Cancer and its treatments are a major cause for impairments and disability. Because cancer treatments have become increasingly successful and have improved survival, there has been an increasing focus on quality of life and, in particular, rehabilitation. Cancer rehabilitation is practiced in outpatient clinics, oncology wards, inpatient rehabilitation units, skilled nursing facilities, nursing homes, long-term acute care centers, palliative care units, and hospices. Common diagnoses addressed include asthenia, deconditioning, hemiplegia, spinal cord injury, peripheral neuropathy, steroid myopathy, lymphedema, bowel/bladder management, limb amputation, and limb dysfunction.
The major goal of cancer rehabilitation is to improve quality of life by minimizing the disability caused by cancer and its treatments and decreasing the "burden of care" needed by cancer patients and their caregivers. The more patients can do for themselves, the more personal dignity they are able to maintain and the less help they require from those around them.
In 1978, Justus Lehmann, supported by the National Cancer Institute (NCI) screened 805 randomly selected cancer patients, identifying multiple problems in the cancer patient population that could be improved by rehabilitation interventions and also multiple barriers limiting the delivery of cancer rehabilitation care (1). More than 20 years later, many of Lehmann's remediable cancer rehabilitation problems as well as barriers to rehabilitation care remain the same (Table 51-1) (1).
Table 51–1. Remediable Rehabilitation Problems and Barriers to Delivery of Rehabilitation Care |Favorite Table|Download (.pdf)
Table 51–1. Remediable Rehabilitation Problems and Barriers to Delivery of Rehabilitation Care
|Remediable Rehabilitation Problems||Barriers to Delivery of Rehabilitation Care|
|Psychological/psychiatric impairments||Lymphedema management||Lack of identification of patient problems|
|Generalized weakness||Musculoskeletal difficulties||Lack of appropriate referral by physicians unfamiliar with the concept of rehabilitation|
|Impairments in activities of daily living||Swallowing dysfunction||Patient too ill to participate|
|Pain||Impaired communication||Patient denies need|
|Impaired gait/ambulation||Skin management||Cancer prognosis too limited|
|Disposition/housing issues||Vocational assessments||Rehabilitation unavailable|
|Neurologic impairments||Impaired nutrition||No financial resources|
|Vocational assessments||Lymphedema management|
In 1980, Dietz categorized cancer rehabilitation into four stages: preventative, restorative, supportive, and palliative (2). Preventative rehabilitation occurs before or immediately after a treatment to prevent loss of function or disability. An example would include preamputation stump care teaching and walker ambulation in a patient with a lower extremity sarcoma. Courneya et al. described a concept called "buffering" where by a cancer patient undergoes exercises and therapies to increase their physical and functional reserves before cancer treatment (3).
Restorative rehabilitation occurs in patients who are believed to be disease free or will have an anticipated relatively stable disease course. A lower extremity sarcoma patient with no known metastatic disease status postamputation undergoing ...