Female Breast Cancer Survivor With Fibromyalgia: A Case Study Regarding Benefits Of Virtual Exercise Training

HISTORY: 63-year-old female with a history of stage 1A, right-sided breast cancer treated with a bilateral mastectomy. Since that time, she has been treated with multi anti-estrogen treatments which have been changed due to numerous musculoskeletal side effects. She currently continues treatment with Tamoxifen. Symptoms include significant fatigue, “mental fog”, and wide-spread musculoskeletal pain. She is currently using gabapentin at 300 mg in the morning 600 mg at bedtime which helps only moderately. PHYSICAL EXAMINATION: Notable for tender points in the upper and lower extremities bilaterally. No joint effusions or deformities noted. She had functional range of motion in all major joints. Neurologic exam was normal. DIFFERENTIAL DIAGNOSES: 1. Inflammatory arthritis 2. Fibromyalgia 3. Adverse effects from anti-estrogen treatment TEST AND RESULTS: Vitamin D, Creatine Kinase, Rheumatoid Factor, Thyroid Stimulating Hormone, and C-reactive protein levels were all normal. MRI of the Lumbar Spine showed only minimal degenerative changes at L4-5 but otherwise normal. FINAL/WORKING DIAGNOSES: Fibromyalgia Syndrome, likely aggravated by anti-estrogen treatment TREATMENT AND OUTCOME: Patient was prescribed an at-home virtual exercise program to improve strength and to reduce pain. Zoom delivered exercise sessions were led by an exercise physiologist certified in cancer exercise training. 3 days a week, the participant was guided through 50 minutes exercises. Exercises were adjusted on days the patient experienced substantial pain. Sessions were scheduled for the afternoons when the patient reported being “less stiff.” For a baseline and post assessment after 3 months, hand grip and a 1-repetition maximum leg press (1RM) were measured to assess strength. A 10-point pain scale was used to measure fibromyalgia pain during exercise. Hand grip strength increased in the right hand from 18 kg to 21 kg, and in the left hand from 17 kg to 21 kg. The patient’s 1RM of the leg press was found to increase from 86 kg to 127 kg. The patient’s pain scale was reduced from an 8/10 to a 2/10 from the first to last exercise session. Through a G-FACT questionnaire, the patient reported a reduction in pain and improved quality of life. This case study was supported by the Cedars-Sinai Cancer CIRCL Hope Warschaw Award.