Post on 10-Dec-2021
Cancer rehabilitation is defined as “medical care that should be integratedthroughout the oncology care continuum and delivered by trainedrehabilitation professionals who have it within their scope of practice todiagnose and treat patients’ physical, psychological and cognitiveimpairments in an effort to maintain or restore function, reduce symptomburden, maximize independence and improve quality of life in thismedically complex population.”
What is CancerRehabilitation?
Cancer rehabilitation, similar to stroke and orthopedic rehabilitation,utilizes a multidisciplinary approach to assessment and treatment thathelps to:
•Address disease-related and treatment-related impairments;
•Decrease the number and/or severity of impairments and long-termproblems;
•Minimize survivors’ distress and disability.
What is CancerRehabilitation?
Focus on screening for physical impairments (from mild
to severe) as they need to be identified and treated to
improve survivors' physical and psychological outcomes
refer cancer survivors who have problems amenable to
rehabilitation interventions to the appropriate health
care professionals who have the expertise to evaluate
and treat their physical impairments and maximize
functional status
What is CancerRehabilitation?
Specific Physical Impairments•Autonomic dysfunction
•Back pain
•Balance dysfunction
•Bowel dysfunction
•Cervical range of motion limitations
•Chemotherapy-induced peripheral
neuropathy
•Chest/thoracic pain
•Cognitive impairment
•Compression neuropathy
•Dystonia
•Gait dysfunction
•Graft-versus-host disease
•Headaches
•History of falls
•Jaw excursion, limited
•Joint pain, localized
•Joint range of motion limitations
•Lumbosacral plexopathy
•Lymphedema•Muscular asymmetry
•Neck pain
•Osteopenia/osteoporosis
•Paralysis
•Plexopathy
•Radiation fibrosis syndrome
•Radiculopathy
•Scapular winging
•Scar adhesions
•Sensory deficits
•Sexual dysfunction
•Shoulder pain
•Speech impairment
•Swallowing impairment
•Trismus
•Urinary dysfunction
•Visuospatial and/or proprioception dysfunction
General Physical Impairments
•Difficulty returning to premorbid activities
•Joint pain, diffuse (e.g., arthralgias)
•Musculoskeletal pain (e.g., myalgias)
•Neuropathic pain
•Somatic pain
•Visceral pain
•Weakness
•Fatigue•Deconditioning
Common Impairments Treated
Functional Disabilities
•Inability to return to work
•Difficulty caring for children/grandchildren
•Limited mobility due to safety concerns (walking, driving,
etc.)
•Inability to travel and take vacations
•Difficulty with ADLs (e.g., dressing, bathing)•Difficulty with IADLs (e.g., chores, shopping)
Common Impairments Treated
Pain
Fatigue
Neurologic Impairments
Bony Metastases
Soft-Tissue Impairments Associated With Cancer Diagnoses
Identifying Physical Impairments in Patients With Cancer
“process on the cancer continuum of care that occurs
between the time of cancer diagnosis and the beginning of
acute treatment and includes physical and psychological
assessments that establish a baseline functional level,
identify impairments, and provide interventions that
promote physical and psychological health to reduce the
incidence and/or severity of future impairments.”
What is Cancer Prehabilitation?
Prehabilitation is medical care that may help
newly diagnosed cancer survivors prepare for
upcoming treatments and either prevent or reduce
the likelihood of long-term problems.
Prehab focuses on effort to reduce physical
impairments, functional disability, pain and
emotional distress. This, in turn, may reduce direct
and indirect healthcare costs and ultimatelyimprove health-related quality of life.
What is Cancer Prehabilitation?
Examples of Prehabilitation Goals
▪ Improve cardiovascular, pulmonary, and/or musculoskeletal function.
▪ Improve balance and reduce the risk of falls.
▪ Reduce anxiety and improve coping with specific cognitive behavioral
strategies.
▪ Improve quality of sleep with sleep hygiene education.
▪ Optimize surgical outcomes with smoking cessation interventions.
▪ Optimize diet with nutrition counseling.
▪ Begin preoperative pelvic floor muscle strengthening to improve
continence outcomes.
▪ Begin pretreatment swallowing exercises to improve swallowing
outcomes.
▪ Implement home safety strategies to avoid falls.
▪ Facilitate return to work with adaptive equipment.
Improving the Oncology-Rehabilitation Interface
▪ Include trained rehabilitation professionals in the formal cancer care programming,
▪ Educate all staff involved in the care of oncology patients about impairment-driven cancer
rehabilitation care.
▪ Establish a multidisciplinary cancer rehabilitation program/service line
▪ Use screening tools to identify impairments.
▪ Identify screening opportunities and integrate with appropriate on-site and/or local referral
resources.
▪ Require documentation of the navigation process, including cancer rehabilitation referrals.
▪ Track patient functional outcomes across the continuum of care beginning with a baseline
assessment.
▪ Include reassessments to identify new or ongoing rehabilitation needs.
▪ Include the patient as a partner in his/her rehabilitation care.