Oncology Rehabilitiation: Difference between revisions

The Rehabilitation 2030 call to action, launched by the World Health Organization in 2017, aimed to advance global access to rehabilitation for non-communicable diseases.[1]  In this context, the field of oncology was declared a priority, considering the acute and persistent effects of cancer. [2]

Oncology rehabilitation is an area that has the potential to reduce cancer-related morbidity and healthcare costs. [3]

Often used interchangeably with cancer rehabilitation, oncology rehabilitation focuses on managing and improving the impairments and functional limitations experienced by individuals with cancer due to the disease itself or the side effects of the treatment they receive. [4]

Side effects of chemotherapy: alopecia, mucositis, pulmonary fibrosis, nausea/vomiting, cardiotoxicity, diarrhoea, neuropathy, myalgia, renal failure, local reaction, myelosuppression, cystitis, phlebitis.

Some of the complications that can be addressed in oncology rehabilitation are listed below. [5]

Four Phases of Oncology Rehabilitation[edit | edit source]

According to the model developed by Dr. Dietz Jr. in 1980 [7], cancer rehabilitation includes four stages:

  1. Preventative rehabilitation phase: More recently called prehabilitation in cancer care, encompasses the time between the onset of cancer diagnosis and the beginning of oncological treatment. The interventions during this period include patient education and therapies that aim to decrease the impact of expected disability from oncological care. [6] It has been found by researchers that it is beneficial to undergo rehabilitation prior to beginning cancer treatment. [8]
  2. Restorative rehabilitation: It focuses on restoring the cured or controlled patients with residual impairments that cause disability to their previous level of function. [6]
  3. Supportive rehabilitation: This phase provides care to maximize functionality as individuals experience declines due to progressive or stable cancer. [6]
  4. Palliative phase: Although palliative care is not limited to the end of life, this model uses this term to emphasise the care aiming at comfort and function in the terminal stage of cancer. [6]

Settings For Oncology Rehabilitation[edit | edit source]

Understanding the context in which rehabilitation care is provided is crucial to ensure patients receive the most suitable treatment. Currently, rehabilitation services can be administered in various settings, including inpatient, outpatient, or at home. However, these services are generally classified into post-acute care and outpatient therapy: [6]

  • Post-acute care: Includes inpatient rehabilitation facilities, skilled nursing facilities, home health care agencies, and long-term care hospitals. [6]
  • Outpatient therapy: Involves patient visits at a therapy center for focused rehabilitation intervention. [6]

The outcome measures that used in studies to assess the patient’s status after the treatment/interventions are listed below. [9]

  • Health-related quality of life and/or quality of life: The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, the 36-Item Short Form Survey, and the Functional Assessment of Cancer Therapy.
  • Activities of daily living and instrumental activities of daily living
  • Fatigue
  • Functional mobility
  • Exercise behavior
  • Cognition function: Neuropsychological tests, patient-reported outcome measures.
  • Communication
  • Sexual function
  • Return to work

Also, you can visit the oncology examination page to see examination tools used for oncology rehabilitation.

Multidisciplinary Rehabilitation[edit | edit source]

Multidisciplinary outpatient cancer rehabilitation can improve a patient’s physical and psychosocial status. [10]

The professions that can be included in the multidisciplinary oncology rehabilitation team are stated below, along with their functions.

Physiatrist[edit | edit source]

Oncology Rehabilitation.jpg
  • Conducts diagnostic evaluations, including electromyography, functional assessments, musculoskeletal and neurological examinations, as well as imaging studies.
  • Prescribes pain-relieving medications to treat nonmalignant conditions arising from cancer treatments.
  • Performs peripheral joint, musculoskeletal, and interventional injections.
  • Recommends assistive devices, such as splints and braces. [11]

Nurse[edit | edit source]

An oncology nurse (nurse practitioner or clinical nurse specialist) plays a wide range of roles as part of the cancer care continuum framework. Those roles provided by oncology nursing care are listed below: [12]

