Ultimately the goal of physical medicine and rehabilitation is to restore an individual to the highest level of function. By definition, functioning is usually thought of in mechanical terms—walking, running, and climbing. In the sports world, it is a question of swimming, soccer, basketball, cycling, skiing, skating, etc. We often take for granted movement or the daily activities of getting dressed, bathed, or going to the restroom—that is, until we no longer have the ability to perform these tasks independently.
In much the same way as an infant begins to roll from abdomen to back, sit, utter a first word, crawl, stand, cruise, and eventually walk, the passage of activities in the cancer patient is characterized by milestones. The determination, practice, and energy that went into these activities are often forgotten.
The same concentration and fortitude are required when attempting to meet the needs of any medical patient. Characteristically, the physician is required to interview a patient in depth and understand that patient's medical background, his or her historical family, and the interplay between different biopsychosocial elements. From a physical medicine and rehabilitation perspective, a patient's overall function requires a detailed personal interview and an understanding of who the patient is—physically, socially, intellectually, motivationally, and spiritually. Sound physical and mental functioning demand harmony between these different features.
Where there is homeostatic malalignment, function suffers, and the patient becomes ill-equipped to meet the challenges of both his or her work and social environment. Maladaptive behaviors may ensue. What previously was an acceptable means of societal interchange—the 40-hour work week, washing the car on Saturday, the family weekend picnic or barbecue, socializing with friends and family, sending cards and letters, and reading books—today, has given way to instant communication, pagers, texting, and blackberries. We are overly integrated and saturated with work, politics, and instant news. Like the cancer patient, we often demonstrate a limited ability to properly and adequately digest, process, sort, categorize, and plan appropriate responses and strategies. Rather in today's world, we need to be constantly vigilant—everything at a moment's notice.
Is it any surprise that older institutions of coping—the afternoon drive, a trip to the cinema, having a cup of coffee and an afternoon chat, and talking to one's spiritual advisor—have been left on the shelf? Gainful employment, meeting social/financial obligations, and maintenance of one's livelihood currently entail competition, potentially a difficult work week, poor sleep, poor nutrition, limited exercise, and, possibly, alcohol/tobacco/pharmacologic coping. In this environment, marriages/relationships may falter, and these unopposed stressors may inadvertently lead to poor overall functioning and diminished individual productivity.
Adding to these stressors is the issue of disease. Cancer patients are not immune from everyday life and functioning—yet, they have the added burden of fighting what is often construed as the "Big C"—a compendium of diseases felt to be laced with a more tangible mortality. Treating cancer involves a multimodal ...