In recognition of October being breast cancer awareness month, we sat down with Comox Physio owner, Shannon Lawrence, to help craft this post. In addition to ownership, Shannon is a registered physiotherapist that has a special interest in pelvic health and oncology. She is also a certified lymphedema therapist. Her expertise and 30+ years of experience make her the perfect fit for our breast cancer Q & A. Read on, friends…
CPC: Hi Shannon. Why don’t you start by telling those that might be unaware, a bit about your qualifications and experience as a physiotherapist who has a special interest in oncology—particularly as it relates to those with breast cancer?
SL: I started on my journey as a breast cancer physio when the clinic owner I was working for on the Mainland took a course in breast cancer rehab and came back all fired up to treat this population. She shared the course materials with me and together we started treating breast cancer patients post-op and partnering with our local surgeons. When I moved to the Island in 1998, I brought this skill and experience with me and started working with our surgical and oncology teams to help this population. Over the years, I’ve taken quite a number of courses from a variety of sources in breast cancer recovery and have even taught a breast cancer rehab course myself. In addition, I’ve attended breast cancer conferences in Canada and the USA and recently participated in the very first Breast Cancer Supportive Care ECHO cohort through UBC and funded by the Canadian Cancer Society.
CPC: Tell us more about ECHO?
SL: The Supportive Care Oncology Practice ECHO is a project funded by the Canadian Cancer Society and is under the direction of Drs. Kristin Campbell (UBC) and Sarah Neil-Sztramko (McMaster). Supportive care for this project is defined as the prevention and management of physical and psychological symptoms, limitations in function and usual life roles and side effects, from diagnosis through active treatment and beyond.
Our first cohort of ECHO aims to address the complexities of providing supportive care services for people living with breast cancer within British Columbia and Yukon. ECHO uses an all teach/all learn platform to build a community of practice for healthcare professionals who deliver breast cancer supportive care in British Columbia and Yukon. We will expand to other provinces in the coming months.
CPC: Your credentials also include certification as a Lymphedema Therapist. Can you explain what that means for patients?
SL: It means I’m also a LANA (Lymphology Association of North America) certified lymphedema therapist. I completed my training through the Klose Academy and then successfully wrote the very challenging LANA exam. This certification allows me to provide comprehensive care to breast cancer patients who have developed lymphedema in their arms.
CPC: In what ways can physiotherapy help those with breast cancer?
SL: Physiotherapy can help throughout the stages of breast cancer recovery from preparing for surgery, post-operative recovery, management of chemotherapy and radiation side-effects, and return to work or activity. We also provide care after breast reconstructions which might include tissue expanders and then breast implants or a variety of different other reconstruction options.
CPC: What do physiotherapy sessions with you look like for these folks?
SL: A breast cancer physiotherapy session always starts with a thorough assessment that includes learning each patient’s cancer journey, their goals for treatment and recovery, and answering any questions.
Assessment of the neck and shoulders is important and includes looking at joint range of motion and muscle stability, surgical scar healing and mobility, and muscle tension. The pectorals, trapezius, subscapularis, and lats all tend to get really tight and can be fibrotic if they were impacted by radiation therapy. We will also look at nerve mobility and sensation. Axillary tethering can be a real problem— this is when the lymphatic vessels that are cut during a surgical biopsy of the axillary lymph nodes become tight like guitar strings and can be painful and pull all the way down the arm or lateral chest wall. We also palpate for edema both in the chest wall or upper extremity.
We provide education on prevention of lymphedema, typical timeframes for recovery, preparation for radiation, management of cancer related fatigue, and management of symptoms of hormone therapy (aromatase inhibitors).
Exercise often first focuses on regaining mobility after surgery or radiation, and then progresses to resistance training and return to work or sport/leisure prep.
Manual therapy and massage techniques might be used to improve mobility of surgical scars, chest wall fascia, and the muscles of the neck and shoulder that might be tight after surgery or have post radiation fibrosis. Hands-on techniques can also help with lymph drainage, edema management, and axillary tethering.
Also, if a patient does develop lymphedema then I can provide manual lymph drainage and measure for correctly fitting compression garments for the arm or chest wall as needed.
CPC: When is the ideal time to seek out physiotherapy services along the breast cancer journey?
SL: We treat breast cancer patients from the prehab phase (preparing for surgery or other adjunctive treatments, or for reconstructions) all the way through post surgical care, management of chemotherapy, radiation and hormone therapy side effects and help with return to daily activities, work and sports. We also provide long standing care for patients who have developed more serious side effects such as lymphedema or chronic pain or have more advanced disease (bone mets or palliative support).
CPC: What advice would you give to someone newly diagnosed with breast cancer?
SL: The message that I would give to a new breast cancer patient is that a breast cancer diagnosis is often very unexpected. Early medical treatment is focused on surgical and oncological interventions and patients can feel easily overwhelmed. Cancer physios can provide that human connection and have the time to answer questions, provide hands on care, and help patients feel supported and empowered throughout their cancer journey. I think the quote that we shared recently on our social media was spot on when it comes to physiotherapy—we have the brains and the training to provide evidence based, best practice care. We also have the hearts to sit with and hold space for patients who are going through an incredibly scary and emotional journey. And finally, we have the experienced hands to feel when a patient’s soft tissue needs to be mobilized so that they can feel better.
CPC: Anything else you would like to share/have the public know?
SL: I like to say to patients that with my 30+ years of experience with breast cancer patients, there aren’t too many situations I’ve encountered that I haven’t seen before. I have fabulous contacts at BC Cancer should I need to reach out to find an answer to a question.
I’m also happy to mention that one of our other physiotherapists at the clinic, Stephanie, is interested in this area of practice now, too. She has just completed a course through the Klose Academy and is starting to see these patients as well.
Sounds great, Shannon. Thanks so much for your time.
To book a cancer recovery physiotherapy session, please call (250) 339-6221. We would be happy to support you on your journey.