  • Delivers people-centred integrated care (in line with the cancer care continuum) and optimal communication with patients and the multidisciplinary team.
  • Offers prevention and early detection of cancer through preventative measures (such as tobacco control and screening for cervical cancer).
  • Helps patients overcome health system barriers, and affect outcomes (such as increasing screening rates). This is often referred to as nurse navigation as well as nurse-led follow-up [6].
  • Does physical examination, chemotherapy assessment clinics, communicating results of scans, and doing procedures such as paracentesis.
  • Offers supportive care, including palliative care through all stages of cancer care. This area is the central pillar of oncology nursing and includes increasing healthy lifestyle behaviours, addressing the psychosocial needs of people with cancer and cancer survivors, and empowering people to self-manage where possible.

    Chemotherapy nurses and their patients share plenty of light moments, despite the seriousness of cancer and its treatment.

The positive outcomes associated with the role of clinical nurse specialist are listed: [13]

  • Psychological outcomes: Supports individuals with cancer.
  • Information outcomes: Meets patient’s information needs.
  • Clinical outcomes: Manages symptoms.
  • Service delivery outcomes: Provides more streamlined access to appropriate services.
  • Patient satisfaction: Rises overall satisfaction scores related to the patients’ experience of services.
  • Cost-effective outcomes: Contributes moderate cost benefits.

Physiotherapist[edit | edit source]

  • Detects and plays an active role in the management of many cancer-related impairments such as pain and reduced range of motion or physical fitness which may prevent patients from performing daily activities and participation roles. They make it possible by teaching coping strategies, maximising compensation capacity, and improving the ergonomics of (alternative) movement strategies. Yet with their specialised knowledge and advanced skills, they can also support individuals with cancer in their specific needs such as lymphoedema, peripheral neuropathy [14], and cancer-related fatigue. [15]

    Certified lymphedema therapist helps to manage and treat lymphedema symptoms using a nighttime compression sleeve.
  • Prescribes exercise programme (which is acknowledged as a standard practice in cancer care recently[16]) to improve strength, cardiorespiratory fitness and quality of life as well as reducing fatigue and depression. [17]
  • Uses beneficial modalities such as Massage Therapy, Transcutaneous Electrical Nerve Stimulation (TENS) and compression bandaging to alleviate the symptoms of patients with advanced cancer. [18]

As recommended by the National Cancer Policy Forum in the United States; the integration of physiotherapy into cancer care in order to reduce long-term, treatment-related adverse effects and disability should start ideally at the point of cancer diagnosis.[19]

Occupational Therapist[edit | edit source]

A wide diversity of practice areas of the occupational therapist in oncology rehabilitation were described by a review study [20]:

  • Return to work
  • Cognition-related roles
  • Fatigue management and energy conservation
  • Quality of life and the impact of cancer on everyday enjoyment, creativity, participation in roles and return to activities
  • Self-management: Includes strategies for lymphoedema management, sleep, exercise, scheduling, and strategies to adapt to changed roles and activities as a result of diagnosis and treatment of cancer.
  • Hand and upper limb rehabilitation, and the effect of cancer on the upper limb and function
  • Equipment prescription: Includes chest and scrotum guards, used for protection from the harsh potential side effects of radiation treatment.
  • Lymphoedema management
  • Home visiting to conduct a needs assessment of people in the palliative phase of cancer.
  • Feeding and the need for independence
  • Pain management
  • The activity of daily living intervention
  • Leisure prescription and occupational engagement

Speech and Language Therapist[edit | edit source]

  • Takes an essential role if there is an existing or likely treatment-related impact on speech and/or swallowing. [21]
  • Uses a combination of multidimensional assessment, education and rehabilitation interventions; to detect the holistic needs of people with a focus on speech, swallowing, voice, and mouth opening; to optimise functional outcomes (such as dysphagia severity, and post-intervention quality of life score[22]). [21]

Dietitian/Nutritionist[edit | edit source]

