ORLANDO, Fla.—Physical therapists diagnose impairments, functional limitations, and participation restrictions in patients with cancer and provide interventions that prevent or ameliorate restrictions or compensate for permanent deficits, explained Shari Berthold, DPT, of Susquehanna Health in Williamsport, Pennsylvania, at the 2nd Annual Oncology Nurse Advisor Navigation Summit.1
A leading cause of emotional distress for cancer survivors is physical disability, and distress is more strongly related to level of disability than to the cancer diagnosis itself. Physical therapy (PT) promotes movement as the foundation for optimizing health. Physical therapy interventions are tailored to an individual patient’s ability and level of function.
Oncology rehabilitation is cost-effective; it lowers both direct and indirect health care costs and improves physical and psychological quality of life for patients with cancer. “Currently, oncology patients have many unmet rehabilitation needs,” stated Berthold.
Clinician-related barriers to rehabilitation include underdiagnosis of impairments, a failure to screen at baseline, reliance on the patient to self-identify impairments, and poor knowledge of evidence-based guidelines (eg, rest for fatigue). A nonexistent or weak interface between oncology and rehabilitation services can lead to omitting rehabilitation from palliative or end-of-life care plans.
Patient-centered barriers to participation in rehabilitation can be related to their cancer (eg, fatigue, nausea, anemia, incontinence), its treatment (eg, immunosuppression, radiotherapy-related skin sensitivities, poor body image, fear of falling), and lack of time due to multiple medical appointments. Nonmedical barriers include a lack of facilities or nearby facilities, the costs of using them, excessive co-pays, and a limited number of allowed visits. Some patients may just be overwhelmed and unsure of how to get started.
Despite the barriers, a simple recommendation from the oncologist to exercise can facilitate participation. Availability of a program supervised by trained health professionals in a hospital is encouraging, especially for those patients who were sedentary previously. Group support and having an exercise partner or role model are also proven to facilitate exercise participation.
Rehabilitation is effective at 3 stages: in the time between diagnosis and initiation of treatment (prehabilitation); during active treatment; and to manage the patient’s disease as a chronic condition after active treatment.
Prehabilitation Intervention between diagnosis and treatment initiation establishes a baseline and anticipates future impairment. It also builds reserve, reduces fear, and establishes a patient-therapist relationship. Prehabilitation is also an opportunity to educate the patient on adverse signs and preventive strategies.
Current evidence supports engaging patients with lung, colorectal, or prostate cancer in physical activity before surgery. Swallowing and prophylactic oral motor exercises can improve outcomes for patients with head and neck cancers. Early physical therapy enhances monitoring and diagnosis of lymphedema.
During active treatment Benefits of rehabilitation during cancer treatment include reduced fatigue, functional gains, improved aerobic capacity, less shortness of breath, improved strength and range of motion, and reduced pain. Psychological and emotional benefits include improved emotional well-being, less anxiety and depression, improved self-efficacy, and improved body image and self-esteem. In addition, body mass index, bone loss, disease recurrence, and secondary diseases, such as heart disease and diabetes, can be reduced with physical therapy.
Rehabilitation during acute care can prevent predicted declines in quality of life. Early mobilization results in fewer complications, less postoperative pain, reduced length of stay, and a faster return to daily activities.
Managing cancer as a chronic condition Cancer treatment can result in a loss of functional ability, reduced quality of life, and disability. Most patients with cancer do not meet the recommended 150 minutes per week of moderate activity, with strength training at least 2 times per week.
Exercise helps patients progress away from illness and toward recovery, gain a sense of normality, and rebuild structure in their life. Physically active survivors have lower rates of disease recurrence, improved survival, and enhanced quality of life.
Navigators should establish a relationship with their facilities’ rehabilitation services director, Berthold suggests. The American Physical Therapy Association’s (APTA) “Find a PT” can help navigators locate physical therapists who specialize in women’s health, pelvic floor dysfunction, oncology, and lymphedema. Other strategies include wellness programs such as LIVESTRONG YMCA, PT clinics, and hospital-based programs. Physical therapy should be a standard part of the cancer team and within the cancer center.
1. Berthold S. Navigating patients through physical therapy. Oral presentation at: Oncology Nurse Advisor Navigation Summit; April 7-9, 2016; Orlando, FL.