Cancer Rehabilitation

What is Cancer Rehabilitation?

With technological advancements, earlier diagnosis and improvements in treatment, cancer-survivors are living longer following the diagnosis of cancer. However, the various treatment options for cancer and cancer itself can lead to multiple unwarranted side effects, inclusive of but not limited to fatigue, pain and weakness. This challenges performance of routine activities, keeping work-commitments, indulging in hobbies and ultimately undermines the fitness levels.

'Rehabilitation' means the process of restoration to health or normal life through training or therapy. Cancer rehabilitation is aimed at lessening the impact of cancer-related physical and psychosocial impairments and improving the quality of life. This rehabilitation is comprehensively based on holistic care assessment, specific cancer care and management of ensuing symptoms.

What is the scope for cancer rehabilitation?

With higher rates of survival and increasing focus on quality of life, cancer care has shifted from 'just living' to 'leading a life to your optimal potential in a way that is more meaningful to you'. Dietz (1980) has described the following stages of cancer rehabilitation:

I. Preventive rehabilitation: Performed before or immediately after surgery, radiotherapy or chemotherapy. The main goal here is to prevent and minimise any impairments.

II. Restorative rehabilitation: Aims to optimise functional recovery, restore daily routines and resume a healthy lifestyle

III. Supportive rehabilitation: Aims to maximize self-care and mobility for patients with declining abilities, recurrence and progressive stages of cancer through treatment directed at prevention of any disuse atrophy, weakness, ulcers and contractures.

IV. Palliative rehabilitation: Aims to ensure a reasonably high quality of life psychosocially and relieve distressing symptoms including pain, edema, breathlessness and poor mobility.

When do I need referral for rehabilitation?

It is recommended that you begin rehabilitation and exercises if you are experiencing any of the following signs and symptoms:

• Excessive and progressive weakness disproportionate to treatment
• Fatigue, hindering your daily life
• Difficulty in moving one or more limbs
• Difficulty in turning, keeping your balance, getting up or walking
• Experiencing tingling, numbness or other sensations
• Difficulty in holding and reaching for objects
• Difficulty in talking or swallowing
• Experiencing pain that is not caused by cancer
• Having muscular or orthopaedic problems
• Difficulty in recovering from treatment
• Difficulty with concentrating or planning
• Reduction in hobbies or leisure activities
• Reduced quality of life and loss of confidence
• Poor sleep hygiene and increased stress responses
• Unsure about how much and how to best exercise

How is the rehabilitation decided?

Cancer rehabilitation is a unique experience for each client based on the cancer-type, potential side-effects of medical treatment, pre-existing co-morbidities and potential day-to-day changes in recovery patterns. Rehabilitation is structured on a bio-psycho-social paradigm - based on your abilities, functional requirements, goals and values. Treatment is individually designed after a thorough evaluation of your cardio-respiratory and neuro-musculoskeletal systems, ability to walk and balance, cognitive skills, fatigue levels, immunological fitness, general health demands and quality of life. Treatment comprises of a comprehensive plan consisting of exercises for strength-balance-flexibility, pain relief techniques, relaxation techniques, fitness regime, stress and sleep management.

We value your expectations and endeavour to set meaningful goals in close collaboration with you. These goals give us a framework to objectively measure your progress through the course of the rehabilitation program. The ultimate aim is to facilitate your transition into a healthy and active lifestyle.

What are the treatment options at Omphysio Clinic?

The core team at our clinic consists of experienced staff excelling in various modalities of treatment and care. Rehabilitation goals are carefully planned after a comprehensive evaluation by the physiotherapists. We offer the following services:

• Pain management
• Post-surgical rehabilitation
• Chemotherapy rehabilitation
• Radiation therapy rehabilitation
• Immunotherapy rehabilitation
• Lymphoedema management
• Cancer exercises
• Gait re-education
• Neuro-musculoskeletal management
• Trigger-point dry needling
• Acupuncture
• Pilates
• Yoga
• Fatigue and stress management
• Relaxation massage
• Aromatherapy

Will the exercises aggravate my symptoms?