Orthotist[edit | edit source]

  • Given that braces are sometimes necessary for people with cancer who have some weakness or paralysis [23], an orthosis provides care to individuals who have neuromuscular and musculoskeletal impairments that limit their functionality and cause disability. [24]
  • They assess the patient’s needs both functionally and cosmetically, design an orthosis, choose the appropriate components, and then fabricate, fit, and align the orthosis or custom-made brace. Additionally, they educate both the patient and the care providers on how to use the orthosis correctly, how to take care of it, and how to determine if it is still appropriate for their needs. [24]

Prosthetist[edit | edit source]

  • A prosthetist provides care to patients undergone amputation. [23]
  • They assess the patient’s needs both functionally and cosmetically, selects suitable materials and components, makes necessary casts, measurements, and modifications (including static and dynamic alignment), evaluates the fit and function of the prosthesis or artificial limb on the patient, and teaches the patient about prosthesis care. [24]

Mental Health Professionals[edit | edit source]

Exercise Physiologist[edit | edit source]

Music Therapist[edit | edit source]

  • Performs assessments to detect the strengths and needs of patients and their families. These assessments include various domains, including emotional status, coping mechanisms, mental health, and symptom distress. [25]
  • By applying music therapy, they can help ensure personalized, comprehensive care and efficient use of often-limited psychosocial care resources. [26]
  1. World Health Organization. Global action plan on physical activity 2018-2030: more active people for a healthier world. World Health Organization; 2019 Jan 21.
  2. Gimigliano F, Negrini S. The World Health Organization” rehabilitation 2030: a call for action”. European Journal of Physical and Rehabilitation Medicine. 2017;53(2):155-68.
  3. Smith SR, Zheng JY, Silver J, Haig AJ, Cheville A. Cancer rehabilitation as an essential component of quality care and survivorship from an international perspective. Disability and rehabilitation. 2020 Jan 2;42(1):8-13.
  4. Cheville A, Smith S, Barksdale T, Asher A. Cancer rehabilitation. Braddom’s Physical Medicine and Rehabilitation. 2021 Jan 1:568-93.
  5. Sleight A, Gerber LH, Marshall TF, Livinski A, Alfano CM, Harrington S, Flores AM, Virani A, Hu X, Mitchell SA, Varedi M. Systematic review of functional outcomes in cancer rehabilitation. Archives of physical medicine and rehabilitation. 2022 Sep 1;103(9):1807-26.
  6. 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 Raj VS, Pugh TM, Yaguda SI, Mitchell CH, Mullan SS, Garces NS. The who, what, why, when, where, and how of team-based interdisciplinary cancer rehabilitation. InSeminars in oncology nursing 2020 Feb 1 (Vol. 36, No. 1, p. 150974). WB Saunders.
  7. Broadwell DC. Rehabilitation needs of the patient with cancer. Cancer. 1987 Aug 1;60(S3):563-8.
  8. Brennan L, Sheill G, O’Neill L, O’Connor L, Smyth E, Guinan E. Physical therapists in oncology settings: experiences in delivering cancer rehabilitation services, barriers to care, and service development needs. Physical therapy. 2022 Mar 1;102(3):pzab287.
  9. Sleight A, Gerber LH, Marshall TF, Livinski A, Alfano CM, Harrington S, Flores AM, Virani A, Hu X, Mitchell SA, Varedi M. Systematic review of functional outcomes in cancer rehabilitation. Archives of physical medicine and rehabilitation. 2022 Sep 1;103(9):1807-26.
  10. Kudre D, Chen Z, Richard A, Cabaset S, Dehler A, Schmid M, Rohrmann S. Multidisciplinary outpatient Cancer rehabilitation can improve Cancer patients’ physical and psychosocial status—a systematic review. Current oncology reports. 2020 Dec;22:1-7.
