Building a bridge between oncology and physical therapy

The power of physical therapy to improve the health and well-being of patients who have undergone treatment for cancer is practically undisputed. Cancer treatments take a toll on a patient's body in addition to the disease itself, so the eradication of cancer is not always the final step in a patient's recovery. Laurie Sweet, a clinical resource analyst at The Johns Hopkins Cancer Rehabilitation Program in East Baltimore, Maryland, describes physical therapy as the Yin to cancer's Yang, and just as much a part of a cure for the disease as chemotherapy, radiation, or surgery (Table 1).

Table 1. Common conditions treated with physical therapy

Decline in balance
Difficulty with walking
Joint stiffness
Numbness in feet or hands
Poor endurance
Postural changes
Scar tissue restriction

Source: Cancer rehabilitation. Johns Hopkins Medicine Web site. Accessed November 1, 2013.

“Reducing pain and returning a patient, as closely as possible, to their original physical baseline is what postcancer physical therapy is all about. It's part of treatment,” Sweet says.

Still, less-than-adequate communication between physical therapy departments and oncology staff leave many patients without enough guidance to properly continue their recovery after the treatment phase. A more formal patient hand-off between oncology and physical therapy would improve and quicken patient recovery and health-related quality of life, said Brandon Wigglesworch, supervisor of the physical therapy department at the University of California San Francisco.

“Many cancer survivors come to us from out of the cold, with no doctor referral,” Wigglesworch told Oncology Nurse Advisor. “They were never told by their oncologist to expect [physical therapy]. But the truth is that every cancer survivor requires some form of physical therapy.” Regardless of whether the patient underwent a biopsy or a mastectomy, lost movement must be regained. If the condition was brain cancer, the concern focuses on motor skills. The challenge may be to relearn how to move your fingers or touch your face. 


In a study in which 202 people undergoing outpatient cancer treatment responded to a 27-item questionnaire, 65.8% reported experiencing functional problems and nearly a quarter (23.9%) reported having trouble walking. However, only two of the 202 participants were given referrals to physical therapy, and those were for pain and limb swelling. None of the patients' functional problems were formerly addressed.1

A study on the prevalence and treatment patterns of physical impairments in patients with metastatic breast cancer found that 92% of patients (150 of 163) reported one or more physical impairments. Although 88% of the identified impairments required physical therapy, only 21% of those requiring physical therapy received treatment.2 The authors of these studies conclude that functional problems are prevalent among outpatients with cancer and are rarely documented by oncology clinicians.1,2


Teresa L. was never told by any of her oncologists to prepare for and commit to physical therapy. Stage 3 Hodgkin lymphoma was diagnosed in the 59-year-old New Yorker in 1995, and after undergoing standard MOPP chemotherapy and radiation treatments, Teresa's lymphoma went into remission. In 2007, she developed breast cancer. Her doctors believe the breast cancer was a side effect of the lymphoma treatment. Following a bilateral mastectomy, she experienced radiation fibrosis, which tightened her skin, and cardiovascular issues. Severe neuropathy in her knees led to several broken bones in her feet.

“There was never any doctor there saying to me ‘you need to watch out for this after treatment, you need to go to physical therapy,'” recalls Teresa. “It was just ‘goodbye' from the hospital staff and that was it.” She sought treatment from physical therapists unfamiliar with what she had endured as a cancer patient. Still coping with the emotions of her cancer survival, Teresa experienced guilt for complaining about pain after surviving cancer. “I didn't want to complain,” she said. “It would have been tremendously advantageous to be told during my cancer treatment that I would require [physical therapy] afterwards. I wouldn't have thought I was crazy or a malingerer.”

Sweet told Oncology Nurse Advisor that everyone along the chain of care for patients with cancer shares some part of the responsibility of ensuring that proper physical therapy is a part of the patient's cancer treatment. “It's sort of all our responsibility to know what the patient's goals are and where physical therapy comes in,” said Sweet. “There are so many people involved—the primary oncologist, the radiation oncologist, nurses, etc.—and everyone needs to watch for the red flags: Can a patient return to their precancer baseline? Is surgical intervention being used to treat the cancer?” 

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