Throughout the rehabilitation program, the physiotherapist would be monitoring your responses before and at the end of each session and liaising with you, your caretaker and consultant to ensure safety and prevent any untoward effects. The treatment is progressed gradually at a low intensity and a pace that's unique and comfortable to each individual client. The intensity of the rehabilitation is moderated towards a level appropriate to your fitness and fatigue levels, specific to your cancer diagnosis and medical treatment.

What is the best way to exercise post-surgery?

The rehabilitation after surgical treatment for cancer involves careful consideration of recovery level in terms of general health, recommended post-surgical restrictions and fatigue levels. Our focus would be on promoting early postoperative ambulation to promote circulation and prevent any deleterious effects of prolonged bed rest. When performing rehabilitation, it is important to first determine how a patient's disease has been explained to him or her and how the patient perceives his or her disease. In addition, determining what issues patients and their families are concerned about at present and with regard to their future makes it possible to provide them with information to allay their concerns. Further treatment involves ensuring good breathing control, improving bed side transfers, gradually encouraging independence in self-care activities, management of fatigue, stress and physical activity levels. Specific treatments involving strengthening, reducing lymphoedema, improving flexibility and motor control will be planned based on type of surgery, type of cancer and comprehensive evaluation of patient's functional capabilities.

Can exercises be done during chemotherapy, radiation therapy and/ or immunotherapy?

Physical strength tends to diminish during cancer treatments as a result of the adverse effects, such as nausea/vomiting, myelosuppression or peripheral neuropathies. Rehabilitation aims to encourage ambulation consistent with the patient's condition even during chemotherapy and to prevent disuse syndrome and maintain physical and muscle strength by performing mild exercise therapy and functional goal oriented activities. Failure to resume ambulation during treatment and the development of severe disuse syndrome often occur, especially among infants and the elderly. It is important for the physiotherapists to visit the patient regularly and to make movement a habit, even if only a little at a time, by incorporating activities that the patients enjoy.

Many patients today receive outpatient chemotherapy/ radiotherapy and treatment is expected to shift even further toward an outpatient setting. Patients undergoing such treatments continue their daily lives at home while receiving treatment. Continuing to work and keep house, while experiencing the adverse effects of treatment often imposes a major burden on patients. In such cases, we would prescribe measures enabling you to understand how much activity is sufficient and to limit or pace potentially difficult and stressful chores. Physiotherapists would help you work on activities which are more meaningful for your daily life, in a slow, gradual and achievable manner. Giving the patients the sense that they are able to control their own activities in this way is an important link to preserving their self-confidence.

What is the scope for exercises during advanced stages of cancer?

Patients with recurrent and advanced cancer experience a variety of symptoms associated with cancer progression. There is a tendency towards malaise, disuse atrophy and lack of sufficient mobility while their general condition deteriorates. When patients express strong wishes, such as 'I want to go to the bathroom' and 'I want to walk', up until the very end, it is sometimes possible to satisfy their wishes by teaching family members how to assist them, making adjustments to the environment around the bed and around the bathroom, and by making walking aids available, even when there is no prospect for improvement in the patients' functions. The rehabilitation approach would take into consideration the goals of the patients and their families, patient's functional abilities, the immediate environment as well as the human support that is available, the utilization of healthcare devices, and the utilization of social resources, so that patients are able to achieve whatever they hope to do.

Even when a patient's general condition deteriorates, it is possible to perform rehabilitation until the very end through palliative interventions, such as range of motion (ROM) exercises for the patients' limbs, massage for swollen lower limbs or breathing assistance. As stated earlier, rehabilitation can be applied throughout the entire phase of disease from the time of diagnosis until the terminal stage, with a strong involvement psychosocial aspects along with physical aspects of the treatment.

Japanese Journal of Clinical Oncology, Volume 41, Issue 6, June 2011, Page NP, https://doi.org/10.1093/jjco/hyr074

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