The Role of Cancer Rehabilitation

The Role of Cancer Rehabilitation

By David Zucker, MD, PhD
Medical Director, Cancer Rehabilitation Services

When learning that you have cancer, it's easy to forget that your body has trillions and trillions of healthy cells. This is true whether the cancer is stage 0 or stage IV. While this may be hard to believe, it is true. Your healthy cells support you in getting through the rigors of treatment. Too often, however, the support that your healthy cells offer is forgotten in the flurry of activities surrounding treatment and the dramatic changes in your everyday life. These changes are not only physical, but emotional, psychological and spiritual. After all, cancer affects the whole person from molecule to spirit.

At the molecular level, your healthy tissues are subjected to profound physiologic demands, demands that take an enormous amount of their energy. Cancer treatments— surgery, chemotherapy, biologic therapies, radiation—are taxing. Athletes need to prepare well for any physically demanding event. Why then, should it be different for cancer survivors? While a far cry from an athletic event, you may be surprised to learn that the same training principles that apply to athletes also apply to cancer survivors. These principles include the correct exercise frequency, intensity, duration and type, tuned individually to your needs as a cancer survivor.

At the level of the spirit, receiving a cancer diagnosis is often the first time that a person recognizes “mortality applies to me”. This can feel like being in "free fall". Facing one's own mortality is one of the most challenging experiences that a human being can encounter. Difficult to discuss, it is an awareness that most cancer survivors encounter, whether the cancer is curable or not.

Unfortunately, death awareness is too rarely discussed in an open and sensitive way by those of us who provide cancer care. Yet this awareness is the foundation of many religious and contemplative traditions. Reckoning with this awareness can open the door to profound and positive changes in one's view of self, other, world, and even cancer itself. Facing this challenging reality takes courage, insight and support. Indeed, the life affirming response that many have is an area of keen interest at the National Cancer Institute. It is often referred to as "benefit finding" or "post-traumatic growth".

While cancer may not cause you to feel sick (this is true in many, many cases, even advanced cancers), there is no doubt that treatment does. Fatigue, pain, difficulty sleeping, numbness and tingling, poor balance, digestive problems, and impaired thinking, all make it difficult to function in everyday life.

So, how can cancer rehabilitation help the whole person—molecules to spirit—cope with cancer and treatment?

  • First, rehabilitation is about function, the ability to participate in everyday life. The role of the cancer rehabilitation physician (“onco-physiatrist”) is to sort through cancer- or treatment-related symptoms that interfere with functioning in everyday life and, with the help of an interdisciplinary team, create an individualized rehabilitation program that will optimize well-being and the ability to participate in customary activities. The rehabilitation team generally includes physical therapists, occupational therapists, counselors, psycho-oncologists, and speech language pathologists.
  • Second, rehabilitation fully involves the survivor in its implementation. You become the steward of your healthy cells. This imparts a sense of control in what otherwise may seem to be an uncontrollable situation. Exercise is a key component of cancer rehabilitation. Research demonstrates that even during treatment, exercise can improve strength and fitness. For breast cancer survivors on treatment, exercise has been shown to reduce treatment related fatigue. After treatment, the benefits continue to build, including further reductions in fatigue, improved mood, and better ability to return to cherished everyday activities.
  • Third, the actual experience of enhanced control over side effects such as fatigue, activity intolerance and pain provides an undeniable sense of accomplishment that energizes and empowers you to more confidently face the challenging spiritual aspects of cancer. You become a fully active participant in your care, the true center of your care team. You and your rehabilitation team attend to your 100 trillion healthy cells while your surgeon, medical oncologist and surgeon attend to curing or putting cancer into remission. This is whole person care.

Ed. note: A version of this blog appeared in Coping with Cancer.

Comments
David Zucker, MD, PhD
Yes, Ken, we do offer both pre-habilitation and rehabilitation during treatment. Starting rehabilitative care before or during treatment is ideal. Over almost a decade we have found that people who train in advance of treatment and train during treatment experience less fatigue, optimize their daily activity tolerance and recover more quickly after treatment. They also can establish a realistic sense of control in what otherwise may seem to be an uncontrollable situation. And, as you point out, research is beginning to validate the efficacy of integrating rehabilitative care and cancer treatment. I like to think about this as a "combined modality approach" to cancer care.
3/27/2014 9:25:53 AM
Ken Martin
Is swedish doing any pre-habilitation (exercise beginning at diagnosis and prior to first treatment)?

http://www.ncbi.nlm.nih.gov/pubmed/23756434
http://www.ncbi.nlm.nih.gov/pubmed/24177690

How about during infusion?
http://meetinglibrary.asco.org/content/41990-74
http://www.ncbi.nlm.nih.gov/pubmed/24627275

Thanks!
3/25/2014 7:53:43 AM
Virgil Thrasher
Dr. Zucker: Three years ago we lost our daughter, Allison, who was a patient of yours. You help prepare Allison for her challenging journey and you helped prepare us of the loss we would suffer. Allison died at peace on Nov. 4, 2010. Her mother, brother and I have suffered a very sad grief. After all is said and done, we want to thank you from the bottom of our hearts for your help in all this. Allison loved you and we do too. Keep up the good and important work that you do. God bless you…
10/22/2013 11:19:59 PM
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