Check cancer survivors for emotional and physical problems

Cancer survivors should be screened for psychological and physical impairments and then referred as appropriate to trained rehabilitation professionals, urged a team of physical medicine and rehabilitation specialists in a recent review of the topic.

According to Julie K. Silver, MD, of the Department of Physical Medicine and Rehabilitation at Harvard Medical School in Boston, Massachusetts, and colleagues, identifying and addressing treatment-induced physical impairments that can lead to considerable disability is an important component of the cancer care provided by oncology nurses and other practitioners. They also noted in their review, published by CA: A Cancer Journal for Clinicians, that physical disability is a leading cause, “or perhaps even the leading cause,” of emotional distress in survivors of cancer.

Yet evidence suggests that patients have many unmet needs, pointed out the researchers. In one study they cited in their review, for example, cancer survivors reported a much worse health-related quality of life for both physical and emotional health compared with population norms. Data show that poor physical health is reported by one in 10 persons without cancer, but by one in four cancer survivors.

However, affirmed Silver's group, the scientific literature demonstrates that rehabilitation improves pain, function, and quality of life in cancer survivors. Furthermore, rehabilitation efforts can relieve physical (including cognitive) impairments at every stage along the course of treatment. This includes engaging in “prehabilitation” before the initiation of cancer treatment as well as multimodal and interdisciplinary rehabilitation during and after acute treatment.

Silver and associates contended that the field of cancer rehabilitation needs to be better understood and clarified, including in areas related to the selection of appropriate screening for impairments and subsequent disability, and the identification of professionals who are qualified to address the rehabilitation needs of affected patients.

“As impairment-driven cancer rehabilitation can significantly improve physical and psychological health outcomes in survivors as well as reduce direct and indirect health care costs, future research efforts should be focused on building on the current evidence in order to provide quality integration of this care into oncology clinical practice,” advised the investigators.
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