Multiple evidence-based guidelines for patients with active cancer or a history of cancer recommend rehabilitation and/or exercise to improve physical and/or cognitive deficits associated with cancer or its treatment.1 Although there are 69 different guidelines in oncology that contain specific recommendations for rehabilitation, rehabilitative services continue to be underutilized among patients with cancer.1,2 

Guideline Recommendations

In oncology, various guidelines support the use of rehabilitation and often focus on the types of physical and/or cognitive deficits that are likely to occur with a specific cancer type or treatment. For example, guidelines have been developed for cancer-associated pain, sexual function, and dementia.1

Examples of existing guideline-supported rehabilitation interventions include the following:


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  • Thyroid cancer: Humidity and breathing exercises; energy conservation strategies
  • Prostate cancer: Pelvic floor exercises for urinary incontinence. Weight bearing resistance and aerobic exercise for patients receiving androgen deprivation therapy
  • Head and neck cancer: Nutritional interventions for individuals who are either overweight or underweight

Given guideline support for rehabilitation, it is important that clinicians and caregivers are aware of rehabilitation’s potential to improve patient functioning and quality of life and recommend rehabilitative services when applicable.

How Rehabilitation Can Help

Cancer and/or its treatment can result in short- or long-term deficits in physical and/or cognitive functioning. Some effects, such as pain or fatigue, can occur regardless of the type of cancer; others such as difficulty swallowing after treatment may be specific to the malignancy. These deficits can have a profound effect on quality of life and can be extensive enough to prevent patient participation in daily work, leisure, or social activities.2 Therefore, rehabilitation is an important component of the care process to help patients overcome or improve any deficits or ongoing symptoms.

Rehabilitation includes exercise and occupational therapy to improve physical and cardiovascular function. It also encompasses cognitive behavioral therapy and psychosocial interventions to improve cognitive deficits and manage stress.2,3 These services can be provided by different types of health professionals or as part of a multidisciplinary care team. The overarching goal of rehabilitation is to improve the patient’s functioning to enhance quality of life and facilitate return to work, school, or other activities. 

Multiple studies have shown that rehabilitation has utility across different cancer types and stages regardless of patient age.1-3 Rehabilitation is also known to be effective before, during, and after anticancer treatments.  

However, despite the benefits of rehabilitation for patients with cancer or a history of cancer, it is estimated that more than 60% of patients live with functional morbidity and only 2% to 9% are referred to rehabilitation services.1 These data suggest that barriers to rehabilitation access exist and subsequently hinder patients from receiving appropriate services. Such obstacles could include a lack of awareness among the oncology care team, a lack of rehabilitation service integration into oncology care delivery, and an underdeveloped infrastructure for rehabilitative services. 

Conclusions

Rehabilitative services are beneficial to patients with active cancer or a history of cancer. Patients should be referred to rehabilitation when affected by deficits that can negatively impact quality of life and ability to participate in work, school, or other activities.

References

  1. Stout NL, Mina DS, Lyons KD, Robb K, Silver JK. A systematic review of rehabilitation and exercise recommendations in oncology guidelines. CA Cancer J Clin. Published online October 27, 2020. doi:10.3322/caac.21639
  2. Hunter EG, Gibson RW, Arbesman M, D’Amico M. Systematic review of occupational therapy and adult cancer rehabilitation: part 1. Impact of physical activity and symptom management interventions. Am J Occup Ther. 2017;71(2):7102100030p1-7102100030p11. doi:10.5014/ajot.2017.023564
  3. Hunter EG, Gibson RW, Arbesman M, D’Amico M. Systematic review of occupational therapy and adult cancer rehabilitation: part 2. Impact of multidisciplinary rehabilitation and psychosocial, sexuality, and return-to-work interventions. Am J Occup Ther. 2017;71(2):7102100040p1-7102100040p8. doi:10.5014/ajot.2017.023572.