Cancer is the uncontrolled growth of cells, which damages healthy tissue and causes disease. The American Cancer Society differentiates more than 100 types of cancers that manifest in diverse ways throughout the human body. Treatment of cancer can vary from local to systemic and from mildly invasive to radical depending on the type of cancer and the extent of disease.
With nearly 12 million cancer survivors in the United States, cancer rehabilitation is a growing field. The goal of this chapter is to highlight the most common issues in the care of these patients that are pertinent to physiatrists. Physiatrists are experts in restoring function and improving quality of life for patients, making them well trained to address the rehabilitative needs of the growing cancer survivor population. As in other settings for rehabilitation, a multidisciplinary team approach is ideal throughout the diagnosis, treatment, survivorship, and palliative care of patients.
OVERVIEW OF CANCER REHABILITATION
More than 1.6 million new cases of cancer were diagnosed in the United States in 2012. With advancements in health care, people are living longer, and as they age, their risk of developing cancer increases. The greatest incidence of cancer is between the ages of 65 and 74 years. The three most common cancers diagnosed in the United States are those of the prostate, female breast, and lung; these unfortunately also have the highest mortality rates.
Cancer rehabilitation was first documented by Drs Howard Rusk and Eugene Taylor in 1949. Funding for cancer rehabilitation was established in 1965 by the Rehabilitation Act, which provided 75% of cost by federal dollars. In 1973 the National Rehabilitation Act provided protection from discrimination for people with handicaps, now defined as disabilities; this was the precursor to the Americans with Disabilities Act, enacted in 1990. More recently, the requirements for the American College of Surgeons’ Commission on Cancer accreditation state that hospitals and cancer centers must provide rehabilitation services to cancer survivors either at their primary facility or by referral.
Two programs that were in the forefront of cancer rehabilitation in the 1960s have maintained their status as leaders in the field of cancer rehabilitation today. They are the University of Texas MD Anderson Cancer Center and a cooperative program with Drs Howard Rusk and J Herbert Dietz, in New York, that has become Memorial Sloan Kettering Cancer Center. These two centers are the only locations in the United States that offer a fellowship dedicated to training physicians in cancer rehabilitation.
Dietz created the first definition of cancer rehabilitation derived from evidence-based medicine. He also created a classification system for the goals of rehabilitation therapy, differentiating among four phases of care: prevention, restoration, supportive care, and palliative care. Prevention is treatment provided to a patient before development of a potential disability that is expected to lessen the severity of disability or its duration. Restoration ...