CANCER AND PT
When someone is undergoing cancer treatment, physical therapy may not be the first healthcare field that comes to mind. Early cancer treatment is met with oncologists, radiologists, geneticists, nurses, and surgeons...and rightly so. However, physical therapy has a large role in cancer recovery.
Cancer rehabilitation is a growing area in medicine due to the increase in cancer survivorship. More and more people are beating cancer due to advances in medical technology, treatment, and early detection. Recent research by the American Cancer Society shows that the five-year survival rate of all cancers that were diagnosed between 2003 and 2009 is 68%. This is a 20% increase from 1975-1977. This demonstrates that the number of cancer survivors will continue to increase in the U.S.. With more cancer survivors, comes the need for more recovery strategies to return these survivors to full and independent living.
Recently, I have been seeing more and more patients with various types of cancer in my practice. Cancer treatment is grueling and has many deleterious side effects that leaves many people exhausted, weak, immunocompromised and unable to participate in normal activities of daily living. This is where physical therapy can make a HUGE difference for these survivors. Despite all the strides that medical research has made in developing effective cancer treatments, people who receive these treatments usually experience extensive physical limitations during and afterwards.
CANCER REHABILITATION: FOUR CATEGORIES
Cancer rehabilitation has been classified into four categories:
Preventative rehabilitation:
This phase starts soon after cancer has been diagnosed and is performed before or immediately after surgery, radiation or chemotherapy. Patients receiving PT in this stage do not demonstrate any impairments of function yet. The goal of this phase of rehab is to prevent the development of impairments.
Restorative rehabilitation:
The goal of this phase is to achieve maximal functional recovery in patients who have impairments of function and have difficulty completing their activities of daily living.
Supportive rehabilitation:
The goal of this phase is to increase self-care abilities and mobility using methods that are effective for patients whose cancer has been advancing and who are experiencing a decline in function due to disease progression. Other goals of this phase are prevention of atrophy or weakening of the musculature throughout the body, prevention of contractures and prevention bed sores in those patients with very limited mobility.
Palliative rehabilitation:
The goal of this phase of cancer rehabilitation is to enable cancer patients in the terminal stage to lead a high quality of life physically, psychologically, and socially. Rehab programs in this stage are designed to relieve symptoms such as pain, dyspnea, and edema. During this phase, PT programs are also focused on instructing patients in breathing and relaxation techniques and the use of assistive devices so that they may still be able to engage in community activities.
WHAT ARE THE COMMON CANCER RELATED IMPAIRMENTS THAT PHYSICAL THERAPY CAN HELP WITH?
There is strong evidence to support the conservative management of cancer related impairments through physical therapy. The most common cancer related impairments include:
Lymphedema: Effective lymphedema management is accomplished through manual lymph drainage, range of motion exercise, and lymphatic bandaging.
Cancer related fatigue or CRF: Individualized aerobic training, strength training, and functional management training is known to reduce the effects of cancer related fatigue both during and after medical treatments.
Pain: There are many interventions that can reduce the intensity and frequency of pain after cancer treatment. These treatment strategies are soft tissue mobilization, gentle joint mobilization, therapeutic massage, electrical stimulation, and therapeutic stretching and strengthening.
Peripheral neuropathy: Many cancer survivors experience peripheral neuropathy which is defined as abnormal nerve function that can be experienced as pain, numbness, tingling, and the inability to move a joint. Physical therapy, specifically neuromuscular re-education, can help improve nerve function or compensate for nerve dysfunction.
Deconditioning: A PT can design a cardiovascular training program to improve cardiovascular endurance in cancer survivors.
Genitourinary complications: For men undergoing treatment for prostate cancer and women undergoing treatment for bladder cancer, incontinence and sexual dysfunction are common. A PT can help to rebuild the strength of the pelvic floor in order to improve urinary continence and reduce pain related to sexual function.
WHEN IS PHYSICAL THERAPY NECESSARY FOR CANCER PATIENTS???
Physical therapy is extremely valuable before, during, and after cancer treatments such as surgery, radiation, and chemotherapy. If you have been diagnosed with cancer, it is important to begin a physical therapy program immediately as it will improve your quality of life regardless of your specific phase of rehabilitation (see above).
A program of physical therapy for a cancer patient is designed to treat common cancer related impairments addressed in the above section. Each physical therapy program is created to meet the individual needs of the patient and is based on the type and stage of the cancer and the treatment course.
This program of physical therapy may include:
strengthening weak muscles to prevent disuse
stretching muscles that are tight from disuse
gentle joint and soft tissue mobilization to prevent or treat pain and stiffness in the muscles and joints throughout the body
neuromuscular re-education for those who are deconditioned or for those who have nerves that have been affected by their medical treatments and has left them without normal movement in their muscles and joints
balance training and fall prevention as many cancer patients experience muscle weakness and peripheral neuropathy, both of which will affect their standing balance and saftey
cardiovascular endurance activities
training to continue to be able to perform activities of daily living and work related activities
bracing or orthotic fabrication for both the upper and lower extremities that may have been weakened by surgery, radiation, chemotherapy, and/or peripheral neuropathy
goal setting by the patients so that they can continue to be independent in some activities and feel that they can still have control over their lives regardless of the patient’s current phase of rehabilitation (see above)