Aerobic Exercise during Cancer Treatments

Aerobic Exercise during Cancer Treatments

Aerobic exercise (a.k.a. “cardio”) has many proven benefits for all humans. Cardio relates to cardiac, meaning it’s for the heart! For cancer thrivers, aerobic exercise can have many excellent benefits (including improved survival rates and decreased rates of recurrence!) and should be recommended for all oncology patients. Read on to learn about the benefits and general recommendations for aerobic exercise during cancer treatments.

Benefits of Aerobic Exercise

  • Increase your sensitivity to treatment = better tumor cell destruction!
  • Prevent muscle loss and build strength (including your heart muscles)
  • Reduce treatment-related side effects
  • Reduce depression and anxiety
  • Improve your sleep
  • Reduce your recurrence and mortality risk significantly (up to 50% for some)
  • Improve your quality of life

Psstttt… if you’re not convinced already, I’m not sure what will get you on board this point!

Types of Aerobic Exercise

  • Walking
  • Riding your bike
  • Running*
  • Interval Training
  • Swimming**

*If running was part of your pre-treatment routine, it may be ok to continue, BUT as some treatments can put you at risk of cardiac dysfunction, it may be best to stick with more gentle cardio until your heart gets stronger. Always check with your doctor or physical therapist!

**Avoid swimming in the ocean or public pools if you are neutropenic, have recently had surgery, or have open wounds/blisters from radiation therapy due to increased risk of infection!

Aerobic Exercise Guidelines

We’ll use the FITT principle for aerobic exercise guidelines:

  • Frequency: 3-5 days per week
  • Intensity: RPE 2-3 – keep it light for cardioPROTECTIVE benefits!
  • Time: 10-60 minute sessions for total of 150 minutes per week
  • Type: Choose your favorite from those listed above!

What is RPE, you ask? RPE, or Rate of Perceived Exertion, is a measure of how hard you feel you’re working. Use this Modified Borg Scale to guide your intensity during your workouts!

Modified Borg
Scale
0RESTING
1VERY EASY
2SOMEWHAT EASY
3MODERATE
4SOMEWHAT HARD
5HARD
6
7VERY HARD
8
9
10VERY, VERY HARD

Special Considerations

  • Understand if the chemotherapeutic agents you received can cause cardiotoxicity. If so, be sure to request a baseline cardiac workup. Know that low-intensity exercise may have a cardioprotective effect during treatment!
  • Monitor your vital signs!
    • Use your fitness tracker to monitor your heart rate OR here’s a video on how to check your heart rate manually!
    • Report any significant or unusual shortness of breath to your physician.
    • Watch for swelling that may be early signs of lymphedema or cardiac dysfunction.
  • Monitor lab values! Generally, if your lab values fall in the following ranges, you should check with your provider before exercising:
    • Neutrophils (ANC) <1.5 x 10^9/L
    • Platelets < 20,000 cells/uL
    • Hemoglobin < 8g/dL (anemia)
  • Be cautious if you know you have any of the following:
    • Bone or lung metastasis
    • Osteoporosis
    • Abnormal sensation or dizziness/imbalance which may increase your fall risk

Now you know some general guidelines for aerobic exercise for cancer patients! By the way, these general guidelines apply to those without cancer as well! Always seek medical advice before starting a new exercise program and remember: All information shared on this page is for educational purposes only. If you are thinking of starting an exercise program, consult with your physical therapist or physician to determine what is right for you!

Aloha ❤

Resistance Training during Cancer Treatments

Resistance Training during Cancer Treatments

You’ve probably heard the old saying, “If you don’t use it, you lose it,” right? Well, it’s true! For oncology patients in particular, resistance training is an important way to maintain strength, balance, and quality of life during and beyond cancer treatments.

Benefits of Resistance Training

  • Maintain functional STRENGTH to continue to do the activities you love
  • Improve or maintain MUSCLE mass
  • Improve or maintain BONE health
  • Improve QUALITY OF LIFE
  • Reduce MORTALITY risk by 33% [Hardee, et al, 2015]

Types of Resistance Training

  • Bodyweight Training
  • Pilates
  • Yoga
  • Weightlifting (free weights, machines, resistance bands, etc.)
  • TRX / Suspension Training

*Pro tip: Choose a type of exercise you enjoy to make it fun and something you look forward to!

