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
- Director of Cancer Research
- Department of Population Medicine
- Associate Professor
- 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:
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- 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