Rehabilitation for cancer

DEFINITION: Rehabilitation aims to treat the physical, emotional, and psychological limitations often experienced by cancer patients. The goal of rehabilitation is to help the individual with cancer participate as fully and independently as possible in daily life. During rehabilitation, the cancer patient works to regain skills and abilities lost through the effects of cancer or cancer treatment.

Cancers treated: All types of cancers beginning before, during, or after cancer treatment

Why performed: The specific goals of rehabilitation are different for each individual. In general, rehabilitation aims to allow the individual to function as fully and independently as possible. The rehabilitation team will include different allied health professionals depending on the goals and needs of the individual. Often, the rehabilitation team will include many health professionals, such as a physical therapist, an occupational therapist, a rehabilitation nurse, a psychologist or psychiatrist, a nutritionist or registered dietician, the individual’s physician or oncologist, pain management specialists, a case manager, and home health workers.

The rehabilitation team will work with the patient and the patient’s family and loved ones to help the patient regain as high a degree of functioning as possible. The specific activities included in the rehabilitation plan usually comprise dressing, bathing, cooking, eating, and other activities of daily living. Some individuals may receive help recovering the ability to drive, take public transportation, or other aspects of mobility.

For individuals whose job skills were affected by cancer or cancer treatment, regaining the skills necessary to return to a job is usually considered a high priority. An occupational therapist or other rehabilitation team member may help the individual determine what skills are required, work to improve those skills, and seek ways to modify the employment environment so that the individual may return to work sooner.

The individual may have goals in addition to those necessary for return to employment or for daily living. Many recreation and leisure activities that were formerly pleasurable may become difficult or impossible because of cancer or cancer treatment. Rehabilitation therapists listen to the patient to address additional goals, such as camping, sailing, playing sports, or playing music.

Patient preparation: Before meeting with a rehabilitation specialist, the patient may want to consider specific rehabilitation goals. Making a list of activities or skills the patient would like to work on can help the rehabilitation therapist consider activities other than daily living that are important in that individual’s life. Goals can be specific, such as being able to knit or type again, or more general, such as being able to play with children or grandchildren.

The patient preparation required before the individual rehabilitation sessions will vary depending on the type of therapy. The rehabilitation specialist will give the patient-specific information about what steps to take before a session, which may include doing gentle stretches to warm up or even mentally preparing to meet the challenges that rehabilitation therapy provides.

Steps of the procedure: The steps of rehabilitation are very individualized. They depend on the type of therapy and the patient’s specific needs and goals. Rehabilitation therapy often breaks down the goal activity or skill into smaller parts or steps and works on one step at a time. For example, an occupational therapist helping a patient regain the ability to feed themselves may work on the action of bringing the food to the mouth as one activity, the act of using a spoon or fork to scoop food as a separate activity, and the act of cutting food as an individual skill. As these aspects of feeding oneself are mastered, they are combined into more complex sequences of actions.

Another way to approach rehabilitation is to increase the patient's daily abilities in the affected areas. In this case, the rehabilitation therapist might focus on getting food from the plate or bowl into the mouth using the hands and slowly adding skills, such as using a spoon, then a fork, and then working on cutting food.

Rehabilitation also often helps to identify assistive devices that individuals can use to help them accomplish various tasks. In some cases, these devices are only necessary for a short time; in other cases, they will be used by the individual for the rest of their life. For instance, a rehabilitation specialist may help an individual regain the ability to walk using a walker or help an individual who had a leg amputated master using a prosthetic leg.

After the procedure: The steps after rehabilitation will vary depending on the type of therapy performed. After therapy involving physical activity or exercise, stretches and cooldown activities are usually performed. The rehabilitation therapist will often assign the individual exercises or activities to practice each day, sometimes several times a day, before the next session. This approach ensures that the progress made during the session is maintained until the next session. The patient’s family members or caregivers may be shown how to help the individual complete these exercises.

Rehabilitation therapy may be continued for weeks, months, or even longer. When the therapy has ended, the therapist may give the patient a list or set of exercises or activities to continue to help maintain the skills gained during therapy or to help the patient continue to make improvements.

Risks: The risks associated with rehabilitation are generally mild but different for different rehabilitation therapy forms. There are some risks that during physical therapy, individuals may strain or pull muscles or otherwise overextend or injure themselves, especially if the proper stretching and warmup routine is not followed before the therapy. Risks of occupational therapy and other forms of rehabilitation therapy that involve the patient working to perform certain actions or movements, such as dressing or bathing, may also result in strain or injury if the individual pushes too hard to accomplish the task before their body is ready. An individual working on regaining the ability to walk may fall unless carefully monitored. Generally, these and other physical risks from rehabilitation are very low if a qualified health professional oversees the therapy.

There may also be some emotional risks relating to rehabilitation. The issues discussed with a psychologist or psychiatrist can often be painful or upsetting as they help the individual with cancer work through the fear, uncertainty, and feelings of hopelessness that often accompany cancer diagnosis and treatment. Although discussions with a psychologist or therapist can often be upsetting, they help the patient effectively process these emotions.

Results: Rehabilitation results are usually very positive. With consistent effort by the patient and rehabilitation team, many lost skills and abilities can be regained. Many patients return to jobs and activities in which they could not participate without rehabilitation. Psychological and emotional rehabilitation help patients regain a positive outlook and overcome the fear and unhappiness often associated with cancer and cancer treatment. A comprehensive rehabilitation plan involving many allied health professionals and family, friends, or other caregivers is often especially effective.

The rehabilitation team must help the patient develop a realistic view of the amount of work required by rehabilitation, the time required to reach goals, and what rehabilitation goals will likely be realistic overall. Having realistic expectations can help reduce frustrations and negative feelings that may occur during the rehabilitation process as hurdles are met and overcome.

Bibliography

Baima, Jennifer A, and Ashish Khanna. Cancer Rehabilitation : A Concise and Portable Pocket Guide. Springer, 2020.

Cheville, Andrea, et al. "Cancer Rehabilitation." Braddom's Physical Medicine and Rehabilitation, 2021, pp. 568-593. doi.org/10.1016/B978-0-323-62539-5.00029-1.

Chowdhury, Rabeya A., et al. "Cancer Rehabilitation and Palliative Care—Exploring the Synergies." Journal of Pain and Symptom Management, vol. 60, no. 6, 2020, pp. 1239-1252. doi.org/10.1016/j.jpainsymman.2020.07.030.

Cifu, David X. Braddom's Physical Medicine and Rehabilitation E-book. Elsevier Health Sciences, 2020.

Davis, Carol M. Complementary Therapies in Rehabilitation: Evidence for Efficacy in Therapy, Prevention, and Wellness. 4th ed., Routledge, 2024.

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Peter, A, and Carter Ann. Combining Touch and Relaxation Skills for Cancer Care: The Hearts Process. Singing Dragon, 2019.

Rauh, Stefan. Survivorship Care for Cancer Patients: A Clinician’s Handbook. Springer, 2021.

Ward, Elizabeth C., and Corina J. van As-Brooks. Head and Neck Cancer: Treatment, Rehabilitation, and Outcomes. Plural Publishing, 2024.

"What Is Cancer Rehab?" American Cancer Society, 22 May 2024, www.cancer.org/cancer/survivorship/be-healthy-after-treatment/what-is-cancer-rehabilitation.html. Accessed 20 July 2024.