How Occupational Therapy Can Help
Preventative (or “risk-reducing”) medicines for breast cancer are an important option for people at increased risk such as those with a strong family history, genetic mutations such as BRCA1/BRCA2, or other risk factors. People who have been treated for breast cancer follow up with hormonal or immunotherapy to prevent future recurrence.
These medicines can lower the chance of breast cancer development or recurrent but they can also bring side effects that affect daily life and well-being. Understanding these treatments and knowing when to reach out for support can help ensure that prevention does not come at the expense of quality of life.
Aromatase Inhibitors (AIs): Anastrozole, Letrozole, Exemestane
How they work:
AIs block the enzyme aromatase, which converts other hormones into estrogen. They are primarily used in postmenopausal individuals to prevent ER+ breast cancer recurrence or development.
Common side effects:
- Joint stiffness and muscle pain
- Bone loss (osteopenia or osteoporosis)
- Hot flashes and fatigue
- Mild mood or cognitive changes
How OT can help:
OT practitioners can help design joint protection programs and introduce adaptive exercise routines to maintain mobility and independence. Education in safe movement patterns, ergonomic supports, and home modifications can help ease discomfort and sustain participation in meaningful activities. If needed, orthoses can be recommended or fabricated to support painful joints to promote function or reduce pain. Additionally, OTs can help integrate mindfulness or relaxation strategies to manage pain perception and stress.
Selective Estrogen Receptor Modulators (SERMs)
How they work:
SERMs, including Tamoxifen and Raloxifene, act on estrogen receptors in a tissue-specific way—blocking estrogen in the breast but mimicking it in other tissues such as bone.
Common side effects:
- Hot flashes and night sweats
- Leg cramps or muscle aches
- Increased risk of blood clots
- Changes in the uterine lining
- Mood fluctuations and fatigue
How OT can help:
Occupational therapy can support individuals in managing fatigue and temperature regulation through daily routines, clothing choices, and energy conservation techniques. Strategies such as sleep hygiene programs, stress management tools, and exercise planning can reduce the impact of side effects on everyday activities. It is used for both pre- and postmenopausal individuals to reduce the risk of estrogen receptor-positive (ER+) breast cancer.
Immunotherapy
How it works:
Immunotherapy harnesses the body’s immune system to identify and destroy cancer cells. While primarily used for active cancer treatment, some emerging therapies are being studied for prevention in high-risk populations.
Common side effects:
- Fatigue and muscle weakness
- Joint pain
- Skin reactions or rashes
- Changes in energy, sleep, or mood
How OT can help:
Occupational therapy interventions focus on fatigue management, sensory comfort, and pacing strategies to sustain participation in work, self-care, and leisure. Lifestyle redesign and gradual activity progression help clients adjust to changes in energy and ensure that prevention measures fit within a balanced, meaningful life.
When to Talk to Your Oncologist
Preventative medicine should protect your future health without compromising your present well-being. Contact your oncologist if you experience:
- New or worsening pain, swelling, or limited movement
- Signs of blood clots (leg pain, swelling, sudden shortness of breath)
- Bone pain or signs of fracture
- Persistent fatigue or depression
- Side effects that interfere with your ability to perform daily tasks or enjoy life
Your oncologist can adjust medication type or dosage, recommend bone density monitoring, or collaborate with your occupational therapist to optimize function and comfort when musculoskeletal issues are present or if fatigue inhibits you from managing your daily activities.
The Role of Occupational Therapy in Breast Cancer Prevention and Survivorship
Occupational therapy bridges the gap between medical prevention and daily living. By addressing fatigue, pain, emotional well-being, and engagement in valued activities, OT helps individuals sustain healthy routines and a strong sense of identity throughout their prevention journey.
Prevention is not only about lowering risk, it’s about supporting quality of life today. With a collaborative care team that includes your oncologist and occupational therapist, you can create a plan that keeps you healthy, active, and thriving.
If you are dealing with issues as a breast cancer survivor or pre-vivor and live near Evanston, IL, visit my website to explore services.
Empowering You to Live Well—Before, During, and Beyond Cancer.
This post is in honor of my completion of 5 years of Tamoxifen, 20mg, every night. As a five year breast cancer survivor, my risk of recurrence is officially low. Per the Breast Cancer Index test, I gain no benefit from continuing treatment.
I was not happy to begin Tamoxifen and the five years felt like a jail sentence. In venting my displeasure, I sent a group text to friends on the first night of beginning the hormone therapy. My text read something like: “Hooray, I took my first Tamoxifen and now only have 1,824 to go.” A very wise friend replied: “Well, we are glad you will have so many days to live.”
That text exchange reminded me about why I was taking the T-20. It wasn’t easy but I made it to the finish line and hopefully have many more days to live. And I’m really hoping to get better quality sleep now that I’m done!
Flourish Recovery & Wellness 