Physical rehabilitation for cancer survivors
- Jonas M Sokolof, DO
Jonas M Sokolof, DO
- Assistant Professor
- Department of Rehabilitation Medicine
- Weill College of Medicine of Cornell University
- Assistant Attending Physician
- Department of Neurology/Rehabilitation Services
- Memorial Sloan-Kettering Cancer Center
- Maryam Rafael Aghalar, DO
Maryam Rafael Aghalar, DO
- Attending Physician
- Nassau University Medical Center
- Michael D Stubblefield, MD
Michael D Stubblefield, MD
- National Medical Director for Cancer Rehabilitation
- Select Medical Corporation
- Medical Director for Cancer Rehabilitation
- Kessler Institute for Rehabilitation
- Section Editors
- Patricia A Ganz, MD
Patricia A Ganz, MD
- Section Editor — Cancer Survivorship
- UCLA Schools of Medicine and Public Health
- Jonsson Comprehensive Cancer Center
- Larissa Nekhlyudov, MD, MPH
Larissa Nekhlyudov, MD, MPH
- Section Editor — Cancer Survivorship
- Associate Professor
- Department of Medicine
- Brigham & Women’s Hospital
- Harvard Medical School
Cancer rehabilitation is a specialty of physical medicine and rehabilitation that aims to meet these needs for cancer survivors. Rehabilitation focuses on the evaluation and treatment of functional loss and pain disorders with the goal to restore maximal function, which, depending on the patient’s specific needs, may involve a multidisciplinary team, including a physiatrist (ie, physical medicine and rehabilitation clinician), physical therapists, occupational therapists, speech and language therapists, and a lymphedema therapist. The importance of cancer survivorship care inclusive of attention to the medical, functional, and psychosocial consequences of cancer and its treatment were cited as important areas to address in an Institute of Medicine (IOM) consensus study report issued in 2006 . It is important to identify and refer to those healthcare professionals that are qualified and have the expertise in treating patients' rehabilitation needs .
Cancer rehabilitation is typically a coordinated endeavor that requires an open channel of communication to the primary oncology team (eg, medical oncologist, radiation oncologist, and/or surgical oncologist) and the primary care providers. In addition, supportive services play a critical role in the rehabilitation of cancer survivors, including those by nurses, recreational therapists, nutritionists, social workers, mental health professionals, orthotic and prosthetic specialists, chaplains, vocational counselors, hospice liaisons, home care agencies, support groups, and educational outreach programs .
This topic will discuss cancer rehabilitation, including a specific discussion of the techniques and approaches utilized in the setting of rehabilitation, their indications, and evidence of their benefit. We will discuss in the following sections specific physical impairments that we most commonly see, with evidence of how rehabilitation can be effective (table 1). Other topics in cancer survivorship are covered separately. (See "Overview of cancer survivorship care for primary care and oncology providers".)
MODELS OF REHABILITATION
The majority of rehabilitation programs address specific physical impairments caused by the cancer and its treatments. It is important to note that general physical exercise has been shown in many studies to have tremendous benefits in cancer survivors, including improving fatigue, quality of life, mood, decreased cancer recurrence, and improved survival . This is beyond the scope of this chapter and is discussed extensively elsewhere. (See "The roles of diet, physical activity, and body weight in cancer survivorship".)
Cancer rehabilitation plays a role throughout the continuum of cancer survivorship. General cancer rehabilitation is often grouped into categories known as the Dietz Classification . These include:
- Hewitt, M, Greenfield, S, Stovall, E, et al. From cancer patient to cancer survivor: Lost in transition. (National Academies Press, Washington DC), 2006 http://www.iom.edu/Reports/2005/From-Cancer-Patient-to-Cancer-Survivor-Lost-in-Transition.aspx (Accessed on January 31, 2011).
- Silver JK, Baima J, Mayer RS. Impairment-driven cancer rehabilitation: an essential component of quality care and survivorship. CA Cancer J Clin 2013; 63:295.
- Stubblefield MD. Rehabilitation of the cancer patient. In: Cancer, Principles and Practice of Oncology, Devita VT, Hellman S, Rosenberg SA (Eds), Lippincott, Williams & Wilkins, Philadelphia 2011. p.2500.
