Cancer rehabilitation

Last updated

Cancer rehabilitation has been defined in the scientific literature as a distinct field of medicine [1] that focuses on reducing or eliminating side-effects of cancer treatment and improving survivors' strength, ability to function and quality of life

Contents

This field is a subspecialty of Physical Medicine and Rehabilitation (PM&R), also known as physiatry and/or rehabilitation medicine.

Scope of the specialty

Cancer rehabilitation providers focus on improving each patient's functional status. Using an interdisciplinary model of care, professionals identify patients’ goals, improve their function, develop a patient and family centered plan of care that accounts for medical, physical, psychological and social components. The aim is helping patients improve their cancer-related symptoms and treatment side effects, while promoting optimal patient function at home, work and in the community. [1] Additionally, cancer rehabilitation physicians work on identifying musculoskeletal and neurologic problems and treat them with a variety of treatments including medications, procedures and therapy. Some of those procedures include, but are not limited to, various types of injections and other procedures. Therapeutic exercises include those guided by physical, occupational and speech therapists to work on specific motor or cognitive impairments as well as difficulties performing activities of daily living (ADLs) (dressing, bathing, toileting etc.) and instrumental activities of daily living (IADLs) such as house cleaning, shopping, etc. [2] However, patient-driven general exercise to maintain or improve endurance and overall functional status is also an important component of the rehabilitation process. Because cancer patients’ problems typically are complex and survivors have a high likelihood of developing physical, mental and functional issues, rehabilitation experts have recommended that cancer rehabilitation be integrated in oncology care early on. [3] Several clinical articles have highlighted the effectiveness of rehabilitation interventions before, during, and after cancer treatment to screen for, assess, and treat patients’ functional needs. [2]

Practice

Cancer Rehabilitation Team

Physicians that specialize in PM&R are usually called physiatrists (or rehabilitation medicine physicians). These doctors lead interdisciplinary teams, and they are specialists in the non-surgical treatment of musculoskeletal problems and rehabilitation medicine. Physiatrists should ideally be a part of the cancer care team as they perform diagnostic evaluations, provide unique expertise in prescribing medications, perform injections and prescribe appropriate splints and other devices to treat non-cancerous conditions that are a result of cancer treatments or the cancer itself. [3] [4] Other potential members of the cancer rehabilitation team include, but are not limited to, physical and occupational therapists, speech language pathologists, nurses, exercise physiologists, oncology social workers, case managers and psychologists.

Patient Assessment

The cancer rehabilitation team evaluates and treats patients for various orthopedic, neurological and medical conditions caused by cancer or cancer-directed treatment (e.g. chemotherapy) that can significantly affect survivors’ function and quality of life. These are some of the areas that the cancer rehabilitation team may focus on: [5]

Cancer Rehabilitation Clinical Models

Hospital Care

Hospital-based cancer rehabilitation is provided in inpatient rehabilitation facilities, skilled nursing facilities, long-term care hospitals and hospice facilities. Cancer patients undergo a formal functional assessment to identify impairments with the aim of providing comprehensive therapy and medical care to improve their overall functional status. During this care, a variety of services are offered including, but not limited to: physical therapy, occupational therapy, speech therapy, nutrition, psychology and nursing. [6]

Home Care

In these programs, patients receive services directly at home to provide help with symptom management, wound care, vital signs monitoring and medication management. These are typically nurse-driven programs, however, they could also be driven by therapists when the focus is function. In those cases, the home services are directed to provide patients with home therapists to undergo home driven physical, occupational or speech therapy programs. [6]

Outpatient care

These programs promote identification and management of treatment toxicities that affect function in an outpatient setting. They offer a variety of services to address physical and emotional needs of patients. Some of these services are provided by physicians, nurses, psychologists and therapists. However, these programs could be very different from one institution to another. [6]

Prehabilitation

Cancer prehabilitation refers to the assessments and interventions that are conducted just after diagnosis but before cancer treatment begins. A panel of experts has highlighted the importance of establishing rehabilitation services prior to the oncological treatment to optimize tolerance to surgery or adjuvant treatments, minimize toxicity and improve outcomes. Recent clinical studies have shown that cancer prehabilitation and rehabilitation can increase function and may improve outcomes and disability rates. [7] For example, a 2020 study looking at men awaiting surgery for urological cancer showed that high-intensity interval training (HIIT) may improve heart and lung fitness within a month before their surgery. [8] [9]

Related Research Articles

Hemiparesis, or unilateral paresis, is weakness of one entire side of the body. Hemiplegia is, in its most severe form, complete paralysis of half of the body. Hemiparesis and hemiplegia can be caused by different medical conditions, including congenital causes, trauma, tumors, or stroke.

