Eric Wisotzky, MD
Associate Member, Georgetown Lombardi Comprehensive Cancer Center
Director, Cancer Rehabilitation, MedStar National Rehabilitation Network
Assistant Professor, Rehabilitation Medicine
Georgetown University School of Medicine
Imagine your breast cancer patient, Mrs Robinson, after cancer treatment. She has been through surgery, chemotherapy, and radiation. She is now fatigued, deconditioned, with impaired shoulder range of motion, and impaired balance from neuropathy. She is unable to get back to her job working in retail as she is too tired, can’t reach up to take things off a high shelf, and she is worried about falling.
Now imagine that same patient who has had a rehabilitation specialist as part of her treatment team from day one. She has been engaging in exercise throughout her treatment process. For this reason, she has minimal fatigue. She has been doing range of motion and strengthening exercises for her shoulder, so she has no problems reaching overhead. In addition, she has been strengthening her legs and engaging in a balance rehabilitation program, so she is not at risk for falls. The major functional sequalae of her cancer treatments have been averted through a proactive rehabilitation program.
Cancer rehabilitation has been defined as, “medical care that should be integrated throughout the oncology care continuum and delivered by trained rehabilitation professionals who have it within their scope of practice to diagnose and treat patients’ physical, psychological, and cognitive impairments in an effort to maintain or restore function, reduce symptom burden, maximize independence, and improve quality of life in this medically complex population.”1
The key points in this definition are that this is medical care that cancer patients should expect and that it should be delivered by trained rehabilitation professionals: physiatrists, physical therapists, occupational therapists, or speech language pathologists.
What sets trained rehabilitation professionals apart from trainers is the length and scope of training. Trainers (available at most gyms) typically gain their certification in less than a year (often online), while rehabilitation professionals often have four or more years of training and have expertise in diagnosing and treating physical impairments. Rehabilitation professionals will also have a stronger understanding of complex medical issues cancer patients face.
So why do cancer patients need rehabilitation? It has been demonstrated that cancer survivors have poor physical health-related quality of life compared with age-matched controls.2
Given that physical performance and activity levels correlate with physical quality of life in cancer survivors,3
it should seem obvious that rehabilitation should be incorporated into the cancer treatment continuum to preserve and restore function and quality of life.
Another critical point regards distress. Distress has become a required symptom to be tracked for cancer center accreditation. While distress is often intuitively linked with psychological factors, most are unaware that distress is most strongly linked with physical function. One study showed that physical disability was the number one source of distress in cancer survivors. 4
It is clear that cancer centers must screen for and treat physical disability and distress as well.
To further support the concept that rehabilitation is critical to cancer care, consider a few studies that demonstrate that rehabilitation interventions may in fact enhance cancer treatment outcomes. A recent systematic review reported six studies demonstrating a 41% to 51% decreased risk of breast cancer mortality associated with physical activity.5
Another example is a recent study demonstrating that late-stage gastrointestinal cancer patients undergoing chemotherapy and radiation were more likely to complete treatment and had fewer hospitalizations if given a rehabilitation program including exercise and relaxation techniques.6