Breast cancer is a life-interrupting event. This much is an obvious statement. However, a lesser-known fact is that the treatments for breast cancer involve an after-effect of chronic or persistent pain in 60% of cases. Thus, treating the cancer is concern number one. But after the fact, solving the problem of musculoskeletal pain becomes a common after-care issue. A study released in 2019 undertook the task of analyzing the available studies on this issue. After a massive database search the results are in: “current evidence suggests that manual therapy is considered effective for treating chronic musculoskeletal pain in female breast cancer survivors.”
The study is applicable to chiropractic care, as our profession comes under a number of modalities collectively called “manual therapies.” Other professions that sit under this banner, albeit from a different modus operandi, include Osteopathy and Physiotherapy.
The task of undertaking an analysis like this is massive: the authors scoured 1562 titles and screened them before arriving at a final number of 5 peer-reviewed studies to look over. There is a lot of work left to go, as the five studies did not cover all of the modalities that fall under the “manual therapy” banner, nor describe the applications of techniques or intensities for these treatment types.
However, the data indicates that “manual therapy seems to provide good results.”
The fact is that chronic musculoskeletal pain has many factors contributing to it. Currently, the American Society of Clinical Oncology Breast Cancer Survivorship Care Guidelines recommends that “Women with CMP [Chronic musculoskeletal pain] due to breast cancer treatment should receive proper rehabilitation [1].” This can take on many forms, such as massage, exercises, and stretching for example. However, “manual therapy has also been shown to have good effects for pain reduction in the same patients [1].”
Researchers went on to comment on some of the potential mechanisms that might explain the therapeutic benefit, but also noted that the manual therapy interventions are “cheap and safe.”
For breast cancer survivors, the cancer treatments “particularly affect the upper limbs and thorax [1].” It is therefore unsurprising that the upper limbs and thorax tend to be common areas for chronic pain and inflammation after the fact.
The studies that were included in the review covered 127 women between the ages of 25 and 75 who received treatment, and 112 who did not receive treatment (i.e. manual therapy post-cancer). The primary outcomes included:
- chronic pain decreased
- pressure pain threshold increased (i.e. ability to cope with pain)
Several other measures were taken into consideration by the studies, but no significant changes were noted. But still, a decrease in pain and an increase in the ability to cope with pain are significant findings indeed.
Impacting Adaptability
It should be noted that this study did not look at chiropractic care specifically. Interventions focused on things like massage, myofascial release, and other modalities. Nor did the study measure effects on the nervous system directly. It is the latter that chiropractors are most concerned with, and this is not something that has been completely ignored in the literature.
Chiropractic care and breast cancer certainly isn’t a topic we have a large bank of data on. However, it is well covered in the literature that heart rate variability takes a long time to bounce back post-cancer. This effect doesn’t discriminate based on gender or type of cancer either.
Why does Heart Rate Variability matter? Essentially, it is a measurement of how well the body can adapt. If heart rate variability is low, that generally means that the body isn’t adapting well to stressors. That’s bad. The higher someone’s heart rate variability is, the better it is as it indicates a nervous system that is well-tuned, and well able to respond to the different challenges we face (physically or otherwise). Heart rate variability isn’t something that just exists within the chiropractic sphere either. It is a commonly used measure of nervous system health.
Late last year, we published an interview with Dr. Otto Janke, a chiropractor who had authored a case review covering improvements in heart rate variability post-breast cancer [2]. The report detailed the case of a 43-year-old woman who was 8-months post-cancer. She had gone through a double radical mastectomy and chemotherapy. Even 8 months after her treatment ceased, ”Her heart rate variability was still toast,” said Dr. Otto. “It’s not that she wasn’t healing or responding well. Its that she was responding exactly as many, many women do around the world who are post-breast cancer, post-surgery, post-chemotherapy. “Research shows [this effect] can be up to ten years.”
Not only can this effect be present for a long time, but other research has also indicated that heart rate variability study “could be a clinically useful tool to detect cardiovascular disease in early-stage breast cancer survivors [3]” and a predictive factor for cancer survival [4].
While we certainly lack clinical trials tying chiropractic care specifically to cancer survival rates, what we do have is mounting evidence that chiropractic care may have a positive impact on heart rate variability [5, 6, 7]. When you combine that with existing non-chiropractic research that shows heart rate variability to be a significant factor when it comes to the ongoing health outcomes of cancer survivors, then we think this is certainly something worth considering.
REFERENCES:
- da Silva F, Moreire G, Zomkowski K, de Noronha M, Sperandio F (2019), “Manual Therapy as Treatment for Chronic Musculoskeletal Pain in Female Breast Cancer Survivors: A Systematic Review and Meta-Analysis,” Journal of Manipulative and Physiological Therapeutics, 42. Is. 7, Pp. 503-513, https://www.sciencedirect.com/science/article/pii/S0161475418302628 retrieved 3 June 2020
- Staff Writer, (2019), “Interview with Dr Otto Janke – HRV Post-Cancer Case Study,” Australian Spinal Research Foundation, https://spinalresearch.com.au/interview-with-dr-otto-janke-hrv-post-cancer-case-study/ retrieved 3 June 2020
- Caro-Moran E, Fernandez-Lao C, and Galiano-Castillo N (2015), “Heart Rate Variability in Breast Cancer Survivors After the First Year of Treatments: A Case-Controlled Study.” Biological Research for Nursing, https://journals.sagepub.com/doi/abs/10.1177/1099800414568100?journalCode=brna retrieved 3 June 2020
- Kloter E, Barrueto K, Klein S, Scholkmann F and Wolf U (2018), “Heart Rate Variability as a Prognostic Factor for Cancer Survival – A Systematic Review,” Frontiers in Physiology, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986915/ retrieved 3 June 2020
- Staff Writer (2017), “Possibile clinical applications of heart rate variability,” Australian Spinal Research Foundation, https://spinalresearch.com.au/possible-clinical-applications-heart-rate-variability/retrieved 3 June 2020
- Staff Writer (2018),”Improvements in HRV under chiropractic care,” Australian Spinal Research Foundation, https://spinalresearch.com.au/improvements-in-hrv-under-chiropractic-care/ retrieved 3 June 2020
- Staff Writer (2018), “Subluxation vs. Subluxated: How HRV can help map the difference,” Australian Spinal Research Foundation, https://spinalresearch.com.au/subluxation-vs-subluxated-how-hrv-can-help-map-the-difference/ retrieved 3 June 2020
