What is Cancer Rehabilitation?

Treating cancer can require powerful medicines and procedures which, while effective at fighting cancer, can also be tough on the rest of the body. There are many drugs and interventions available to treat cancer, and doctors and scientists are developing many more. Some systemic treatments involve the use of drugs, like chemotherapy, immunotherapy or targeted therapy. Others, like surgery or radiation therapy, are local treatments because they affect a specific area of the body. 

With any treatment, whether it’s initial treatment of cancer or rehabilitation from cancer and treatment, it’s important to remember the following.

• Learn as much as you can beforehand
• Understand that your situation is unique and each person’s situation is different
• Ask questions so you will know what to expect

Cancer treatment can be intense, physically and mentally. Part of making the most out of your treatment is rehabilitating from it so you can be as independent, comfortable and active as possible. 

Rehabilitative care after cancer can help with the following things.

• Improve your endurance, strength and mobility
• Increase your confidence and self-esteem
• Make the activities of daily living and caring for yourself easier
• Help you cope with anxiety, distress or other emotional issues
• Reduce fatigue, pain and other lingering side effects
• Return to work
• Formulate a long-term plan for cancer survivorship

We sat down with Sarah Becker, PT, DPT, who is the Rehab Therapy Supervisor at INTEGRIS Jim Thorpe Outpatient Rehabilitation to better understand cancer rehab, what to expect and how it works.

How soon after the final cancer treatment does rehab care begin? Or is rehab care ever concurrent, or happening at the same time as, cancer treatment?

Rehab can be performed concurrently or after treatment. A lot of times, we are seeing patients while they are completing radiation or chemotherapy. And with breast cancer, we see them a few weeks after surgery (lumpectomy/mastectomy). And lymphedema (swelling due to lymph fluid build-up in the body), can arise at any time after cancer treatment begins, so treatment will begin when symptoms arise.

Is cancer rehab the same as physical therapy?

It can include physical therapy and can also include occupational and/or speech therapy. Physical therapy will treat for deconditioning and weakness from chemotherapy or radiation, balance problems from chemo-induced neuropathy (a set of symptoms caused by damage to nerves that control the sensations and movements of our arms, legs, hands, and feet), or any kind of joint pain associated with cancer treatment. 

Occupational therapy is primarily focused on lymphedema related to any cancer and breast cancer symptoms including shoulder pain, surgical site pain or tightness, and cording. What is cording? After surgery to remove lymph nodes in the armpit, some women develop cord-like structures under the skin on the inner arm.

Speech therapy will treat people with problems after head/neck cancers or cognitive/memory deficits related to cancer treatment. These memory or cognitive challenges are sometimes referred to as ‘chemo brain,’ or ‘chemo fog.’ More than 70% of people with cancer have these problems, and about a third of people still have them after treatment.

Is rehabbing from chemo different than rehabbing from radiation?

It can be. Both treatments can cause weakness and fatigue, which can mean similar treatments. With radiation, there can also be tissue and joint changes that may need more hands-on techniques as opposed to more exercises with the weakness and fatigue.

How long after cancer treatments does it take to find a new normal in terms of how a person feels?

It definitely depends on the person, type of cancer, and type of treatment. Some people are able to have relatively short treatments, while others are on chemo for many months or even years. This is determined by the plan set by the medical oncologist. Our role as rehabilitative therapists is more to support the patient through treatment and get them back as quick as treatment allows.

What are the steps in post-treatment rehab from cancer?

A cancer patient is typically referred to rehab by their medical oncologist, radiation oncologist or surgeon, and at that time the patient is set up for an evaluation with a physical therapist, occupational therapist or speech therapist. 

The therapist will perform an extensive evaluation to determine a plan of care, and also which services the patient will require, which may include therapeutic exercise, lymphedema treatment or manual therapy, among others. Manual therapy refers to the use of hands-on treatment to decrease pain, increase mobility, and improve function. 

After the evaluation, and establishment of the plan of care, we will work with the patient to determine a plan that will work around their current treatment schedule as needed.

In an outpatient setting, what can someone expect from their initial rehab appointment? Do they need to bring anything?

The first visit includes obtaining extensive history of their cancer and cancer treatment. The therapist will then perform testing as needed to establish a baseline function which may include testing or rating pain, fatigue, range of motion, strength, gait, balance, sensation, swelling, flexibility, functional assessment, etc.  

The therapist will then discuss the results/findings with patient to establish a plan to achieve the person’s specific goals for therapy, how that plan will be carried out and what treatments will be necessary.

What might make it necessary to undergo rehab therapy as an inpatient rather than on an out-patient basis?

Typically, no cancer specific rehab will happen in an acute setting. The patient may receive rehab services similar to any other inpatient that would address bed mobility, transfers, gait, and ADL (activities of daily life) training.