- Lemanne D, Cassileth B, Gubili J. The role of physical activity in cancer prevention, treatment, recovery, and survivorship. Oncology (Williston Park) 2013; 27:580.
- Dietz JH Jr. Rehabilitation of the cancer patient. Med Clin North Am 1969; 53:607.
- Silver JK, Baima J. Cancer prehabilitation: an opportunity to decrease treatment-related morbidity, increase cancer treatment options, and improve physical and psychological health outcomes. Am J Phys Med Rehabil 2013; 92:715.
- DeSantis CE, Lin CC, Mariotto AB, et al. Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin 2014; 64:252.
- Hayes SC, Johansson K, Stout NL, et al. Upper-body morbidity after breast cancer: incidence and evidence for evaluation, prevention, and management within a prospective surveillance model of care. Cancer 2012; 118:2237.
- Ebaugh D, Spinelli B, Schmitz KH. Shoulder impairments and their association with symptomatic rotator cuff disease in breast cancer survivors. Med Hypotheses 2011; 77:481.
- Cheville AL, Tchou J. Barriers to rehabilitation following surgery for primary breast cancer. J Surg Oncol 2007; 95:409.
- Kilbreath SL, Refshauge KM, Beith JM, et al. Upper limb progressive resistance training and stretching exercises following surgery for early breast cancer: a randomized controlled trial. Breast Cancer Res Treat 2012; 133:667.
- Beurskens CH, van Uden CJ, Strobbe LJ, et al. The efficacy of physiotherapy upon shoulder function following axillary dissection in breast cancer, a randomized controlled study. BMC Cancer 2007; 7:166.
- Scaffidi M, Vulpiani MC, Vetrano M, et al. Early rehabilitation reduces the onset of complications in the upper limb following breast cancer surgery. Eur J Phys Rehabil Med 2012; 48:601.
- Torres Lacomba M, Mayoral Del Moral O, Coperias Zazo JL, et al. Axillary web syndrome after axillary dissection in breast cancer: a prospective study. Breast Cancer Res Treat 2009; 117:625.
- Alves Nogueira Fabro E, Bergmann A, do Amaral E Silva B, et al. Post-mastectomy pain syndrome: incidence and risks. Breast 2012; 21:321.
- Layeeque R, Hochberg J, Siegel E, et al. Botulinum toxin infiltration for pain control after mastectomy and expander reconstruction. Ann Surg 2004; 240:608.
- Burstein HJ, Winer EP. Aromatase inhibitors and arthralgias: a new frontier in symptom management for breast cancer survivors. J Clin Oncol 2007; 25:3797.
- Thorne C. Management of arthralgias associated with aromatase inhibitor therapy. Curr Oncol 2007; 14 Suppl 1:S11.
- Gaillard S, Stearns V. Aromatase inhibitor-associated bone and musculoskeletal effects: new evidence defining etiology and strategies for management. Breast Cancer Res 2011; 13:205.
- Greenlee H, Crew KD, Shao T, et al. Phase II study of glucosamine with chondroitin on aromatase inhibitor-associated joint symptoms in women with breast cancer. Support Care Cancer 2013; 21:1077.
- Crew KD, Capodice JL, Greenlee H, et al. Randomized, blinded, sham-controlled trial of acupuncture for the management of aromatase inhibitor-associated joint symptoms in women with early-stage breast cancer. J Clin Oncol 2010; 28:1154.
- Irwin ML, Cartmel B, Gross C, et al. Randomized trial of exercise vs usual care on aromatase inhibitor-associated arthralgias in women with breast cancer. The hormones and physical exercise study. San Antonio Breast Cancer Symposium 2013. Abstract S3-03.
- Tsai HJ, Hung HC, Yang JL, et al. Could Kinesio tape replace the bandage in decongestive lymphatic therapy for breast-cancer-related lymphedema? A pilot study. Support Care Cancer 2009; 17:1353.
- Białoszewski D, Woźniak W, Zarek S. Clinical efficacy of kinesiology taping in reducing edema of the lower limbs in patients treated with the ilizarov method--preliminary report. Ortop Traumatol Rehabil 2009; 11:46.
