Bethany Meyer, OTR/L, CLT
Each year, over 71,000 women are diagnosed with a gynecological cancer and are forced to face stressful situations, difficult decisions, and the unknown; oftentimes with little to no education regarding the long-term effects they may experience. Gynecological cancers occur when abnormal cells grow within the female reproductive organs and include cervical, vaginal, ovarian, uterine, and vulvar cancers. Unfortunately, at this time there are limited methods of testing for early detection. For women diagnosed with these cancers, treatment options include surgery, chemotherapy, and radiation therapy, which can be life-saving. However, more often than not, these treatments leave lasting effects on the body—especially the surrounding pelvic structures (Yang et al., 2012). Effects like muscle tension, scar adhesions, cancer related fatigue, and lymphedema can be difficult to manage. These can also lead to other painful and frustrating conditions. Survivors commonly report urinary, bowel, or sexual dysfunction, along with chronic pain (Yang et al., 2012). Though survivors are thankful for their life, these conditions significantly decrease the QUALITY of life; but there is hope and there are options for treatment! Occupational therapy is a conservative method for lessening and managing these after effects of cancer. In the following paragraphs, I will discuss each condition and how they can be addressed by a specially trained OT.
Cancer related fatigue is a common side effect of cancer and cancer treatment. Unlike normal fatigue, it is not relieved by rest or sleep, and is frustrating because it is disproportionate to one’s actual level of activity, i.e., you feel exhausted though you have done little physical activity. CRF is often accompanied by brain fog, or difficulty concentrating during simple tasks. It is easy to understand how this combination has a negative effect on quality of life. The best management of CRF is a combination of energy conservation techniques, stress management, and INDIVIDUALIZED exercise and occupational therapy is a great tool for this; using a combination of activities you enjoy, you will learn how to safely increase your activity level and maximize your energy.
In addition to fatigue, cancer survivors often suffer from chronic tension, leading to an increased risk for experiencing pain. This chronic tension can be due to long term stress, both emotionally and physically. During gynecological cancer treatment, individuals experience an enormous number of stressful situations—from financial burden, to physical discomfort, radiation, surgery, and what can feel like an “assault” to our bodies most private region. If there is a lack of effective stress management, this negative energy is actually stored within the tissues of the body, including the shoulder, abdominal, and pelvic floor muscles. The stress creates inflammation and/or tension within these areas and leads to pain/dysfunction during meaningful activities. In turn, the inflammation produces a pain response (and decreases your body’s ability to tolerate the pain), increases stress, and increases muscle tension—it is a vicious cycle! Through education, manual techniques, and tailored movement, this muscle tension can be reduced, and pain free movement restored.
Cancer treatment can also bring about scar tissue adhesions. Surgery and radiation lead to the development of scar tissue within the pelvis, abdomen, low back, and hip regions. Though scarring is the body’s mechanism of healing tissue, adhesions lead to restriction during movement, and can even lead to dysfunction in the organs of the pelvis and abdomen. This dysfunction is manifested by a pulling or shooting pain with functional movement, constipation, urinary or bowel incontinence, or an increase in urinary urgency and frequency. Pain during sexual intercourse is also a common complaint of persons with scar tissue adhesions. Through manual techniques and modalities, scar tissue can be stretched, desensitized, and mobilized to improve comfort and reduce symptoms.
Another consideration many people are not prepared for during or after cancer treatment is the increased risk of developing lymphedema. But what is lymphedema? In simplest terms, lymphedema is swelling of a body part (e.g., leg, pelvis, trunk), because your lymphatic system is not doing it’s job to remove wastes from the tissue. Individuals with lymphedema feel a heaviness of the limb, and have an increased risk for developing infections if it is not well managed. Lymphedema often occurs after a lymph node has been removed or damaged through surgery or radiation, and even if lymphedema does not develop right away, there is a lifetime risk of developing the condition. Though lymphedema cannot be “cured”, by participating in Complete Decongestive Therapy with a specially trained therapist, your lymphedema can be well managed.
Though cancer survivorship is a celebration, these long-term side effects can be a constant, negative reminder of the struggles that cancer brings about. However, survivors do not have to suffer through pain, dysfunction, or a decreased quality of life! Finding a specially trained Occupational Therapist is the 1st step in the process. As a certified lymphedema therapist and pelvic floor specialist, I have the training required to manage lymphedema and pelvic floor dysfunction. As an OT, I am passionate about problem solving to determine what is appropriate for each individual. Though each survivor brings a different story, different challenges, and different (but many) strengths, the goal at Advanced PT is always the same: to return each woman to activities that are meaningful, enjoy each day, and celebrate life.
Yang, E.J. e al., (2012). Effect of a pelvic floor muscle training program on gynecological cancer survivors with pelvic floor dysfunction: A randomized controlled trial. Gynecology Oncology; 125, 705-711
CDC, Inside knowledge: Get the facts about gynecological cancer. Centers for Disease Control and Prevention. Retrieved from: www.CDC.gov/cancer/knowledge.