SUS: Chamber foresees physiotherapy to treat breast cancer – 11/07/2023 – Balance and Health

This week, the Chamber of Deputies approved a bill that provides for physiotherapy in the SUS (Unified Health System) for people who have undergone surgery to treat breast cancer.

The PL, which is awaiting approval in the Senate, guarantees physiotherapy for rehabilitation and prevention of post-operative complications if medically indicated — for both women and men.

The demand is great and is not always met by specialized teams, says mastologist Henrique Lima Couto, doctor in women’s health and member of Febrasgo (Brazilian Federation of Associations of Gynecologists and Obstetricians).

According to him, in addition to mastectomy and breast reconstruction, armpit surgeries resulting from breast cancer require physical therapy because of the high rate of lymphedema, that is, the accumulation of fluid, in the postoperative period. The main one is radical lymphadenectomy, also known as armpit dissection, he says.

Lymphedema arises due to the removal of lymph nodes from the armpit during the procedure. This can cause a disorder in the lymphatic system that stops completely absorbing lymph, a liquid present throughout the body — which causes excessive swelling of the limb, makes it heavy and causes difficulty in range of motion.

“Physiotherapy of the upper limbs with the treatment of lymphedema and its prophylaxis is essential in the immediate post-operative period, on the same day that the patient undergoes surgery, and the following day, and must be continued in the period following surgery, to avoid sequelae that can restrict movement”, says the doctor.

When there is an early diagnosis, it is possible to perform conservative surgeries, with much less mutilation, says oncologist Ricardo Caponero, scientific director of Femama (Brazilian Federation of Philanthropic Institutions to Support Breast Health).

“Today, when we have an ultrasound examination showing that there is no involvement of the axillary lymph nodes, we even have the option of not even removing the sentinel lymph node. Unfortunately, as the disease progresses, the treatment is more mutilating, with greater functional damage. The greater the dysfunction caused, the greater the need for physiotherapy”, he states.

Publicist Paula Dultra, 43, had surgery to combat breast cancer in 2011. The procedure was quadrantectomy, when part of the breast tissue is removed with immediate reconstruction, combined with underarm emptying. Since then, she hasn’t stopped doing physical therapy.

“At the time, they only recommended physiotherapy at least 30 days later. As I was missing the lymph nodes in my armpit, the fluid was not circulating, so I felt a lot of pain and discomfort. It only started to improve even with the intense physiotherapy I started doing”, he says. Dultra, who now strengthens her arm muscles in Pilates, also with a physiotherapist.

Even so, she was left with a sequelae of the surgery, called “monoparesia”, a reduction in strength in the upper limb. “I think I’m light because of this work [de fisioterapia] I did and am doing”, he says.

Physiotherapy can also help women who have undergone mastectomy and breast reconstruction in recovering movement and range of upper limbs, in addition to helping to reduce patients’ pain, says the mastologist who is a member of Febrasgo. According to him, this is necessary because prostheses are often placed behind the muscles or interfere with the muscular compartment.

The project approved by the Chamber amends a 1999 law, which guarantees the right to breast repair plastic surgery through the SUS in cases of mutilation resulting from cancer treatment. If implemented, these women would also have the right to physiotherapy in all cases of complications resulting from breast cancer treatment.

Inca (National Cancer Institute) estimates 74 thousand new cases of breast cancer per year in Brazil between 2023 and 2025.

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