities for you.
Bone density. Lack of activity and certain cancer treatments can cause weakening of your bones, which could lead to bone fractures. Certain types of exercise can prevent bone loss and maintain bone strength. Your physical therapist can teach you safe and effective exercises to help steadily build your bone strength.
Lymphedema and swelling. Certain cancer treatments can result in lymphedema (swelling in the arms or legs) or other types of swelling. Your physical therapist can use several methods to reduce, control, and prevent lymphedema and swelling, such as specialized gentle massage, special movements and exercises, and application of compressive garments such as arm sleeves, gloves, and leg stockings.
Surgical incisions. Your physical therapist can help you care for any surgical incisions and sutured areas, by checking for infection and assisting with dressing changes. The physical therapist also can help prevent some kinds of scarring and skin tightness as the suture line heals. Your physical therapist can use very gentle massage or certain technologies to keep the skin as soft and pliable as possible.
Body weight. By creating an exercise and physical activity program tailored just for you, your physical therapist will help you reduce body fat and maintain a healthy body weight, which can improve your energy levels.
Mood. Exercise helps elevate mood and reduce depression in everyone, including cancer patients and survivors. A diagnosis of cancer, and cancer treatment, can be stressful and cause mood changes in anyone. Proper exercise, individualized for each person by a physical therapist, can help reduce stress and improve mood.
Brain fog. Exercise helps relieve brain fog. Your physical therapist can design an individualized program of exercise that can help reduce memory loss and brain fog.
Daily activities. Your physical therapist will discuss activity goals with you and use them to design your treatment program. Cancer survivors usually increase their physical activity gradually; your treatment program will help you reach your goals in the safest, fastest, and most effective way possible.
Walking. Your physical therapist will help improve your ability to walk using techniques such as strengthening exercises, walking training, and balance activities. If you have nerve damage (neuropathy), your physical therapist may provide bracing and other techniques to make it easier or safer for you to walk. Your physical therapist also may recommend using an assistive device, such as a walker or cane.
Sports training ability. Athletes undergoing cancer treatment can continue to train for their sport to a degree, depending on the type of cancer and treatment. Physical therapists design safe, challenging, sport-specific training programs to help athletes reduce loss of fitness and strength during cancer treatment.
Motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in any stiff joints. These might begin with "passive" motions that the physical therapist performs for you, and progress to active exercises and stretches that you do yourself. You can perform these motions at home to help hasten healing and pain relief.
Flexibility. Your physical therapist will determine if any muscles are tight, start helping you to stretch them, and teach you how to stretch them at home.
Strength. If your physical therapist finds any weak or injured muscles, the physical therapist will choose, and teach you, the correct exercises to steadily restore your strength and agility.
Coordination. Your physical therapist will help you improve and regain your coordination and agility, so you can perform household, community, and sports activities with greater ease.
Balance. Your physical therapist will examine your balance, and choose specific exercises that you can perform in the clinic and at home to improve your balance and prevent falls. Your physical therapist may also teach you how to use a cane or walker to help maintain your balance when walking and standing.
Home program. Your physical therapist will teach you strengthening, stretching, and pain reduction exercises to perform at home. These exercises will be designed specifically for your needs.
Can This Injury or Condition Be Prevented?
The risk of cancer can be reduced by:
- Maintaining a healthy diet
- Engaging in consistent exercise and physical activity throughout life
- Keeping your weight at a healthy level
- Avoiding tobacco in any form
- Avoiding too much sun exposure
More information on preventing cancer can be found at the American Cancer Society’s website.
Side effects of cancer treatment may be reduced or prevented by:
- Staying active every day
- Avoiding too much bedrest
- Keeping active and participating in activities and exercises that you like to do, as often and as vigorously as possible
Your physical therapist can help you choose the safest, most effective exercises to perform before, during, and after cancer treatment.
Real Life Experiences
Mary Lynn is a 60-year-old nurse who was recently diagnosed with uterine cancer. Prior to her diagnosis, Mary Lynn was an active person, working full-time at the local hospital, gardening on the weekends, and enjoying ballroom dancing several evenings a week. She also liked to travel and work out at her neighborhood gym.
Mary Lynn wanted to minimize the side effects of her treatment as early as possible, so she met with her physical therapist following her diagnosis and prior to her surgery.
Mary Lynn’s physical therapist conducted a full evaluation of her strength, flexibility, balance, sensation, coordination, and endurance. He observed how well she could walk, go up and down stairs, and get into and out of a chair.
He designed a treatment program to address her specific problems, which included posture, muscle strength and flexibility problems, mild balance loss, and low endurance. He taught her exercises to strengthen her weakened muscles, stretch them gently, regain her balance, and rebuild her aerobic endurance. Mary Lynn completed several sessions with her physical therapist before her surgery. She felt stronger and more confident about the surgery because of her improved physical condition.
Mary Lynn’s cancer treatment included a hysterectomy, chemotherapy, and radiation therapy. She continued to receive treatments from her physical therapist after her surgery and during her chemotherapy treatments.
Mary Lynn’s physical therapist repeated her full examination every few weeks, or whenever she felt new symptoms. At each visit, he asked her to describe any current problems or side effects. He examined her surgical incision to monitor healing. Shortly following surgery, Mary Lynn said she felt some pelvic discomfort and had experienced some incontinence. After she started the chemotherapy, she described experiencing numbness and burning in her feet, and a loss of balance when standing or walking. She also noted that she wasn’t hearing as well, had gained weight, and was feeling fatigue throughout the day.