Resistance Training Guidelines

  • 2-3 days per week
  • Focus on major muscle groups
  • Moderate Intensity
    • 40-60% of maximal effort
    • RPE 3-6

What is RPE, you ask? RPE, or Rate of Perceived Exertion, is a measure of how hard you feel you’re working. Use this Modified Borg Scale to guide your intensity during your workouts!

Modified Borg
Scale
0RESTING
1VERY EASY
2SOMEWHAT EASY
3MODERATE
4SOMEWHAT HARD
5HARD
6
7VERY HARD
8
9
10VERY, VERY HARD

Special Considerations for the Oncology Population

Take extra precaution AND work with a specialist if you know that you have:

  • Bone Metastasis
  • Osteoporosis
  • Abnormal sensation or dizziness/imbalance which may increase your fall risk!

Now you know some general guidelines for resistance training for cancer patients! By the way, these general guidelines apply to those without cancer as well! Always seek medical advice before starting a new exercise program and remember: All information shared on this blog is for educational purposes only. If you are thinking of starting an exercise program, consult with your physical therapist or physician to determine what is right for you!

Aloha ❤

BCAM is BACK!

BCAM is BACK!

I know I’ve been terrible at keeping y’all up to date on my life lately, but that’s because I’m just busy living right now. When I look back on my life one year ago, I still have a hard time believing any of this actually happened. Cancer treatments consume your life for nearly a year (or more for some), and then you’re just done? When chatting with other survivors, we all seem to comment on how none of it seems real. We were in survival mode for so long, and when the dust finally settled, we had to come to terms with the fact that, yes, indeed, we did have cancer. What a trip!

Every day gets easier, but some days all the feels creep up and you don’t know whether to be sad or angry or go hide in the corner until it passes. I try not to take anything for granted, but I’m just human, too, and I often get sucked back into the usual work, sleep, eat, repeat. With that said, I’ve been making a concerted effort to go for walks by the beach, do yoga, hit up weekly farmer’s markets, and get together with friends when I can. Those things help. A lot. Make time to do things that bring you joy.

On Monday, I had my annual MRI – just a follow up scan to keep a close eye on things. Thankfully, all looks clear. There is a small area of enhancement in the same area where I mentioned I needed a biopsy back in July which already came back benign so here’s hoping I don’t need another biopsy! In my professional opinion, I’m right in the middle of tissue healing from radiation therapy, and there’s a lot of scar tissue forming right now. With that comes a lot of tightness and discomfort in my left chest wall, and I think that friction is creating a small cyst in that region.

Again, the survivorship game is not all sunshine and rainbows. While everything is technically “all good” now, sometimes it isn’t. There are a lot of things that I still need to work through, but I just choose to take it one day at a time.

October is Breast Cancer Awareness Month

This brings me to the main point of this post which is that Breast Cancer Awareness Month is back! I personally choose to refer to BCAM as “Breast Cancer ACTION Month” as I think it’s a great time to donate to breast cancer research, reach out to family/friends you know going through cancer and offer your support, and speak up to lawmakers and organizations with power to make change in medical care for cancer patients.

October is a time of pink ribbons and shameless promotion of products that support breast cancer. Breast cancer thrivers have coined this “pinkwashing” and want to remind you to be mindful of any products you purchase this year. Any major company that claims to put proceeds to support breast cancer better be donating at least 20% of their profits to organizations that fund breast cancer research. And, if you choose to make a donation to breast cancer organizations, choose one or two that fund research primarily or that you know directly supports thrivers with care packages, financial support, or practical support (like providing free wigs, offering transportation or house cleaning, or fertility preservation assistance).

Here are a few of my favorite breast cancer organizations to support:

My BCAM Action Plan

This October, I’ll be focusing on holding the American Cancer Society accountable for their recent change in recommendations to delay annual mammogram screening for those age 45 and older. This is a recent change in recommendations and adds insult to injury to prior recs that both breast self-exams (BSE’s) and clinical breast examinations are not indicated for early detection of breast cancer. These recommendations are based off a study out of Shanghai in 2018 that indicated that more benign lesions were found on BSE’s than malignant ones, and therefore led to unnecessary procedures like imaging and biopsies. In case you can’t guess who benefits from these recommendations, let me spell it out for you…INSURANCE COMPANIES.