  11. Silver JK, Baima J, Mayer RS. Impairment‐driven cancer rehabilitation: an essential component of quality care and survivorship. CA: a cancer journal for clinicians. 2013 Sep;63(5):295-317.
  12. Young AM, Charalambous A, Owen RI, Njodzeka B, Oldenmenger WH, Alqudimat MR, So WK. Essential oncology nursing care along the cancer continuum. The lancet oncology. 2020 Dec 1;21(12):e555-63.
  13. Kerr H, Donovan M, McSorley O. Evaluation of the role of the clinical Nurse Specialist in cancer care: an integrative literature review. European journal of cancer care. 2021 May;30(3):e13415.
  14. Seth, N.H. and Qureshi, I., 2023. Effectiveness of physiotherapy interventions on improving quality of life, total neuropathy score, strength and reducing pain in cancer survivors suffering from chemotherapy-induced peripheral neuropathy–a systematic review. Acta Oncologica, 62(9), pp.1143-1151.
  15. Stuiver MM, Stout NL, Dennett AM, Speksnijder CM, Campbell KL. An international perspective on integrating physiotherapists in oncology care. Journal of physiotherapy. 2019 Oct 1;65(4):186-8.
  16. Cormie P, Atkinson M, Bucci L, Cust A, Eakin E, Hayes S, McCarthy AL, Murnane A, Patchell S, Adams D. Clinical Oncology Society of Australia position statement on exercise in cancer care. Medical Journal of Australia. 2018 Aug;209(4):184-7.
  17. Dennett AM, Sarkies M, Shields N, Peiris CL, Williams C, Taylor NF. Multidisciplinary, exercise-based oncology rehabilitation programs improve patient outcomes but their effects on healthcare service-level outcomes remain uncertain: a systematic review. Journal of Physiotherapy. 2021 Jan 1;67(1):12-26.
  18. Vira P, Samuel SR, Amaravadi SK, Saxena PP, Rai PV S, Kurian JR, Gururaj R. Role of physiotherapy in hospice care of patients with advanced cancer: a systematic review. American Journal of Hospice and Palliative Medicine®. 2021 May;38(5):503-11.
  19. National Academies of Sciences, Engineering, and Medicine. Long-term survivorship care after cancer treatment: Proceedings of a workshop. National Academies Press; 2018 Jul 9.
  20. Wallis A, Meredith P, Stanley M. Cancer care and occupational therapy: A scoping review. Australian occupational therapy journal. 2020 Apr;67(2):172-94.
  21. 21.0 21.1 Rothrie S, Fitzgerald E, Brady GC, Roe JW. The role of the speech and language therapist in the rehabilitation of speech, swallowing, voice and trismus in people diagnosed with head and neck cancer. British Dental Journal. 2022 Nov 11;233(9):801-5.
  22. Balbinot J, Real CS, Melo CC, Dornelles S, Costa SS. Quality of life in tongue cancer treated patients before and after speech therapy: a randomized clinical trial. Brazilian Journal of Otorhinolaryngology. 2022 Aug 15;88:491-6.
  23. 23.0 23.1 ILLINOIS | Physical Therapy Continuing Education [EBOOK]. Elite Learning. Chapter 5, An Overview of Oncology Rehabilitation, Updated. Available from: https://info.elitelearning.com/hubfs/ebooks/illinois-physicaltherapy-ebook.pdf#page=49
  24. 24.0 24.1 24.2 Chui KC, Jorge M, Yen SC, Lusardi MM. Orthotics and Prosthetics in Rehabilitation E-Book. Elsevier Health Sciences; 2019 Jul 6.
  25. Wentworth TA. What We Do and Who We Are: The Role of Music Therapy Scope of Practice and Scope of Competence in the Development of Professional Identity (Doctoral dissertation, Ohio University).
  26. Knott D, Krater C, MacLean J, Robertson K, Stegenga K, Robb SL. Music Therapy for children with oncology & hematological conditions and their families: advancing the standards of psychosocial care. Journal of Pediatric Hematology/Oncology Nursing. 2022 Jan;39(1):49-59.


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