- Hershman DL, Lacchetti C, Dworkin RH, et al. Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol 2014; 32:1941.
- Kelley MJ, Kane TE, Leggin BG. Spinal accessory nerve palsy: associated signs and symptoms. J Orthop Sports Phys Ther 2008; 38:78.
- Baldwin ER, Baldwin TD, Lancaster JS, et al. Neuromuscular electrical stimulation and exercise for reducing trapezius muscle dysfunction in survivors of head and neck cancer: a case-series report. Physiother Can 2012; 64:317.
- Kizilay A, Kalcioglu MT, Saydam L, Ersoy Y. A new shoulder orthosis for paralysis of the trapezius muscle after radical neck dissection: a preliminary report. Eur Arch Otorhinolaryngol 2006; 263:477.
- Van Daele DJ, Finnegan EM, Rodnitzky RL, et al. Head and neck muscle spasm after radiotherapy: management with botulinum toxin A injection. Arch Otolaryngol Head Neck Surg 2002; 128:956.
- Stubblefield MD, Levine A, Custodio CM, Fitzpatrick T. The role of botulinum toxin type A in the radiation fibrosis syndrome: a preliminary report. Arch Phys Med Rehabil 2008; 89:417.
- Pfister DG, Cassileth BR, Deng GE, et al. Acupuncture for pain and dysfunction after neck dissection: results of a randomized controlled trial. J Clin Oncol 2010; 28:2565.
- Scott B, D'Souza J, Perinparajah N, et al. Longitudinal evaluation of restricted mouth opening (trismus) in patients following primary surgery for oral and oropharyngeal squamous cell carcinoma. Br J Oral Maxillofac Surg 2011; 49:106.
- Dijkstra PU, Sterken MW, Pater R, et al. Exercise therapy for trismus in head and neck cancer. Oral Oncol 2007; 43:389.
- Tang Y, Shen Q, Wang Y, et al. A randomized prospective study of rehabilitation therapy in the treatment of radiation-induced dysphagia and trismus. Strahlenther Onkol 2011; 187:39.
- Kamstra JI, Roodenburg JL, Beurskens CH, et al. TheraBite exercises to treat trismus secondary to head and neck cancer. Support Care Cancer 2013; 21:951.
- Shulman DH, Shipman B, Willis FB. Treating trismus with dynamic splinting: a cohort, case series. Adv Ther 2008; 25:9.
- Stubblefield MD, Manfield L, Riedel ER. A preliminary report on the efficacy of a dynamic jaw opening device (dynasplint trismus system) as part of the multimodal treatment of trismus in patients with head and neck cancer. Arch Phys Med Rehabil 2010; 91:1278.
- Hartl DM, Cohen M, Juliéron M, et al. Botulinum toxin for radiation-induced facial pain and trismus. Otolaryngol Head Neck Surg 2008; 138:459.
- Benton A. Hemispheric dominance before Broca. Neuropsychologia 1984; 22:807.
- Veramonti TL, Meyers CA. Cognitive dysfunction in the cancer patient. In: Cancer Rehabilitation: Principles and Practice, 1st, Stubblefield MD, O'Dell M. (Eds), Demos Medical Publishing, 2009. p.992.
- Devine JM, Zafonte RD. Physical exercise and cognitive recovery in acquired brain injury: a review of the literature. PM R 2009; 1:560.
- Medical Inpatient Rehabilitation Criteria Task Force (JL Melvin, Chairman). Standards for assessing medical appropriateness criteria for admitting patients to rehabilitation hospitals or units. http://www.aapmr.org/advocacy/health-policy/medical-necessity/Documents/MIRC0211.pdf (Accessed on May 05, 2014).
- MODELS OF REHABILITATION
- Role of the physiatrist
- SPECIFIC IMPAIRMENTS
- Upper extremity pain
- - Shoulder dysfunction
- - Axillary web syndrome
- Postmastectomy pain syndrome
- Aromatase inhibitor-associated musculoskeletal syndrome
- Spinal accessory nerve palsy
- Dropped head syndrome
- Speech and swallowing dysfunction
- Cognitive dysfunction
- ACCESSING REHABILITATION SERVICES
- Criteria for rehabilitation in various settings
- SUMMARY AND RECOMMENDATIONS