For adolescent and young adult (AYA) cancer thrivers (ages 15-39) who are ineligible for annual mammograms, the only way for us to detect cancer early is through BSE’s. The more frequently we do these screenings, the earlier we can seek care for any abnormal findings, and the better our prognosis if we should be very unlucky to find a malignancy. I found my lump on a BSE and it saved my life. I will advocate for BSE’s until my lungs give out. Should you feel so inclined to support this cause with me, please reach out to the American Cancer Society via phone/chat or social media to let them know how you feel about this!

I’ll also be sharing a bit on social media about how PT can be helpful before, during, and after cancer treatment because October is also National Physical Therapy Month. Follow me on Instagram for more – @bri.d.pt!

Beyond that, October is my favorite month, so I’m going to get some Halloween decorations out and get ready for Spooky Season! Maybe I’ll pull out the old purple wig for Halloween this year, too! Stay well, friends!

Aloha ❤

Oh, hey!

Oh, hey!

It’s officially been a minute (or a few months, but who’s counting?)! I had every intention of continuing to write, but in all honesty, I just needed a break from the cancer updates and info sharing.

Recently, Justin and I have been super busy! We were finally able move into our new home a few weeks ago (thanks, mom & Malia!), and then we immediately left on vacation to Montana and Washington, leaving our cute new place a mess with unpacked boxes and mismatched furniture. We are so grateful to have a new space where we can start fresh after navigating so much uncharted territory in 2020. I’m looking forward to lots of memories made here ❤

While traveling, we were able to visit with all of my family, celebrate the 4th of July in Butte, America (there’s no better place to be on the 4th – don’t knock it til you’ve tried it!), catch a few fish on the Big Hole, reconnect with our best buds from PT school, and even witness one of them get married (Congrats, Riki & Anthony!). I was so elated to be able to hug everyone and see all my favorite kiddos. Hawaii is great y’all, but it’s times like this when you realize living on an isolated island in the Pacific isn’t always all it’s cracked up to be! I cried so hard before we came back home because I know I truly have such special relationships with all of you.

Besides our recent adventures, all is well down here. I’ve been working heavy part-time and I’ve realized that I’m now able to help my oncology patients on a much deeper level. I’ve always tried to empathize as much as I could, but the reality is that, unless you’ve gone through cancer yourself, you probably can’t relate. This isn’t to discourage anyone from working with oncology patients, but rather a reminder that what they’re going through is far more than just physical discomfort.

As far as my health goes, I had an ultrasound on my left breast a few weeks ago due to a suspicious spot I found while doing one of my way-too-frequent self-checks. It turned out to be just scar tissue (as expected), but they also found a small cyst-like area above it, and I’ll go for aspiration next week just to be safe “because of my history.” I wonder if it will ever get easier hearing that, but likely not…

I’ve continued to work with my naturopathic doctor to get to the root cause of my autoimmune thyroid dysfunction. I completed a urine test to determine heavy metals toxicity and the results indicated high levels of mercury and platinum and moderately-high levels of lead. Mercury is linked to many environmental sources, but is primarily associated with high levels of dietary fish. The platinum levels are residual from the platinum-based chemotherapy (Carboplatin) that I received over 12 weeks last year, and lead is also find in many environmental sources including water, pipes and paint. So I will treat it with a chelating agent which will strip the metals from their sneaky hiding places in my body….after I eat one last giant poke bowl!

I also completed a food sensitivity test and will get those results back in a few weeks. Again, I am a huge believer in holistic care. If there are things I can do to optimize my health going forward, then it’s worth a shot to me. I still go to acupuncture about once a month and have continued seeing a mental health professional. It truly takes a village to make it through a cancer diagnosis, and you are all part of that team for me!

I’ll try to be more consistent at posting updates and sharing helpful information, but for now, I’m just going to keep focusing on LIVING and finding joy in each day. Sending you all my love!

Aloha ❤

Chemotherapy: Stretches for Health

Chemotherapy: Stretches for Health

Before beginning any exercise program, please check with your physician or physical therapist! Not all exercises or stretches are appropriate for everyone – please read my full medical disclaimer here before trying any of the exercises listed below.

