Cancer Rehabilitation - The Road Less travelled!
Understanding Autism Spectrum Disorder:
- Cancer rehabilitation is a crucial aspect of cancer care that aims to help individuals maintain or restore their physical, emotional, and social well-being after a cancer diagnosis and treatment.
- It’s a multidisciplinary approach that involves a team of healthcare professionals working together to address the various challenges patients may face.
“In 2018, approximately 180,000 cancer cases and 92,000 cancer deaths in the region were causally linked to alcohol, with risks starting from the first gram consumed and increasing with the amount.”
Overall Cancer Burden:
- Total Cases:In 2022, India recorded an estimated 46 million new cancer cases.
- Incidence Rate:The crude incidence rate in 2022 was approximately 4 per 100,000 individuals.
- Lifetime Risk:It’s estimated that 1 in 9 people in India are likely to develop cancer during their lifetime.
- Projected Increase:Cancer incidence in India is projected to increase by 8% in 2025 compared to 2020.
- Oral Cancer:India accounts for over 85% of oral cancer cases reported worldwide. Tobacco use is a major contributing factor.
- Cervical Cancer:One woman dies of cervical cancer every 8 minutes in India. Rural women have a higher risk compared to urban women.
- Breast Cancer:The incidence rates rise in the early thirties and peak between 50-64 years. The lifetime risk in urban areas is about 1 in 22 women, compared to 1 in 60 in rural areas.
Why cancer rehabilitation is important For the Family:
- Reduces Caregiver Burden: As patients regain independence through rehabilitation, the physical and emotional demands on family caregivers can decrease. This allows family members to return to some of their own routines and reduces the risk of caregiver burnout.
- Provides Education and Support: Rehabilitation teams often educate family members on how to best support the patient, manage their symptoms at home, and create a safe and supportive environment. This can empower families and reduce feelings of helplessness.
- Improves Family Dynamics: When the patient’s physical and emotional well-being improves, it can positively impact family dynamics, reducing stress and tension within the household.
- Offers Emotional Support for Caregivers: Some rehabilitation programs extend emotional support and counselling to family members who are also navigating the challenges of a loved one’s cancer journey.
- Facilitates Communication: Rehabilitation teams can act as a bridge between the patient, family, and the broader medical team, improving communication and ensuring everyone is on the same page regarding the patient’s recovery.
- Promotes Hope and Active Participation: Seeing a loved one actively working towards recovery and regaining function through rehabilitation can instil hope and encourage the whole family to participate in the recovery process.
Why cancer rehabilitation is important For the Patient:
- Addresses Physical Impairments: Cancer and its treatments (surgery, chemotherapy, radiation) can cause a range of physical issues like weakness, fatigue, pain, swelling (lymphedema), balance problems, and reduced mobility. Rehabilitation helps to restore function, build strength and endurance, improve balance, and manage pain, enabling patients to perform daily activities with greater ease and independence.
- Manages Side Effects: Rehabilitation professionals can help patients cope with and manage the often debilitating side effects of cancer treatment, such as neuropathy, fatigue, and cognitive difficulties (“chemo brain”).
- Enhances Independence: By improving physical and cognitive function, rehabilitation empowers patients to be more self-sufficient in their daily lives, reducing their reliance on others for basic tasks. This can significantly boost their self-esteem and sense of control.
- Improves Quality of Life: Cancer rehabilitation aims to improve overall well-being by addressing physical comfort, functional abilities, emotional health, and social participation. This allows patients to engage more fully in life, pursue hobbies, and maintain meaningful relationships.
- Supports Emotional and Psychological Well-being: Dealing with cancer is emotionally challenging. Rehabilitation programs often include psychological support, counselling, and strategies to cope with anxiety, depression, fear of recurrence, and changes in body image.
- Facilitates Return to Activities: Rehabilitation helps patients return to work, school, social activities, and hobbies they enjoyed before their diagnosis, promoting a sense of normalcy and reintegration into their previous life.
- Reduces Hospitalizations: By proactively addressing physical and functional limitations, rehabilitation can potentially reduce the need for hospital readmissions due to complications or decreased functional status.
- Prehabilitation Benefits: Starting rehabilitation before cancer treatment (prehabilitation) can optimize a patient’s physical and mental health, potentially leading to better tolerance of treatment and faster recovery.
Cancer Rehab Team:
Cancer rehabilitation team consists of,
- Physiatrist:Oversees the rehabilitation plan and manages medical issues related to function.
- Physiotherapist:Focuses on movement, strength, and mobility.
- Occupational Therapist:Helps with daily living skills and adapting tasks.
- Speech & Swallow therapist:Addresses communication and eating difficulties.
- Clinical Psychologist:Provides emotional support and cognitive rehabilitation.
- Medico Social Worker:Addresses social, emotional, and practical needs.
