Timing of physical therapy to optimize shoulder range of motion among patients receiving breast radiotherapy

Abstract Purpose Establishing optimal timing of physical therapy (PT) during multimodal breast cancer treatment can be challenging. We hypothesized patients initiating PT post-surgery and pre-radiation therapy (RT) would experience greater gains in functionality compared to PT initiated during/after RT. Methods A retrospective review was performed for patients receiving multimodality breast cancer treatment and PT between 1/2015-8/2021. Three cohorts were established: patients who received no RT, PT initiated before RT (pre-RT), and PT during/after RT (d/a-RT). The primary endpoint was percent change in ipsilateral shoulder ROM between first and last PT visits. Associations between range of motion (ROM) across groups and baseline characteristics were evaluated with analysis of variance testing. Results Thirty-seven patients were identified, median age of 47 years. The no-RT cohort exhibited the greatest mean percent improvement in ROM with PT (74%) versus pre-RT (59%) and d/a-RT (20%). The no RT and pre-RT groups demonstrated greater improvements in ROM compared to patients receiving PT d/a-RT (no RT 74% vs d/a-RT 20%, p = 0.006; pre-RT 59% vs d/a-RT 20%, p = 0.045). There was no difference in ROM gains between the no-RT and pre-RT groups (p = 0.528). Lower baseline ROM was associated with smaller improvements in ROM after PT (p = 0.008). When adjusting for baseline ROM, the no-RT cohort remained associated with ROM improvement compared to the d/a-RT group (p = 0.024). There was no difference in ROM change between no-RT and pre-RT cohorts. Conclusion PT improves shoulder ROM in patients undergoing multimodality breast cancer treatment; however, early initiation of PT before starting RT may maximize ROM gains.