It’s no secret that it can be difficult to stay active during chemotherapy. While exercise has been proven to have many physical and emotional benefits during cancer treatment, some days it’s just difficult to get moving. I’ve designed this short stretching compilation to stretch the spine and major joints of the body to promote mobility and circulation on even the most difficult chemo days. Make these stretches part of your daily routine or use them to loosen up after a nap or before bed!

Watch the video for a full demonstration:

*Note: Video plays at 2x speed! Take your time when you’re stretching!

Child’s Pose

From a kneeling, or seated position, slide the hands forward until you feel a stretch in the shoulders and lower back. Hold for 30-60 seconds as tolerated.

Modifications: For greater stretch of the side body, walk the hands to the left or right.

Cat/Cow

Begin on hands and knees in a neutral spine position with hips stacked over knees and shoulders stacked over the wrists. Inhale and slowly drop the belly to arch the back, lifting the breast bone. The, exhale and round the back from the tailbone to the neck, broadening the space between the shoulder blades. Alternate moving into each position for 5-10 repetitions.

Modifications: Perform in a seated position, reaching forward as you round the back, and allowing the arms to reach behind you as you lift the chest.

Hip Flexor Stretch

In a kneeling position, square your hips and tuck your tailbone until a gentle stretch is felt across the front of the hip. Perform deep breaths. Hold 30-60 seconds as tolerated.

Modifications: Perform in a standing partial lunge position, hold onto something for balance. To increase the depth of the stretch, sidebend the body away from the bottom/back leg.

Hamstring Stretch

In a kneeling or seated position, stretch one leg out in front of you. Square the hips and straighten the knee as you hinge from your hips to deepen the stretch along the back of the leg. Try not to round the lower back to allow for the best stretch. Hold for 30-60 seconds as tolerated.

Modifications: Lie on your back and use a strap/towel to pull a straight leg up toward the ceiling. Flex your foot to deepen the stretch.

Butterfly Stretch

Sit with the soles of your feet touching and knees dropping down toward the floor. Perform deep breaths. Hold for 30-60 seconds as tolerated.

Modifications: Place pillows or yoga blocks under the knees to reduce strain on the hips, lean forward to deepen the stretch.

All stretches are designed to be gentle, but can be progressed if they become too easy. Stretches can be performed 1-3 times per day as needed.

Happy stretching!

Aloha ❤

Breast Surgery: Post-Op Stretches

Breast Surgery: Post-Op Stretches

Before beginning any exercise program, please check with your physician or physical therapist! Not all exercises or stretches are appropriate for everyone – please read my full medical disclaimer here before trying any of the exercises listed below.

After both breast-conserving surgeries and mastectomies, people often find they have difficulty reaching overhead or behind their back, washing or fixing their hair, or feeling tightness throughout the chest wall. The following stretches are helpful to improve range of motion and help you restore your ability to complete your usual daily tasks!

These stretches should be done after a sufficient amount of time has passed post-operatively so all incisions in the breast, chest, or axilla (armpit) have healed. Be sure that any incisions are well-healed before attempting these stretches without guidance from a healthcare professional. Normal soft tissue healing of the skin and underlying tissues takes about 4-6 weeks. Stretching might be uncomfortable as you push into tight areas, but you should not typically experience pain >5/10 while performing stretches.

Watch the video for a full demonstration:

*Note: video plays at 1.5x speed – take your time when you stretch!

Shoulder Stretches

In a kneeling, or seated position, slide the hands forward until you feel a stretch in the shoulder or axilla. Perform gentle repeated stretches (10-15 repetitions) or hold for longer durations (30-60 seconds) as tolerated.

Modifications: For greater stretch of the side body, walk the hands to the left or right.

Cat/Cow

Begin on hands and knees in a neutral spine position with hips stacked over knees and shoulders stacked over the wrists. Inhale and slowly drop the belly to arch the back, lifting the breast bone. The, exhale and round the back from the tailbone to the neck, broadening the space between the shoulder blades. Alternate moving into each position for 5-10 repetitions.

Modifications: Perform in a seated position, reaching forward as you round the back, and allowing the arms to reach behind you as you lift the chest.

Sidebend Stretch

In a seated or standing position, grasp your affected arm with the opposite hand and gently lean away to stretch the shoulder and side body. Breathe deeply into the ribs on the affected side. Hold 30-60 seconds as tolerated.

