Cancer Rehabilitation

By: Dr Peter A.C. Lim ,
      Head and Senior Consultant,
      Department of Rehabilitation Medicine, SGH

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.