A Physical Therapy Program for      
Breast Cancer Recovery

Read a Q&A with Diana

Full Circle Developer and Director Diana Tjaden shares her thoughts on the rewards and challenges of starting and running this unique program, what she feels she and her staff have accomplished over the years, how much the program has meant to some of its patients, and where she'd like to take it in the future.

physical therapy FOR BREAST CANCER is an option most doctors don’t consider. What motivated you to start thIS PROGRAM?

Before I created the Full Circle program, I’d treated women with breast cancer for eight years. I found over and over again that they required a particular type of care, an individualized approach to physical therapy that addressed their particular needs. I wanted to bring all these women together in one place, to focus on them and make their breast cancer recovery process easier.... Many of the women we see suffer from pain and discomfort but thought they just had to live with it because they had breast cancer. They come to Full Circle and are amazed to find out that that’s not true. I founded the program to help these women progress in an environment that’s totally dedicated to their specific needs and issues.

What was it like in the beginning when Full Circle first opened its doors?

It was nerve-wracking, because I couldn’t know for sure what was going to happen. But it was exciting to finally be in the right place, and to be able to provide the appropriate care for these women, and to do the things I wanted to do. When we first started up the program, we had 10 patients who had followed me from the physical therapy facility I’d work at previously. Since then, the program has grown in leaps and bounds.

How many patients does Full Circle serve?

In our first full month, July 2011, we had 52 actual visits. By 2014 we'd increased that number to well over 300 a month. Today we're at nearly 600. Our growth has been phenomenal and gratifying.

How are these women finding out about Full Circle?

We have some great doctors now who have become believers and who regularly refer patients to us. Historically doctors haven’t prescribed physical therapy for this population, so I’ve invested a lot of time in meeting with doctors to educate them, giving lectures at hospitals, and sending out information about our program. People are also hearing about us more and more through word of mouth. Women come to us and realize they don’t have to live with the limitations they’ve been struggling with, and they tell their friends and doctors.

As you’ve worked on growing your number of patients and Full Circle’s reputation, what are some of the challenges you’ve faced?

Marketing the program requires a lot of time, and that was especially true at the beginning. So I needed to work that into my schedule, and still do. My staff needed training on things like how patients recovering from breast cancer are different from other physical therapy patients, what kind of precautions need to be taken with them, and how they should be progressing. And just running a business was a challenge: dealing with insurance companies and things like that. That was all totally new to me, and there was a lot to learn.

Who are the other physical therapists who've joined your team?

We hired Laura Cavallo first, in June 2012. Laura had worked with us the prior year when I was on maternity leave, and I was finally able to bring her on staff once we'd grown the program to a certain point. Kathy, Sandra, and Kristine have been fantastic additions over the years, and our most recent hire is Fran, our physical therapist assistant. Each one of them brings substantial experience to the office. As a team they cover many different aspects of care.

The most important question: What has Full Circle been able to do for its patients? How has physical therapy AFFECTED them?

Physically, they come in in so much pain, and with a little bit of work and education they’re able to regain their strength and their range of motion. We let them decide on goals for themselves. They’re pleasantly surprised when they’re able to do things they’ve done in the past, sometimes things they didn’t think would be possible.

One of my favorite things about treating this population is that I often see them very early on, as little as three weeks after surgery. So I can educate them in advance about different things they might experience during chemo, and how to handle them, or things they’ll feel during radiation—as opposed to getting them after they’ve already been through all that. It helps them, just being aware of the things they’ll face. Plus, when they come here they can talk to other patients who’ve gone through it. It becomes like a support group. They’re not just helped physically; the benefits are psychological as well. This is a place for women who are all dealing with the same fundamental thing. We support them, and they support each other. It’s really an amazing atmosphere. I have so much respect for these women.

Regarding patients’ progress FROM THE THERAPY: Could you give some specific examples?

One woman loved weight-training and hiking, but didn’t think she’d be able to do those things anymore. After physical therapy, she can. She said it changed her life. For some patients, it’s small things like being able to reach for something in the kitchen cabinet, lift a gallon of milk out of the refrigerator, or brush their hair. Many of them just want to be able to get back to their normal routine. We help them regain the ability to do these things.... One of our most touching cases was a woman whose surgery and radiation treatment had left her in pain for 18 years, to the point that she'd been unable to hug her small children. Her doctors had never been able to solve her problem. After five visits here, she was able to hug her kids. They’re older now, but she can hug them!

Those are amazing achievements. Does physical therapy always produce these kinds of results in women recovering from breast cancer? Or are there patients who don’t improve?

Not everybody responds so quickly or to such a dramatic degree, but no one ever says physical therapy made no change at all. They’re able to do more—everybody says that. Even if they came in with pain and it got only a little better, they can do things they couldn’t do before.

How would you describe the impact your patients have had on you?

They motivate me to learn about different ways to treat them most effectively. To keep up with the latest research. To go to different courses and learn new techniques. They’re great women. They don’t sweat the small stuff. They’re tough as nails. They make the most of everything they have. When you see people going through something life-changing like breast cancer, it makes an impression on you. It makes you appreciate things more.

Where would you like to take the Full Circle Breast Cancer Recovery Program in the years to come?

I want to keep educating people: doctors and patients as well as the general public. We're starting a discussion group, which will be led by one of our former patients who has these types of skills. Many of our patients find the point when they finish their treatment to be a difficult one, because suddenly they're on their own; this discussion group is a way for them to stay connected with other people with whom they can trade insights, information, and inspiration.  I want to keep things with the program flowing well, as they do now. Most of all, I want to continue to show by example that for patients with breast cancer, physical therapy should be the standard of care from the very beginning. Right from their diagnosis, PT should be there.

Is there anything else that’s important for people to know about you and Full Circle?

Just that, when patients look back on their recovery, I want them to look back on physical therapy as a very positive experience. I want them to remember us and our program. Just like we’ll remember them.