Even with a shared responsibility for communicating the need for physical therapy to cancer survivors, only doctors can issue the referral necessary to place a patient in a physical therapy regimen specifically aligned for cancer survivorship. With the exception of the state of Maryland, where patients can refer themselves into advanced physical therapy programs, private insurance will not cover or reimburse physical therapy costs unless the patient has a referral from the doctor, said Sweet.

The difference between physical therapy specifically designed for cancer survivors and conventional physical therapy is as much about what to do right as it is about what not to do wrong. For example, cancer survivors with weakened immune systems or those who underwent bone marrow transplants should avoid public gyms and pools until their white blood cell counts are refortified. Patients exposed to radiation therapy should avoid chlorine. Patients with severe neuropathy that effects balance should avoid treadmills, and so on.3 Teaching cancer survivors to watch for any approaching threat to their health is another dividend of cancer-specific physical therapy.

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Becky O., a two-time breast cancer survivor from Portland, Oregon, developed severe lymphedema in her right arm following her third breast cancer diagnosis and a double mastectomy. “I had a lot of pain from my arm, and it was swelling to such a huge size,” Becky recalls. “But with the [physical therapy] I was taught to watch for the beginning signs of a lymphedema attack, and was given some great techniques to keep it at bay.”


The science of physical therapy itself continues to advance beyond what used to be its own boundaries. Techniques that were once avoided with cancer patients are now being embraced, such as upper extremity resistance training for survivors with upper extremity lymphedema. Once believed to be dangerous, the practice has been found to be beneficial.3

Battling cancer at the patient level is so much about focusing on the now that overlooking posttreatment issues is not difficult. Wigglesworch adds, “It’s like a cancer patient asking if they are going to live. Oncology would rather concentrate on the now.”

But patients deserve to know enough to prepare for any future that arrives, and they need to be assured that every aspect of their condition is documented so any needed physical therapy is accurately targeted and covered by their insurance. Nurses are in an ideal position to provide assistance here, said Wigglesworch. “Patients need to know physical therapy will be part of recovery,” he said. Patients should be observed with physical therapy in mind, so insurance companies do not deny claims. Nurses foster this communication, and that can save cancer survivors a lot of grief.

Dan Neel is a medical writer based in San Francisco, California. 


1. Cheville AL, Beck LA, Petersen TL, et al. The detection and treatment of cancer-related functional problems in an outpatient setting. Support Care Cancer. 2009;17(1):61-67.

2. Cheville AL, Troxel AB, Basford JR, Kornblith AB. Prevalence and treatment patterns of physical impairments in patients with metastatic breast cancer. J Clin Oncol. 2008;26(16):2621-2629.

3. Silver JK, Baima J, Mayer RS. Impairment-driven cancer rehabilitation: an essential component of quality care and survivorship [published online ahead of print July 15, 2013]. CA Cancer J Clin. 2013;63(5):295-317. http://onlinelibrary.wiley.com/doi/10.3322/caac.21186/full. Assessed October 29, 2013.