Modifications: Lie on the unaffected side over a pillow or foam roller and gently stretch the affected arm overhead, limit the range of motion as tolerated.

Pec Stretch

Lie on your back and allow one or both elbows to fall out to the side. For mastectomy patients, perform only one side at a time until cleared by your physician to perform both sides together. Do not allow the back to arch away from the floor or bed. Hold for 30-60 seconds as tolerated.

Modifications: place pillow/s or a yoga block under the elbow to allow tight shoulders/chest walls to relax during the stretch. This stretch can also be performed standing with forearms placed against a doorframe.

Open Book Stretch

Begin lying on the unaffected side with knees bent to 90 degrees to protect the low back. Place the affected arm behind the head and allow the body to rotate and open up the front of the affected shoulder/chest. Breathe in as you open and exhale to return to the starting position. Repeat 5-10 times.

Modifications: Straighten the affected arm for a greater stretch or circle the arm over the head to stretch in various angles.

All stretches are designed to be gentle, but can be progressed if they become too easy or maintained if full range of motion is achieved. Stretches can be performed 1-3 times per day as needed.

Happy stretching!

Aloha ❤

365

365

It’s been one whole trip around the sun since we read the dreaded pathology report… “consistent with invasive ductal carcinoma.” And in these last 365 days, I feel like I’ve lived 100 different lifetimes. Newly diagnosed. Fertility planner. Chemo baldie. Breast conservation surgery advocate. Radiation breath-holding champion. Student. Educator. Survivor.

Now, the scars are fading. My irradiated skin is healed (although a little pale if you ask me). My energy is slowly returning. Life is going back to “normal,” whatever that is these days. I’ve been a little silent on the blog and on social media because a lot of my energy is going toward trying to remember what I told myself when I was first diagnosed…

YOU ARE NOT YOUR DIAGNOSIS.

Some days it’s difficult to remember who I was before cancer. Honestly, sometimes I come across an old photo and I don’t even recognize that girl! So I’m setting out to reinvent myself a bit. I’m prioritizing adventure, travel, learning new things, letting in old things that bring me joy, and not wasting one single second doing something I don’t feel passionate about…at least trying anyway.

I learned in the past year that I am fearless. I can do anything I put my mind to, but the one thing that scares me is missing out on doing the things I love and crave with the people I care about the most because of things I “should” be doing. Nothing is more important to me in this lifetime. From here on out, if it’s not a whole-hearted “yes!” for me, I’m not doing it.

You’ll likely be seeing a lot of different content from me in the future as I plan to continue the blog to share information about physical therapy, pelvic health, oncology, and other things that I feel everyone should know about. At heart, I am most passionate about teaching, sharing knowledge, and educating myself, so if you’d like to keep learning with me, I’m happy to share this space with you.

In the meantime, please keep me in your prayers as I have my “new baseline” mammogram today. As it usually works with true divine intervention, my scans are scheduled exactly on my 1 year anniversary of my diagnosis. While I feel deep down that everything’s going to look great, there’s always that tiny voice in the back of my mind saying “what if…” Honestly, I’m not sure if it will ever get easier to repeat imaging, but I’m choosing to see it as a privilege that I get to have these scans at all. God must want me here for something!

As my friend Kate says, “If you’re very lucky, life goes on.”

I hope you’ll do something that makes you feel wildly, beautifully alive today. Do it for all those we’ve loved and lost. I’m incredibly grateful for all of you.

Aloha ❤

It’s Going…

It’s Going…

**Full disclosure – this post contains affiliate links. I may earn a small commission when you purchase from certain companies at no additional cost to you. You can read my full disclaimer here. Mahalo!

Hi, friends. It’s been a minute! I just wanted to share that today I am officially 5 months out of chemo! That sounds super gangster, right?!

Many things have changed since October, and I feel like there’s a bit more “normalcy” happening. I’ve gone back to work part-time and have had wonderful patients. I almost forgot how much I love patient care. I got vaccinated for COVID. I even got my first post-chemo haircut… What more can a girl ask for?

1st post-chemo cut!