<span class="mw-page-title-main">Physical therapy</span> Profession that helps a disabled person function in everyday life

Physical therapy (PT), also known as physiotherapy, is a healthcare profession, as well as the care provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, management, prognosis, patient education, physical intervention, rehabilitation, disease prevention, and health promotion. Physical therapist is the term used for such professionals in the United States, and physiotherapist is the term used in many other countries.

Occupational therapists (OTs) are health care professionals specializing in occupational therapy and occupational science. OTs and occupational therapy assistants (OTAs) use scientific bases and a holistic perspective to promote a person's ability to fulfill their daily routines and roles. OTs have training in the physical, psychological, and social aspects of human functioning deriving from an education grounded in anatomical and physiological concepts, and psychological perspectives. They enable individuals across the lifespan by optimizing their abilities to perform activities that are meaningful to them ("occupations"). Human occupations include activities of daily living, work/vocation, play, education, leisure, rest and sleep, and social participation.

<span class="mw-page-title-main">Occupational therapy</span> Healthcare profession

Occupational therapy (OT) is a healthcare profession that involves the use of assessment and intervention to develop, recover, or maintain the meaningful activities, or occupations, of individuals, groups, or communities. The field of OT consists of health care practitioners trained and educated to improve mental and physical performance. Occupational therapists specialize in teaching, educating, and supporting participation in any activity that occupies an individual's time. It is an independent health profession sometimes categorized as an allied health profession and consists of occupational therapists (OTs) and occupational therapy assistants (OTAs). While OTs and OTAs have different roles, they both work with people who want to improve their mental and or physical health, disabilities, injuries, or impairments.

<span class="mw-page-title-main">Pain management</span> Interdisciplinary approach for easing pain

Pain management is an aspect of medicine and health care involving relief of pain in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professionals provide some pain control in the normal course of their practice, and for the more complex instances of pain, they also call on additional help from a specific medical specialty devoted to pain, which is called pain medicine.

<span class="mw-page-title-main">Geriatrics</span> Specialty that focuses on health care of elderly people

Geriatrics, or geriatric medicine, is a medical specialty focused on providing care for the unique health needs of the elderly. The term geriatrics originates from the Greek γέρων geron meaning "old man", and ιατρός iatros meaning "healer". It aims to promote health by preventing, diagnosing and treating disease in older adults. There is no defined age at which patients may be under the care of a geriatrician, or geriatric physician, a physician who specializes in the care of older people. Rather, this decision is guided by individual patient need and the caregiving structures available to them. This care may benefit those who are managing multiple chronic conditions or experiencing significant age-related complications that threaten quality of daily life. Geriatric care may be indicated if caregiving responsibilities become increasingly stressful or medically complex for family and caregivers to manage independently.

The primary goals of stroke management are to reduce brain injury and promote maximum patient recovery. Rapid detection and appropriate emergency medical care are essential for optimizing health outcomes. When available, patients are admitted to an acute stroke unit for treatment. These units specialize in providing medical and surgical care aimed at stabilizing the patient's medical status. Standardized assessments are also performed to aid in the development of an appropriate care plan. Current research suggests that stroke units may be effective in reducing in-hospital fatality rates and the length of hospital stays.

The Bobath concept is an approach to neurological rehabilitation that is applied in patient assessment and treatment. The goal of applying the Bobath concept is to promote motor learning for efficient motor control in various environments, thereby improving participation and function. This is done through specific patient handling skills to guide patients through the initiation and completing of intended tasks. This approach to neurological rehabilitation is multidisciplinary, primarily involving physiotherapists, occupational therapists, and speech and language therapists. In the United States, the Bobath concept is also known as 'neuro-developmental treatment' (NDT).

