Chapter 67: Rehabilitation

KEY CONCEPTS

• Cancer rehabilitation is a medical subspecialty practiced by physical medicine and rehabilitation (PM&R) physicians, also known as physiatrists. Cancer physiatrists practice in a variety of settings to address a wide array of diagnoses and impairments, with the end goals of optimizing independent function and quality of life.

• The four phases of cancer rehabilitation as described by Dietz in 1980 are: preventive, restorative, supportive, and palliative. These concepts help cancer physiatrists frame their functional assessment and treatment goals when working with cancer patients and their treating oncologic teams.

• The Karnofsky Performance Scale and Eastern Cooperative Oncology Group Scale of Performance Status are widely used as overall functional assessment tools but are limited by overgeneralization and poor correlation with cognitive status. The Functional Independence Measure or the Boston University Activity Measure for Post-Acute Care used by rehabilitation professionals are more comprehensive tools to assess current function and changes over time.

• Neurorehabilitation broadly includes any impairment or functional deficit that results from compromise of the central nervous system (CNS) resulting from direct tumor invasion or as a byproduct of cancer treatment. These can include cognitive deficits, motor impairments, neuropathy, apraxia, ataxia, dysphagia, aphasia, spasticity, or bowel/bladder dysfunction. Depending on the severity or complexity of the impairment, comprehensive evaluation by a cancer rehabilitation physician may be beneficial.

• Musculoskeletal rehabilitation broadly includes any impairment or functional deficit that results from compromise of the musculoskeletal system (bone and/or surrounding soft tissue) resulting from primary, secondary, or metastatic tumor invasion, or as a byproduct of cancer treatment. Topics addressed include amputee care, radiation fibrosis, general musculoskeletal diagnosis and treatment, wound care, bone health, and exercise guidance. Depending on the severity or complexity of the impairment, comprehensive evaluation by a cancer rehabilitation physician may be beneficial.

• There is a growing body of evidence demonstrating that moderate to vigorous exercise confers some protection against several different types of cancer. Along these same lines, “prehabilitation” is an emerging field of interest in oncology. By improving physical function, optimization of nutrition, gaining muscle mass and strength, improving body composition, providing tobacco and/or alcohol cessation counseling, and managing mood before planned cancer treatment, studies have shown improved patient outcomes and reduction in healthcare costs by decreasing length of stay, reducing post-treatment complications, and reducing hospital readmission rates.