How to prioritize breast cancer impairments

The side effects & impairments that a breast cancer survivor may experience truly depend on their cancer & their treatments. Many patients will undergo some combination of surgery, chemotherapy, radiation therapy, hormonal therapy, and maybe more.

So what we’re going to talk about in this episode are some of the more common impairments that you will see, how to screen for them, and how to ultimately prioritize the often laundry list of impairments that patients can experience.

The most common impairments after breast cancer treatment

The most common impairments seen in the breast cancer population include cancer-related fatigue, pain, upper quadrant dysfunction, lymphedema, decreased QOL, ADL difficulties, CIPN, balance problems & falls, fertility issues, cardiovascular toxicities, depression, cognitive issues, sleep disturbances, & bowel/bladder/sexual dysfunction. 

One thing to consider here: Many patients who undergo more treatment and more aggressive treatments are more likely to experience more significant impairments.

HOWEVER: just because a patient doesn’t undergo as aggressive of treatment or as many treatment rounds, does not mean that they will not develop a particular impairment.

For example, patients who undergo a sentinel lymph node biopsy are still at risk for developing lymphedema. When we don’t tell patients their risk or the full story of potential side effects, this actually harms patients.

If we downplay the risks, we run the potential of not accurately informing our patients about what they could develop down the road.

How to prioritize impairments from a laundry list

These three questions will help you prioritize impairments, especially with our more complex patient cases, with multiple side effects & impairments. All warrant consideration for every individual patient that you encounter.

Commonly, I find myself asking all of these questions to help determine what’s the most critical impairment for me to address first.

What was the patient referred for?

When the patient comes in with a referral, the referral reason is often the most visible impairment to the referring provider. Or maybe it’s the impairment the referring provider noted as part of their physical examination or screening process.

But this isn’t a foolproof method. Many times, the medical team is strapped for time meaning that they are not going to have time to ask all the questions or even listen fully to what the patient is experiencing.

Sometimes patients answer yes to a question that they are experiencing XYZ impairment, but that’s not actually something that bothers them on a day-to-day basis or keep them from doing things that they want to do or need to do. Sometimes it’s not actually the biggest problem our patients are experiencing.

What is the patient complaining about the most?

Starting first with patient complaints is a fantastic way can really show the patient that you’re paying attention to them.

I like to ask patients what brings them in today and then stop talking. By putting them in the driver’s seat, this allows them to tell you what is really bothering them and how it’s really bothering them.

A common mistake here is to immediately start asking follow-up questions or even to interrupt the patient. DO NOT GIVE INTO THIS TEMPTATION!

This is actually one of the worst things that we can do.

By focusing the eval on the patient and what the patient is experiencing and determining his most important for them, we really have the opportunity to demonstrate that we care about the patient.

While this is my favorite way to prioritize impairments, it’s definitely not always the best way.

Sometimes patients are experiencing different side effects & impairments that are compounded by others. So even though “x” impairment is the squeaky wheel, it actually being exacerbated by “y” impairment over here. We may have to actually address “y” impairment first before we can really make a difference on the patient’s number one complaint, “x.”

What is the easiest thing to get started on?  Where can you make the biggest difference right away?

We will not always have the answers, as much as we want to.  Sometimes, we have to stop and look at what will make a difference for the patient right here and right now.

We won’t always get this right, but sometimes this is truly the best place to get started when we have a very complex patient in front of us.


When you’re first working with the person with breast cancer, it can be overwhelming to imagine or even see all of the impairments that this person is experiencing.

However, when we stop to assess the whole picture and truly prioritize what is most important to address first, it becomes a lot simpler.

The next time you find yourself getting overwhelmed, come back to this episode and refresh yourself on how to prioritize a patient’s impairments.

So now I want to hear from you: what did I miss? What else would you include in this episode about breast cancer-related impairments? Message me on Instagram and let me know.

Until next time this is Elise with TheOncoPT.  And remember you are exactly the physical therapist that your patients with cancer need. So let’s get to work.


  • Ewertz M, Jensen AB. Late effects of breast cancer treatment and potentials for rehabilitation. Acta Oncol 2011;50(2):187-93

More from this episode:

Listen to my interview with Beth Hoag, pelvic floor physiotherapist – part 1

Listen to my interview with Beth Hoag, pelvic floor physiotherapist – part 2

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