• ChoosePT Guide

    Physical Therapy Guide to Cancer

    Cancer is the growth of abnormal cells in the body that causes the destruction of normal, healthy cells. This process can affect the health and function of different parts of the body, and can cause death. As much as 38.4% of the population in the United States will have cancer at some point in their lives. More than 1.7 million Americans receive a new cancer diagnosis each year, resulting in 600,000 deaths. Physical inactivity appears to contribute to these numbers. Cancer deaths are higher among men than women in the U.S. It is highest in African American men, and lowest in Asian or Pacific Islander women. Worldwide, about 14 million new cancer cases are diagnosed each year, with 8.2 million cancer-related deaths recorded.

    Cancer and cancer-related treatments can cause physical problems. These problems can include pain, numbness, swelling, weakness, loss of balance, and difficulty moving or walking. According to the American Cancer Society, people undergoing cancer treatment, and cancer survivors, should maintain consistent physical activity to decrease fatigue and improve the ability to perform daily tasks. Physical therapists create treatment plans that use physical activity to help cancer survivors manage side effects of treatment and cancer-related problems, improve their health and function, and return to work and other activities.

    Physical therapists are movement experts who improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.

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    What Is Cancer?

    Cancer is the name given to a collection of diseases that involve an uncontrolled growth of abnormal cells. These cells interfere with normal cells and can spread throughout the body.

    Cancer is diagnosed in children and adults. It can affect any part of the body, including organs, bones, muscles, and blood. The most common types of cancer in the U.S. (in descending order) are:

    • Breast.
    • Lung.
    • Prostate.
    • Colon.
    • Skin.
    • Bladder.
    • Kidney/renal.
    • Uterine.
    • Thyroid.

    Cancer death rates in the U.S. have declined since the early 1990s. More Americans are surviving cancer than ever before.

    Treatment for cancer can include surgery, chemotherapy, and/or radiation. Some people with cancer also may be treated with immunotherapy (using the immune system to fight cancer), targeted therapy (gene therapy), or hormone therapy. Cancer and the side effects of treatment can cause physical problems, such as:

    • Pain.
    • Numbness, tingling, and/or reduced feeling in your arms and legs.
    • Blockage in the lymphatic system (lymphedema). This blockage can lead to swelling in your arms, legs, shoulders, hands, fingers, chest, or neck.
    • Muscle weakness.
    • Joint stiffness.
    • Fatigue.
    • Loss of endurance.
    • Loss of bone density (bone strength).
    • Difficulty moving or walking.
    • Chronic risk of losing your balance.
    • Weight gain or weight loss.
    • Cognitive changes (brain fog).
    • Heart problems.
    • Shortness of breath or breathing difficulties.
     

    Signs and Symptoms

    Sometimes cancer does not cause any signs or symptoms, but it is found during a medical examination or screening.

    Common signs and symptoms of cancer can include the following.

    Signs:

    • Unexplained weight loss.
    • Unexplained bleeding or bruising.
    • Skin changes.

    Symptoms:

    • Fever.
    • Night sweats.
    • Fatigue.
    • Pain.
    • Numbness.
    • Nagging cough.
    • Headaches.
    • Vision problems.
     

    How Is It Diagnosed?

    A doctor diagnoses cancer. A physical therapist can examine a person who has received a cancer diagnosis for physical problems that cause discomfort or difficulty with movement. This examination is designed to test 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 Therapy for Cancer Survivors

    Physical therapists are trained and educated to understand all of your health conditions, including a cancer diagnosis. Physical therapists evaluate individuals for their unique treatment needs and may help them recover faster than they would on their own.

    Your physical therapist will work with you to develop a specialized treatment program to help reduce and improve cancer-related problems, improve your strength and function, and address your needs and goals.

    Physical activity can help people maintain a normal body weight and may help to decrease the risk of:

    • Some cancers.
    • Heart disease.
    • High blood pressure.
    • Diabetes.
    • Osteoporosis.

    In addition to reducing the risk of developing certain cancers, physical activity and exercise also can improve a person’s chances of surviving cancer. The American Cancer Society and other groups recommend physical activity for people who are receiving cancer treatment and those who have completed treatment.

    Physical therapists design personalized exercise and treatment programs to help cancer survivors increase their physical activity. Physical activity has been shown to reduce or prevent many cancer-related problems, including fatigue.

    Physical therapists can help people before and after cancer surgery. Before surgery, they can evaluate cancer survivors for existing problems (such as those listed above) and help address them. After surgery, they can help to:

    • Address any movement issues.
    • Reduce pain.
    • Manage the healing of the incision site.
    • Minimize scarring.

    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, or spasms. Your physical therapist may apply hands-on techniques (manual therapy) or use treatments like electrical stimulation to help decrease your pain and ease your symptoms. They 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). This can cause fatigue. Research shows that 150 minutes per week of moderate-intensity exercise (such as walking) can help improve aerobic capacity, reduce fatigue, and promote healing for patients with cancer. Your physical therapist can assess your aerobic capacity and determine the best aerobic activities for you.

    Bone density or bone strength. Lack of activity coupled with certain cancer treatments can cause weakening of your bones, which could lead to bone fractures. Certain types of exercise can prevent bone loss and help maintain bone strength. Your physical therapist can teach you safe and effective exercises to help steadily build your bone strength.

