April 1, 2014

Although women with advanced-stage breast cancer face intense physical and emotional hurdles, much can be done to improve their quality of life, says R. Samuel Mayer. In his experience as medical director of cancer rehabilitation in Johns Hopkins’ Department of Physical Medicine and Rehabilitation, he says patients with metastatic cancer—who make up about 25 percent of cancer patients referred for inpatient or outpatient rehabilitation at The Johns Hopkins Hospital—have benefited from a plan focused on activities that matter most to them.

Metastases in breast cancer survivors primarily occur in the liver, brain and bones, notes Mayer. Patients with brain metastases contend with neurologic deficits and possibly paralysis on one side, he says, while patients with recurrences to the bone may battle pain from pathologic fractures and spinal compression. For patients with metastases to the liver, fatigue presents the greatest challenge, he says, but physical exhaustion plagues all of these patients, especially those receiving continuous radiation and/or chemotherapy or who have undergone surgery.

After an assessment of the patient’s limitations, a physiatrist and specially trained physical and occupational therapists customize a rehab program, with input from the patient. It begins, says outpatient physical therapist Laurie Sweet, with strategies to help manage fatigue. “Energy conservation is key,” she says, along with patient and family education. “So we talk to families about walkers, tub chairs or toilet aids to ease movement. Through positioning and adaptive equipment, we can reduce the strain.”

An occupational therapist, meanwhile, addresses daily activities like dressing, grooming, increasing fine motor skills, falls prevention and improving memory. All 15 inpatient and outpatient therapists have been specially trained to care for patients with advanced cancer, says Mayer. When appropriate, they consult with specialists, including rehabilitation psychologists and speech-language pathologists, all the while keeping the patient’s oncologist in the loop.

“We work as a team,” says Sweet. “We know we may not be able to offer a cure, but we can add value and quality to these patients’ lives so they can participate in activities that are most meaningful to them.”

Because of the hospital’s high volume of complex patients with stage IV breast cancer, says Mayer, the rehabilitation team has built considerable expertise with this population. “We help maximize their strength and motivation,” Mayer says, “to live for a child’s wedding or to celebrate a grandchild’s birth,” something Mayer has witnessed time and again.