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease that affects the central nervous system (CNS). Several therapies for it exist, although there is no known cure.

St. Cloud Hospital is a hospital in St. Cloud, Minnesota, United States. It is a Catholic-affiliated, not-for-profit institution and part of CentraCare Health. The hospital has more than 9,000 employees, 400 physicians and 1,200 volunteers. It serves 690,000 people in a 12-county area.

Neurorehabilitation is a complex medical process which aims to aid recovery from a nervous system injury, and to minimize and/or compensate for any functional alterations resulting from it.

Aquatic therapy refers to treatments and exercises performed in water for relaxation, fitness, physical rehabilitation, and other therapeutic benefit. Typically a qualified aquatic therapist gives constant attendance to a person receiving treatment in a heated therapy pool. Aquatic therapy techniques include Ai Chi, Aqua Running, Bad Ragaz Ring Method, Burdenko Method, Halliwick, Watsu, and other aquatic bodywork forms. Therapeutic applications include neurological disorders, spine pain, musculoskeletal pain, postoperative orthopedic rehabilitation, pediatric disabilities, and pressure ulcers.

<span class="mw-page-title-main">Swami Vivekanand National Institute of Rehabilitation Training and Research</span> Medical research institutes in India

Swami Vivekanand National Institute of Rehabilitation Training and Research is an autonomous institute functioning under the Ministry of Social Justice and Empowerment of India. It is located in Olatpur, 30 km from Cuttack.

Preoperative rehabilitation, prehabilitation or prehab, is a form of healthcare intervention that takes place before a medical or surgical intervention with the aim to reduce side effects and complications, and enhance recovery. Multidisciplinary team involvement can range from physiotherapists, occupational therapists, respiratory therapists, doctors, pharmacologists, anesthesiologists, psychologists, psychiatrists and sports physiologists.

<span class="mw-page-title-main">Management of cerebral palsy</span>

Over time, the approach to cerebral palsy management has shifted away from narrow attempts to fix individual physical problems – such as spasticity in a particular limb – to making such treatments part of a larger goal of maximizing the person's independence and community engagement. Much of childhood therapy is aimed at improving gait and walking. Approximately 60% of people with CP are able to walk independently or with aids at adulthood. However, the evidence base for the effectiveness of intervention programs reflecting the philosophy of independence has not yet caught up: effective interventions for body structures and functions have a strong evidence base, but evidence is lacking for effective interventions targeted toward participation, environment, or personal factors. There is also no good evidence to show that an intervention that is effective at the body-specific level will result in an improvement at the activity level, or vice versa. Although such cross-over benefit might happen, not enough high-quality studies have been done to demonstrate it.

This article is about physical therapy in carpal tunnel syndrome.

When treating a person with a spinal cord injury, repairing the damage created by injury is the ultimate goal. By using a variety of treatments, greater improvements are achieved, and, therefore, treatment should not be limited to one method. Furthermore, increasing activity will increase his/her chances of recovery.

Vision rehabilitation is a term for a medical rehabilitation to improve vision or low vision. In other words, it is the process of restoring functional ability and improving quality of life and independence in an individual who has lost visual function through illness or injury. Most visual rehabilitation services are focused on low vision, which is a visual impairment that cannot be fully corrected by regular eyeglasses, contact lenses, medication, or surgery. Low vision interferes with the ability to perform everyday activities. Visual impairment is caused by factors including brain damage, vision loss, and others. Of the vision rehabilitation techniques available, most center on neurological and physical approaches.

<span class="mw-page-title-main">Vestibular rehabilitation</span> Form of physical therapy for vestibular disorders

Vestibular rehabilitation (VR), also known as vestibular rehabilitation therapy (VRT), is a specialized form of physical therapy used to treat vestibular disorders or symptoms, characterized by dizziness, vertigo, and trouble with balance, posture, and vision. These primary symptoms can result in secondary symptoms such as nausea, fatigue, and lack of concentration. All symptoms of vestibular dysfunction can significantly decrease quality of life, introducing mental-emotional issues such as anxiety and depression, and greatly impair an individual, causing them to become more sedentary. Decreased mobility results in weaker muscles, less flexible joints, and worsened stamina, as well as decreased social and occupational activity. Vestibular rehabilitation therapy can be used in conjunction with cognitive behavioral therapy in order to reduce anxiety and depression resulting from an individual's change in lifestyle. However, there’s often confusion about whether vestibular rehabilitation falls under physical therapy (PT) or occupational therapy (OT).

