Home Books The MD Anderson Manual of Medical Oncology, 3e

Chapter 59: Rehabilitation

Sunny S. Dhah; Jack B. Fu; Ki Y. Shin

GENERAL PRINCIPLES

Cancer and its treatments are a major cause for impairments and disability. Because cancer treatments have become increasingly successful and have improved survival, there has been an increasing focus on quality of life and, in particular, rehabilitation. Cancer rehabilitation is practiced in outpatient clinics, oncology wards, inpatient rehabilitation units, skilled nursing facilities, nursing homes, long-term acute care centers, palliative care units, and hospices. Common diagnoses addressed include asthenia, deconditioning, hemiplegia, spinal cord injury, peripheral neuropathy, somatic and neuropathic pain, steroid myopathy, lymphedema, bowel/bladder management, limb amputation, and limb dysfunction.

The major goal of cancer rehabilitation is to improve quality of life by minimizing the disability caused by cancer and its treatments and decreasing the “burden of care” needed by patients with cancer and their caregivers. The more patients can do for themselves, the more personal dignity they are able to maintain and the less help they require from those around them.

In 1978, Justus Lehmann, supported by the National Cancer Institute (NCI), screened 805 randomly selected patients with cancer, identifying multiple problems in the population of patients with cancer who are amenable to rehabilitation interventions along with barriers limiting the delivery of rehabilitation care. More than 30 years later, many of Lehmann’s remediable cancer rehabilitation problems and barriers to rehabilitation care remain the same (Table 59-1).

Table 59-1Remediable Rehabilitation Problems and Barriers to Delivery of Rehabilitation Care

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Table 59-1 Remediable Rehabilitation Problems and Barriers to Delivery of Rehabilitation Care

Remediable Rehabilitation Problems

Barriers to Delivery of Rehabilitation Care

Psychological/psychiatric impairments

Lymphedema management

Lack of identification of patient problems

Generalized weakness

Musculoskeletal difficulties

Lack of appropriate referral by physicians unfamiliar with the concept of rehabilitation

Impairments in activities of daily living

Swallowing dysfunction

Patient too ill to participate

Pain

Impaired communication

Patient denies need

Impaired gait/ambulation

Skin management

Cancer prognosis too limited

Disposition/housing issues

Vocational assessments

Rehabilitation unavailable

Neurologic impairments

Impaired nutrition

No financial resources

Vocational assessments

Lymphedema management

Impaired nutrition

Data from Lehmann JF, DeLisa JA, Warren CG, et al. Cancer rehabilitation: assessment of need, development, and evaluation of a model of care. Arch Phys Med Rehabil. 1978;59:410-419.

These problems are familiar to rehabilitation professionals because many are also found in traditional noncancer rehabilitation patients. Lehman also described major barriers to the delivery of cancer rehabilitation care, including the lack of identification of these problems by oncologists and the lack of referral to rehab professionals for a rehabilitation intervention. In addition, there are multiple patient-related factors that can affect the successful rehabilitation of the patient with cancer. Several reported by DeLisa include reduced life expectancy, extensive comorbidities, degree of pain, the dynamic nature of cancer lesions, the demands of anticancer therapies, and the desire to spend remaining time with loved ones (¹).