    Lymphedema and swelling. Some cancer treatments can result in lymphedema (swelling caused by a blockage in the lymphatic system) or other types of swelling. Your physical therapist can use methods to reduce, control, and prevent lymphedema and swelling, such as:

    • Hands-on therapy (manual lymphatic drainage).
    • Special movements and exercises.
    • Applying and showing you how to use compression (bandages or garments, such as arm sleeves, gloves, and leg stockings).

    Surgical incisions. Your physical therapist can help you care for any surgical incisions. They can check for infection and assist with dressing changes. They also can help prevent some kinds of scarring and skin tightness as your incision heals. Your physical therapist can use very gentle massage or certain technologies to keep your skin as soft and flexible as possible.

    Body weight. Your physical therapist can tailor an exercise program just for you to help you achieve and maintain a healthy body weight. This can improve your energy levels and reduce your risk for heart disease, diabetes, and other chronic conditions.

    Mood. Physical activity helps elevate mood and reduces symptoms of depression in everyone, including cancer survivors. A cancer diagnosis, and cancer treatment, can be stressful and cause mood changes. Proper exercise, designed by a physical therapist for your specific condition and goals, can help you reduce stress and improve your mood.

    Cognitive changes (brain fog). Exercise has been shown to help manage decreased memory or attention, which is sometimes called brain fog. Your physical therapist can design a personalized program of exercise that can help improve your memory, attention, or organization skills.

    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 can help you reach your goals in the safest, fastest, and most effective way possible.

    Walking. Your physical therapist can help you improve your ability to walk using strengthening exercises, walking training, and balance activities. If you have nerve damage (neuropathy), your physical therapist may recommend bracing and other techniques to make it easier or safer for you to walk. They also may teach you to use an assistive device, such as a walker or cane, if needed.

    Sports training ability. Athletes undergoing cancer treatment can continue to train for their sport to a degree. Your ability to train will depend on the type of cancer and treatment. Physical therapists design safe, challenging, sport-specific training programs to help athletes minimize 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 speed healing and pain relief.

    Flexibility. Your physical therapist will determine if any muscles are tight. They will start helping you stretch them and teach you how to improve your flexibility at home.

    Strength. If your physical therapist finds any weak or injured muscles, they will select, and teach you, the right exercises to steadily restore your strength.

    Coordination. Your physical therapist can help you improve and regain your coordination and agility. This will help you to perform household, community, and sports activities with greater ease.

    Balance. Your physical therapist will examine your balance. They will teach you specific exercises to perform in the clinic and at home. These exercises can help to improve your balance and prevent falls. Your physical therapist also may teach you how to use a cane or walker for 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 to meet your needs and goals.

     

    Can This Injury or Condition Be Prevented?

    Research has shown that there are risk factors that may increase a person’s chances of getting cancer. The risk of cancer may be reduced by:

    • Maintaining a healthy diet.
    • Regularly exercising or performing physical activity throughout life.
    • Keeping your weight at a healthy level.
    • Avoiding tobacco in any form.
    • Limiting how much alcohol you drink.
    • Avoiding too much sun exposure.

    Side effects of cancer treatment may be reduced or prevented by:

    • Staying active every day.
    • Avoiding too much bed rest.
    • Participating in activities and exercises that you enjoy, as often as possible.

    Your physical therapist can help you choose the safest, most effective activities and exercises to do before, during, and after cancer treatment.

     

    What Kind of Physical Therapist Do I Need?

    All physical therapists are prepared through education and experience to treat cancer-related movement problems and help restore function for cancer survivors. However, you may want to consider:

    • A physical therapist who has experience treating people with cancer before and after surgery, during cancer treatment, and after cancer treatment has ended. 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 oncologic physical therapy. This physical 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, friends, or 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 cancer-related problems.
    • 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.

    Find a PT near you!

     

     

    Further Reading

    The American Physical Therapy Association 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 articles link to a PubMed* abstract of the article which may offer free full text, so that you can read it or print out a copy to bring with you to your health care provider.

    American Cancer Society. Signs and symptoms of cancer. American Cancer Society website. Revised August 11, 2014. Accessed October 7, 2020.

    Campbell KL, Winters-Stone KM, Wiskemann J, et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc. 2019;51(11):2375–2390. Article Summary in PubMed.

    Kessels E, Husson O, van der Feltz-Cornelis CM. The effect of exercise on cancer-related fatigue in cancer survivors: a systematic review and meta-analysis. Neuropsychiatr Dis Treat. 2018;14:479–494. Article Summary in PubMed.

    Segal R, Zwaal C, Green E, et al. Exercise for people with cancer: a systematic review. Curr Oncol. 2017;24(4):e290–e315. Article Summary in PubMed.

    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. Article Summary in PubMed.

    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. Article Summary in PubMed.

    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. Article Summary in PubMed.

    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. Article Summary in PubMed.

    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. Article Summary in PubMed.

    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. Article Summary in PubMed.

    Murtezani A, Ibraimi Z, Bakalli A, et al. 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. Article Summary in PubMed.

    Mishra SI, Scherer RW, Snyder C, et al. 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. Article Summary in PubMed.

    Kampshoff CS, Buffart LM, Schep G, et al. 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. Article Summary in PubMed.

    *PubMed is a free online resource developed by the National Center for Biotechnology Information. PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.

    Revised and reviewed in 2020 by Amy Tible, PT, DPT, MBA, board-certified clinical specialist in oncologic physical therapy and certified lymphedema therapist. Authored in 2017 by Andrea Avruskin, PT, DPT.

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