Mary Lynn’s physical therapist regularly updated her treatment program to address any new problems. He applied gentle electrical stimulation to her feet to help relieve her discomfort. He taught her exercises to strengthen and reactivate the muscles in her pelvic region, and relieve her pain and incontinence. He gave her a simple, easy home program to do for a few minutes each day. Mary Lynn readily agreed to the treatment, and stuck with her home program; she knew that doing so would speed her recovery.
With the help of her physical therapist, Mary Lynn improved steadily over the next few months. She noticed that she always felt better after her treatment in the physical therapy clinic, and after exercising.
Mary Lynn was able to continue her gym workouts in a modified way, during her cancer treatment, with the advice and guidance of her physical therapist. She continued her physical therapy and exercise program throughout her chemotherapy and radiation therapy, and increased her exercise level back to her precancer levels within a few weeks after the end of chemotherapy.
Her physician was pleased to see how active and strong Mary Lynn was just a few weeks after finishing her cancer treatment. Because she was able to maintain a good level of fitness during treatment, she was able to get back to the ballroom dance studio, as well.
And just this week, Mary Lynn was proud to share her latest crop of tomatoes and peppers with her neighbors!
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat cancer-related movement problems. However, you may want to consider:
- A physical therapist who has experience treating people with cancer before and after surgery, and during cancer treatment. Some physical therapists have a practice with an oncology, lymphedema, or pain management focus.
- A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in cancer physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapist’s experience in helping people who have your type of problem.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions, and also prepare them for a visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of cancer problems. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Mohamady HM, Elsisi HF, Aneis YM. Impact of moderate intensity aerobic exercise on chemotherapy-induced anemia in elderly women with breast cancer: a randomized controlled clinical trial. J Adv Res. 2017;8(1):7-12. Free Article.
Cornette T, Vincent F, Mandigout S, et al. Effects of home-based exercise training on VO2 in breast cancer patients under adjuvant or neoadjuvant chemotherapy (SAPA): a randomized controlled trial. Eur J Phys Rehabil Med. 2016;52(2):223–232. Free Article.
Van Waart H, Stuiver MM, van Harten AW, et al. Effect of low-intensity physical activity and moderate- to high-intensity physical exercise during adjuvant chemotherapy on physical fitness, fatigue, and chemotherapy completion rates: results of the PACES randomized clinical trial. J Clin Oncol. 2015;33(17):1918–1927. Free Article.
Al-Majid S, Wilson LD, Rakovski C, Coburn JW. Effects of exercise on biobehavioral outcomes of fatigue during cancer treatment: results of a feasibility study. Biol Res Nurs. 2015;17(1):40–48. Free Article.
Yang TY, Chen ML, Li CC. Effects of an aerobic exercise programme on fatigue for patients with breast cancer undergoing radiotherapy. J Clin Nurs. 2015;24(1-2):202–211. Article Summary in PubMed.
Bergenthal N, Will A, Streckmann F, et al. Aerobic physical exercise for adult patients with haematological malignancies. Cochrane Database Syst Rev. 2014;(11):CD009075. Free Article.
Hornsby WE, Douglas PS, West MJ, et al. Safety and efficacy of aerobic training in operable breast cancer patients receiving neoadjuvant chemotherapy: a phase II randomized trial. Acta Oncol. 2014;53(1):65–74. Free Article.
Murtezani A, Ibraimi Z, Bakalli A, Krasnigi S, Disha ED, Kurtishi I. The effect of aerobic exercise on quality of life among breast cancer survivors: a randomized controlled trial. J Cancer Res Ther. 2014;10(3):658–664. Free Article.
Mishra SI, Scherer RW, Snyder C, Geigle PM, Bertanstein DR, Topaloglu O. Exercise interventions on health-related quality of life for people with cancer during active treatment. Cochrane Database Syst Rev. 2012;(8):CD008465. Article Summary in PubMed.
Brdareski Z, Djurovic A, Susnjar S, et al. Effects of a short-term differently dosed aerobic exercise on maximum aerobic capacity in breast cancer survivors: a pilot study. Vojnosanit Pregl. 2012;69(3):237–242. Article Summary in PubMed.
Jones LW, Douglas PS, Eves ND, et al. Rationale and design of the Exercise Intensity Trial (EXCITE): a randomized trial comparing the effects of moderate versus moderate to high-intensity aerobic training in women with operable breast cancer. BMC Cancer. 2010;10:531. Free Article.
Kampshoff CS, Buffart LM, Schep G, van Mechelen W, Brug J, Chinapaw MJ. Design of the Resistance and Endurance exercise After ChemoTherapy (REACT) study: a randomized controlled trial to evaluate the effectiveness and cost-effectiveness of exercise interventions after chemotherapy on physical fitness and fatigue. BMC Cancer; 2010;10:658. Free Article.
Schwartz AL, Winters-Stone K, Gallucci B. Exercise effects on bone mineral density in women with breast cancer receiving adjuvant chemotherapy. Oncol Nurs Forum. 2007;34(3):627–633. Article Summary in PubMed.
Daley AJ, Crank H, Saxton JM, Mutrie N, Coleman R, Roalfe A. Randomized trial of exercise therapy in women treated for breast cancer. J Clin Oncol. 2007;25(13):1713–1721. Free Article.
*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.
Authored by Andrea Avruskin, PT, DPT. Reviewed by the editorial board.