I’m still having to remind myself that I’m only about six weeks out of radiation because some days I get so frustrated by the level of fatigue I feel after only a 6-hour work day. Cancer fatigue does not equal regular fatigue, y’all. It’s a level of physical and emotional exhaustion that I would not wish on anyone. Even a full night of sleep doesn’t quite seem to be enough to fully recharge. I’m not telling you this to complain, but just to remind you to be gentle with your friends and family who’ve had cancer. The long-term effects are not always visible, but they are very, very real.

I can’t remember if I’ve said this, but being officially “cancer free” and completing treatment has not been easy. Over the past year, I was 100% in survival mode, jumping through all the hoops to get this obnoxious little invader out of my body. Then treatment ended, and honestly nothing could’ve prepared me for the emotional tsunami I’ve experienced.

Don’t get me wrong, I am overwhelmingly grateful to have had treatment work so well for me. I know that I am lucky to have caught it early and that a cure was an option. Most days, I can find the joy in knowing I’ve survived and that my body is healing, but there are many days where I feel the very real fear of recurrence or a deep sadness that my life will never quite be as carefree as it was before. There are a lot of tears. I know that this will all get better with time and I’m learning to give myself grace, but the struggle is real, you know?

For now, I’m just taking it one day, one hour, one breath at a time and learning to find peace among the challenges. I’m thankful for all of you reading this. Don’t forget to send a little love to those you love today.

If you’re feeling extra generous, TNBC awareness month is still going strong until March 31! Right now, your donation to the Triple Negative Breast Cancer Foundation will be tripled thanks to some generous sponsors!

Curious what current TNBC research focus is on?

  • Anti-androgen hormonal therapy options
  • Immunotherapy options (targeted treatments) for TNBC with specific basal-like tumors
  • PARP-inhibitors for TNBC patients with BRCA genetic mutations
  • Development of a TNBC vaccine (How cool! I love preventative medicine!)


DONATE HERE or make a purchase from Paris Laundry (a clean living site owned by a fellow #breastie who is donating 10% of all purchases to TNBC research this month) to help us advance TNBC research and find more treatment options for my fellow TNBC warriors!

Aloha ❤

TNBC Day!

TNBC Day!

Hi everyone!

I wanted to share that today, March 3, is TNBC Day! In fact, the whole month of March is dedicated to raising awareness about triple negative breast cancer and fundraising for TNBC research! As you know, I was diagnosed with TNBC last April. TNBC primarily affects younger people (age <50), people with a BRCA1 genetic mutation, black & Hispanic women, and people with Ashkenazi Jewish heritage.

15-20% of new breast cancer diagnoses are triple negative, which means their tumors lack receptors for estrogen, progesterone, or the HER2 protein. Because of this, treatment options are limited for TNBC and there are no targeted therapies available as there are for other types of breast cancer. For this reason, TNBC (which is typically more aggressive and tends to metastasize to the bone, brain, or lungs) can be difficult to treat and that is why I advocate for TNBC research!

Current research is focusing on:

  • Anti-androgen hormonal therapy
  • Immunotherapy for TNBC with specific basal-like tumors
  • PARP-inhibitors for TNBC + BRCA patients
  • Development of a TNBC vaccine (whatttt?!)

For the month of March, 100% of all donations to the Triple Negative Breast Cancer Foundation will go to research. If you are able to give, know that all of us TNBC thrivers (past, present, and future) appreciate you!

Click the photo below to use my personal link to donate to TNBC Foundation!

If you are here because you were recently diagnosed with triple negative breast cancer, here are three things I wish I would have known at the time of my diagnosis (#PowerOf3):

  • O N E : 40% of breast cancers are found on a self-exam! Check you chest & advocate for those under 40 who do not qualify for mammograms yet!
  • T W O : A TNBC diagnosis is not a death sentence! TNBC is an aggressive cancer and it’s treated aggressively, but it also has a higher rate of complete response to chemotherapy than other types of breast cancer – stay hopeful!
  • T H R E E : There is an incredible online community full of young & old TNBC thrivers on Facebook & Instagram. Through these incredible people, I’ve receive comfort, advice, and comedic relief from the cancer saga – come thrive with us! Check out @tnbcfoundation and @tnbc_thrivers on Instagram.

Mahalo & Alooooooha! ❤

Heart Health & Breast Cancer

Heart Health & Breast Cancer

❤ February is American Heart Month ❤

Did you know that heart disease is the #1 leading cause of death for Americans and that 1 in 4 Americans will die of heart disease each year?