Julie Kathleen Silver is an American medical researcher who is an Associate Professor in the Department of Physical Medicine and Rehabilitation at the Harvard Medical School. Her research considers musculoskeletal disorders and cancer rehabilitation. Silver is involved with several initiatives to improve gender equity in medicine.

References

  1. 1 2 Silver, Julie K. (2014-07-15). "Cancer rehabilitation and prehabilitation may reduce disability and early retirement". Cancer. 120 (14): 2072–2076. doi: 10.1002/cncr.28713 . ISSN   1097-0142. PMID   24752917.
  2. 1 2 Silver, Julie K.; Raj, Vishwa S.; Fu, Jack B.; Wisotzky, Eric M.; Smith, Sean Robinson; Kirch, Rebecca A. (2015-12-01). "Cancer rehabilitation and palliative care: critical components in the delivery of high-quality oncology services". Supportive Care in Cancer. 23 (12): 3633–3643. doi:10.1007/s00520-015-2916-1. ISSN   0941-4355. PMID   26314705. S2CID   8718461.
  3. 1 2 Raj, Vishwa S.; Silver, Julie K.; Pugh, Terrence M.; Fu, Jack B. (2017). "Palliative Care and Physiatry in the Oncology Care Spectrum". Physical Medicine and Rehabilitation Clinics of North America. 28 (1): 35–47. doi:10.1016/j.pmr.2016.08.006. PMID   27912999.
  4. ↑ Silver, Julie K. (2015-02-01). "Cancer Prehabilitation and its Role in Improving Health Outcomes and Reducing Health Care Costs". Seminars in Oncology Nursing. 31 (1): 13–30. doi:10.1016/j.soncn.2014.11.003. ISSN   0749-2081. PMID   25636392.
  5. ↑ Silver, Julie K.; Baima, Jennifer; Mayer, R. Samuel (2013-09-01). "Impairment-driven cancer rehabilitation: An essential component of quality care and survivorship". CA: A Cancer Journal for Clinicians. 63 (5): 295–317. doi: 10.3322/caac.21186 . ISSN   1542-4863. PMID   23856764.
  6. 1 2 3 Stout, Nicole L.; Silver, Julie K.; Raj, Vishwa S.; Rowland, Julia; Gerber, Lynn; Cheville, Andrea; Ness, Kirsten K.; Radomski, Mary; Nitkin, Ralph (2016-11-01). "Toward a National Initiative in Cancer Rehabilitation: Recommendations From a Subject Matter Expert Group". Archives of Physical Medicine and Rehabilitation. 97 (11): 2006–2015. doi:10.1016/j.apmr.2016.05.002. ISSN   0003-9993. PMID   27237580.
  7. ↑ Silver, Julie K.; Baima, Jennifer (2013). "Cancer Prehabilitation". American Journal of Physical Medicine & Rehabilitation. 92 (8): 715–727. doi:10.1097/phm.0b013e31829b4afe. PMID   23756434.
  8. ↑ "High-intensity interval training rapidly improves fitness in patients awaiting surgery for urological cancer". NIHR Evidence (Plain English summary). National Institute for Health and Care Research. 2020-06-05. doi:10.3310/alert_40363. S2CID   242684291.
  9. ↑ Blackwell, J. E. M.; Doleman, B.; Boereboom, C. L; Morton, A.; Williams, S.; Atherton, P.; Smith, K.; Williams, J. P.; Phillips, B. E.; Lund, J. N. (10 March 2020). "High-intensity interval training produces a significant improvement in fitness in less than 31 days before surgery for urological cancer: a randomised control trial". Prostate Cancer and Prostatic Diseases. 23 (4): 696–704. doi:10.1038/s41391-020-0219-1. ISSN   1365-7852. PMC   7655502 . PMID   32157250.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.