CANCER
REHABILITATION
By Dr Peter A.C. Lim
Head and Senior Consultant
Department of Rehabilitation Medicine
Singapore General Hospital
The
usual treatment schedule of a person with cancer often revolves
around surgery, radiotherapy, chemotherapy, or other interventions
such as hormone manipulation. Many cancers nowadays have an excellent
prognosis in terms of survival rates. However, an anatomic loss
or physiological dysfunction may result, as may problems with pain
originating from the brain, nerves, muscle and skeleton, psychological
difficulties, and weakness from prolonged bed-rest.
Rehabilitation
is the process of restoring optimal functioning following disease
or trauma, and not only improves functional status but also quality
of life. A rehabilitation physician who specializes in functional-based
assessment and prescription, overall medical care, and management
of associated complications may lead the process. He or she helps
coordinate the intervention from the cancer specialists, surgeons
and physicians, physiotherapists, occupational therapists, speech-language
therapists, and other healthcare professionals.
Rehabilitation
interventions may include targeted therapeutic exercise programs
for weakness and decreased endurance. Spasticity may develop because
of the tumors or from secondary spread to the brain and spinal cord,
requiring repetitive range-of-motion or various medications. Heat
and cold thermal modalities can help with stretching-out contractures
limiting range of limb motion. Ataxia or coordination problems may
benefit from desensitization or strategies such as weighted walking
devices or training in visual compensation. Nerve traction in the
limbs from bony fractures or deformities may be relieved with properly
prescribed orthoses or braces.
Following
limb amputation, the rehabilitation physician is often involved
in proper prescription of a prosthesis or replacement limb. Advice
and counseling in sexual difficulties resulting either directly
or indirectly from the cancer can be helpful. Bony cancer spots
may fracture, needing surgical fixation, spinal bracing, and subsequent
rehabilitation. The tumor itself may cause pain, muscle imbalances,
or spasms. Pain drugs may not be helpful whereas spasticity, depression
and nerve membrane stabilizing medications can be highly effective.
Speech-language
communication difficulties due to brain tumors or mouth and tongue
surgery may improve after therapeutic oral-facial exercises, gestural
compensations, or augmentive devices. Swallowing difficulties need
proper assessment and recommendations. Many patients breathing difficulties
from increased or pooled secretions, weak coughing or weak respiratory
muscles, which often respond well to chest physiotherapy. Energy
conservation techniques, proper adaptive equipment, and even simple
home modifications often solve safety, fatigue, disability and accessibility
concerns. Patients may have ostomies, bladder and bowel retention
or incontinence, and benefit from appropriate training with medications,
suppositories, diapers, and catheters or tubes.
In
summary, rehabilitation should be included as part of the planning
for optimal management of the consequences of cancer.
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