Did you also know that women who’ve had certain types of cancer treatments are at a greater risk for heart disease as well? As treatments for breast cancer have advanced, more breast cancer survivors are living with these long-term consequences of treatments. Some treatments known to have adverse effects on the heart include:

  • Chemotherapeutic agents:
    • Anthracyclines (doxorubicin, epirubicin…a.k.a. “red devil”)
    • Anti-HER2 Agents (herceptin, perjeta)
  • Hormonal therapies (tamoxifen, anastrozole, letrozole)
  • Radiation to the breast/chest wall

For all of the treatments listed above, risk of cardiovascular disease including coronary artery disease and cardiomyopathies (dysfunction of the heart muscle) is elevated. Evidence of cardiotoxicity can show up several months to several years after these treatments are administered. So what does the research say about prevention or reversal of these cardiac side effects?

Prevention of Cardiotoxicity during Cancer Treatments

Firstly, anyone starting any of the above-listed treatments should undergo a baseline cardiac function screening such as an EKG and electrocardiogram to allow for close monitoring of the heart once treatment is administered or completed. Doctors will specifically watch the left ventricle ejection fraction which is an indicator of how well the heart can pump blood to the body.

The benefits of eating a healthy diet full of fruits, vegetables, and whole grains and maintaining a consistent exercise routine during treatment also apply to cancer patients (we’ll discuss this more in a minute). Avoidance of smoking and drinking alcohol is also very important.

From a medical standpoint, oncologists can specify the dosage, timing, and frequency of chemotherapy treatments to minimize their effects on the heart. In some instances, they can prescribe a cardioprotective medication such as a beta-blocker or ACE inhibitor to reduce strain on the heart during chemotherapy, especially if a patient is symptomatic.

Some symptoms that may indicate heart concerns include:

  • shortness of breath
  • swelling in the feet or lower legs
  • rapid or irregular heart beat
  • pain or swelling in the abdomen
  • mental confusion

During radiation, the heart is most at risk if the left side is being treated. Radiation oncologists can have a person use a deep breath hold to minimize the risk of radiation to the heart. They use the radiation simulation to plan the most effective delivery of radiation and ever-advancing treatment techniques to reduce the dose of radiation to the heart.

As you can see, there are many ways to be proactive about heart health during cancer treatment. Patient should never feel as though it’s inevitable to come out on the other side of treatment with heart problems!

Management of Treatment-Related Cardiotoxicity

Should a person develop cardiac issues during cancer treatments, there are more and more evidence-based guidelines emerging for how to improve cardiac function and prevent long-term health consequences. In many cases, treatment-related heart conditions are reversible!

Just like any other muscle in the body, the heart needs to be challenged to get stronger. During cancer treatments, people tend to lose about 27% of their exercise capacity. This means that, as a survivor, it’s time to get in shape.

Ideally, patients and survivors are recommended to get 150 minutes of moderate aerobic exercise per week – that’s about 30 minutes, five days per week. Walking is a great place to start, but patients should choose their favorite type of exercise! Aerobic exercise like running, biking, swimming, or high-intensity interval training (HIIT) are very effective ways to promote healthy heart function. Those who consistently get 150 minutes per week are also shown to reduce their risk of mortality by up to 60% – perks!

From a physical therapy perspective, supervised exercise is best for a few reasons. A knowledgeable physical therapist or exercise physiologist can help prescribe exercise according to guidelines related to the phase of treatment someone is in. Someone in active treatment should not be exercising at the same intensity as a survivor who is 6-12 months out of treatment. Just like recovery from an injury, exercise progression should be progressive and individualized!

Cardiotoxicity is a serious side effect of cancer treatments and should not be overlooked. There are many options for prevention and management of heart conditions that arise for cancer patients and survivors. To find a physical therapist or exercise physiologist who is experienced working with oncology patients, ask your physician for a referral to a trusted provider in your area or use the APTA Find a PT locator!

Sending love to you!

Aloha ❤

To read more, check out these articles:
1. Cardiotoxicity of Contemporary Breast Cancer Treatments (Chuy, et al.)
2. Prevention and Treatment of Chemotherapy-Induced Cardiotoxicity (Avila, et al.)