Stages of Cancer Rehabilitation:
- Preventive – Occurs prior to start of treatment and goal is to reduce functional decline from cancer.
- Restorative – Occurs after Treatment Completion to bring the level of function back.
- Supportive – Occurs after diagnosis of Advanced Cancer To maintain the current functional level.
- Palliative – During end of life; caregiver/ Family training.
Cancer patients have various symptoms which affect their day-to-day life.
- Fatigue
- Nausea
- Pain
- Anxiety
- Insomnia
- Lymphedema
- Shortness of breath
“Tobacco use accounts for 25% of global cancer deaths and is the leading cause of lung cancer, with an estimated 186 million tobacco users in the WHO European Region.”
Crucial Points on Cancer Rehab:
- “Fatigue needs to be evaluated with Electrolyte, endocrine panel, anemia panel, Kidney and liver function evaluation. Common medications used for cancer can also cause fatigue”
- Cancer Pain – Mostly associated with bone metastasis, Bone Pain responds well to local irradiation.
- This is important for rehab because moving or loading on affected bones can precipitate severe pain.
Lymphedema Management:
COMPLEX DECONGESTIVE THERAPY
2 Phases – ✓ Reductive Phase and ✓ Maintenance Phase
including MANUAL LYMPHATIC DRAINAGE (MLD)
Phase 1 – 45mins of MLD followed by compression bandages, remedial exercises.
✓ Bandage should be applied 21 – 24hrs /day
Phase 2 – Long term maintenance program
✓ Compression garments during day
✓ Compressive Bandages during Night
Issues specific with Breast Cancer:
✓ Deficits in Shoulder Movement develops after surgical procedures for tumor removal and breast reconstruction.
✓ Axillary web syndrome
✓ Aromatase inhibitor Musculoskeletal Syndrome (AIMS)
“Smoking increases the risk of lung cancer by up to 22 times compared to non-smokers.”
Issues in Head and Neck Cancer:
- Facial Dysmorphism
- Spinal accessory nerve palsy
- Cervical Contracture
- Radiation induced dryness of mouth
- Inability to eat
- Myofascial dysfunction
CAUTION IN CANCER REHAB:
- Heating modalities should be used with caution
- Heat will dilate local blood vessels and increase metabolic activity in tumor cells.
Authors Note:
“Similarly, massage is presumed to potentiate metastasis by encouraging blood and lymph flow or by dislodging tumor cells. So, Get consulted with a Physiatrist and Oncologist before starting any massage.”
Conclusion:
Cancer Rehabilitation is a varied and challenging field of increasing public health importance. Conventional Rehab interventions succeed in preserving and restoring functional status of Cancer patients.
References:
- Smith SR, Zheng JY, Silver J, Haig AJ, Cheville A. Cancer rehabilitation as an essential component of quality care and survivorship from an international perspective. Disabil Rehabil. 2020 Jan;42(1):8-13. doi: 10.1080/09638288.2018.1514662. Epub 2018 Dec 21. PMID: 30574818.
- Guo Y, Fu JB, Guo H, Camp J, Shin KY, Tu SM, Palmer LJ, Yadav R. Postacute Care in Cancer Rehabilitation. Phys Med Rehabil Clin N Am. 2017 Feb;28(1):19-34. doi: 10.1016/j.pmr.2016.09.004. PMID: 27912997.
- Torgbenu E, Luckett T, Buhagiar MA, Phillips JL. Guidelines Relevant to Diagnosis, Assessment, and Management of Lymphedema: A Systematic Review. Adv Wound Care (New Rochelle). 2023 Jan;12(1):15-27. doi: 10.1089/wound.2021.0149. Epub 2022 Apr 6. PMID: 35196892.
- Shen A, Wu P, Qiang W, Fu X, Zhu F, Pang L, Wang F, Lu Q. Factors associated with lymphedema self-management behaviours among breast cancer survivors: A cross-sectional study. J Clin Nurs. 2023 Oct;32(19-20):7330-7345. doi: 10.1111/jocn.16833. Epub 2023 Jul 25. PMID: 37491890.
- Sathishkumar K, Chaturvedi M, Das P, Stephen S, Mathur P. Cancer incidence estimates for 2022 & projection for 2025: Result from National Cancer Registry Programme, India. Indian J Med Res. 2022 Oct-Nov;156(4&5):598-607. doi: 10.4103/ijmr.ijmr_1821_22. PMID: 36510887; PMCID: PMC10231735.
- Singh MP, Misra S, Rathanaswamy SP, Gupta S, Tewari BN, Bhatt ML, Kumar V. Clinical profile and epidemiological factors of oral cancer patients from North India. Natl J Maxillofac Surg. 2015 Jan-Jun;6(1):21-4. doi: 10.4103/0975-5950.168215. PMID: 26668448; PMCID: PMC4668727.
