Background
Cancer rehabilitation is the process through which individuals diagnosed with cancer regain their physical, emotional, and social well-being following cancer treatments. These treatments, which may include chemotherapy, radiation, surgery, or a combination of these, often leave behind lasting or permanent side effects. Rehabilitation is designed to help individuals recover function, regain independence, and improve their quality of life. Many cancer treatments, while effective in combating the disease, can cause long-term changes in the body, requiring patients to engage in various forms of rehabilitation to address these effects. By focusing on rehabilitation, cancer survivors can regain strength, alleviate discomfort, and improve their overall ability to function in their life.
Nutritional Support
For cancer survivors, proper nutrition is crucial for recovery and maintaining overall health. Dietitians play an important role in managing weight fluctuations, maintaining nutritional balance, and addressing any digestive issues resulting from cancer treatments. Many cancer treatments can alter appetite, digestion, and nutrient absorption, making it difficult for patients to maintain a healthy weight or get the right nutrition. Rehabilitation that includes nutritional support can help prevent malnutrition, promote healing, and improve energy levels, making it an essential component of the recovery process.
Social and Vocational Support
The post-treatment phase of cancer recovery can be emotionally and socially challenging. Many survivors face difficulties in adjusting to life after treatment, especially if they need help returning to their normal activities or re-entering the workforce. Social workers, vocational counsellors, and support groups can offer invaluable resources and guidance to help survivors navigate these challenges. Rehabilitation services can help individuals reconnect with their social networks, find emotional support, and successfully transition back into work or other aspects of their lives. These services are customized to meet the individual needs, depending on the type of cancer, the treatments received, and the specific challenges that the patient faces. Cancer rehabilitation is an essential part of survivorship care that can significantly increase the survivor’s overall recovery and well-being.
Breast Cancer and Rehabilitation
Breast cancer rehabilitation focuses on the multidisciplinary approach that helps survivors regain strength, mobility, and emotional health after treatment. It addresses the physical and psychological effects of treatment, providing support for both the recovery of function and emotional well-being. A breast cancer rehabilitation program may help patients manage the side effects of treatments, including surgery, chemotherapy, and radiation therapy, and can improve their overall function in daily life.
Clinical History
Clinical Trials: Clinical trials are often available to explore new treatment options that may be beneficial for some patients.
Bone-Directed Therapy: In cases where the cancer spreads to the bones, treatments like bisphosphonates or denosumab help manage bone-related complications.
Systemic Effects of Cancer-Related Deconditioning
Cancer treatments can result in deconditioning, which refers to the physical decline caused by prolonged inactivity during treatment. Different systems in the body can be affected, and rehabilitation is crucial in addressing these systemic effects.
Musculoskeletal System: Muscle weakness, bone density loss, and joint stiffness are common due to inactivity, treatment side effects, or surgeries like mastectomy or lymph node removal.
Cardiovascular System: Lack of physical activity and chemotherapy drugs like anthracyclines can reduce cardiovascular fitness and increase fatigue, making it difficult to perform daily tasks.
Respiratory System: Prolonged bed rest and inactivity can reduce lung capacity and lead to respiratory infections.
Endocrine System: Treatments like chemotherapy and hormone therapy can disrupt hormonal balance, affecting metabolism and energy levels.
Neurological System: Fatigue and neuropathy from treatments can affect cognitive function, including concentration and memory.
Immune System: Physical inactivity, along with stress and poor nutrition, can weaken the immune system, increasing the risk of infections.
Psychological Effects: Depression, anxiety, and reduced motivation for physical activity can result from the loss of independence or ongoing fatigue.
Rehabilitation for Head and Neck Cancer
Rehabilitation plays an important role in helping individuals recover from head and neck cancer treatment. These cancers often affect critical functions like speech, swallowing, and breathing. Rehabilitation focuses on restoring as much of these functions as possible and addressing any physical and emotional challenges that arise.
Speech and Swallowing Therapy: After treatment, many patients experience hoarseness, difficulty articulating words, or difficulty swallowing. Speech-language pathologists work with patients to improve speech clarity and swallowing techniques to avoid aspiration.
Physical Therapy: Physical therapists can help with neck mobility, pain management, and improving flexibility after surgery or radiation, as well as managing lymphedema.
Nutritional Support: A dietitian can develop a personalized eating plan to manage difficulties such as dry mouth or pain while eating and may recommend soft foods or feeding tubes if necessary.
Rehabilitation for Musculoskeletal Cancer Survivors
Musculoskeletal cancers, such as osteosarcoma, Ewing’s sarcoma, and chondrosarcoma, are rare but complex to treat due to their location in the bones, muscles, and soft tissues. Treatment often involves surgery, chemotherapy, and radiation, and rehabilitation is essential to help restore function and independence.
Physical Therapy: A crucial part of rehabilitation is physical therapy which helps with pain management, restoring function, improving strength, and enhancing joint mobility.
Psychosocial Support: Counselling, support groups, and cognitive therapy help individuals cope with emotional and psychological challenges during recovery.
Lymphedema Therapy: Specialized therapy can help manage swelling in limbs after surgery or radiation involving lymph nodes.
Rehabilitation in Cancer Syndromes
For patients with cancer syndromes such as Li-Fraumeni Syndrome, which predisposes individuals to multiple cancers, musculoskeletal manifestations like scoliosis or joint issues can complicate recovery. Rehabilitation professionals, including physical and occupational therapists, work to address these challenges. The main rehabilitation goals include improving strength and mobility, managing pain, and providing psychological support to help patients cope with the emotional effects of their condition and treatment.
Rehabilitation of Primary and Secondary CNS and PNS Tumors
For patients with tumors in the central nervous system (CNS) or peripheral nervous system (PNS), rehabilitation is a critical component of their recovery. Depending on the tumor’s location and the treatments involved, rehabilitation can focus on improving motor skills, balance, coordination, cognitive function, and speech.
Physical Rehabilitation: Physical therapy helps patients regain strength, improve mobility, and address balance or coordination issues.
Cognitive Rehabilitation: Memory exercises and compensatory strategies help patients with cognitive deficits due to brain tumors.
Speech and Swallowing Therapy: This is crucial for patients with tumors affecting areas controlling speech and swallowing, focusing on rehabilitation techniques to ensure safe swallowing and improved communication.
Psychosocial Support: Counseling and support groups provide emotional support to patients and families coping with the challenges of cancer treatment and recovery.
Treatment Paradigm
Treatment Approaches
Breast cancer treatment typically involves surgery, radiation, chemotherapy, and hormone therapy.
Surgery: There are several types of surgeries for breast cancer, such as lumpectomy, where only the tumor and some surrounding tissues are removed, or mastectomy, which involves the removal of part or all of the breast. Sentinel node biopsy is another procedure in which underarm lymph nodes are removed if cancer cells are suspected to have spread.
Radiation Therapy: Radiation uses high-energy rays to destroy any remaining cancer cells after surgery, particularly when the tumor was large or spread to lymph nodes.
Chemotherapy: This treatment can be adjuvant (given after surgery) to eliminate any remaining cancer cells or neoadjuvant (given before surgery) to shrink the tumor.
Hormone Therapy: For hormone receptor-positive breast cancers, medications like tamoxifen or aromatase inhibitors block hormones such as estrogen or progesterone, which may fuel the growth of cancer cells.
Targeted Therapy: Drugs such as Herceptin (trastuzumab) specifically target cancer cells without affecting healthy cells.
Immunotherapy: This boosts the body’s immune system to fight cancer and may be used for some cancers like triple-negative breast cancer.
