After interacting with hundreds of oncology patients at our cancer rehab clinic, I’ve noticed that the battle against cancer is often considered won once the patient is in remission (or when the cancer is stabilized). That certainly is an important milestone. However, I don’t think patients should settle for that outcome alone. Let me explain.
If you had a stroke, the doctor would not consider you fully recovered when your blood work returned normal results and you were no longer in life-threatening danger. Similarly, if you broke your hand or foot badly enough to require surgery, you would not consider yourself fully treated on the day you took off the cast.
In both situations, your initial hospital treatment would be followed by weeks of physical therapy — in the case of stroke, perhaps months — to help you regain the movement and strength you had before. Physical therapy would be a necessary, natural, and expected phase of your recovery.
The same ought to be true for cancer patients, but cancer rehab is often not viewed the same way. Many cancer patients, their families, and their oncologists think that treatment is done once the cancer is in remission or is stabilized. In my view, this is a paradigm that needs to be corrected for the health of all cancer survivors.
Treating the cancer is really only the first part. Part two, which is just as necessary, is about helping your body physically recover from the damage wrought by cancer treatments.
Why is physical therapy necessary for cancer rehabilitation?
Cancer treatments are necessarily harsh to destroy the cancer in your body. The enormous toll they take on your overall physical health is part of the collateral damage.
During chemotherapy and radiation, you can lose weight and muscle mass. You may have overwhelming fatigue or decreased tolerance to activity. You may also experience nerve damage/loss of sensation, or loss of strength which can be dangerous to you since your body won’t warn you if you’ve cut or scalded yourself and could predispose you to balance difficulties putting you at risk for a fall.
If you undergo surgery, you will need to deal with tissue damage, and if the surgery is on organs such as your lungs, you may experience shortness of breath and difficulty breathing.
In addition to tissue damage, you may have to deal with less tangible side effects like changes in blood pressure, cardiac issues, respiratory difficulty, radiation burns, and lymphedema/swelling.
I mention these side effects because they’re things all cancer patients should be aware of, and to emphasize how different cancer recovery is from another type of physical recovery, such as from a sports injury. Cancer rehab is specialized medical therapy for unique medical needs.
Your oncologist may recommend rest, but rest alone will not bring you back to your former physical health. In many cases, the ailments you’re feeling will only worsen if you’re sitting still. That’s why physical therapy is integral to cancer recovery: it’s the main way you’ll regain your former strength, mobility, and flexibility, and avoid a decreased quality of life now and into the future.
How is cancer rehabilitation different from regular physical therapy? Can I go to a regular physical therapist?
Just like physicians, nurses and other healthcare professionals, physical therapists graduate from school as a general practitioner. Only after graduation do physical therapists choose to remain a general practitioner or to specialize in a certain specialty (neurology, cardiovascular, geriatric, pediatric, oncology to name a few). This requires years of advanced training and education.
Physical therapists who specialize in cancer rehab take advanced education or certifications to learn more about cancer treatments, their side effects and how to properly – and safely- treat cancer patients. There are many safety precautions with post treatment late effects, precautions post cancer surgery and other conditions related to cancer treatments that a “generalist” physical therapist may likely not be aware of/have knowledge of. Just as the hospital would assign you to a physical therapist who specializes in neurologic conditions if you had a stroke, you need to go to a specialist in cancer rehab following cancer treatment. The advanced knowledge that a specialist has can make all the difference in how fast and how well you recover.
For example, a lymphedema specialist will be familiar with techniques such as Complete Decongestive Therapy (CDT), which includes compression bandaging, skin care, and massage therapy and exercise. Exercise is not the only, or even the first, therapy technique for lymphedema. Also, for those at risk for/have developed lymphedema, there are very specific exercise precautions that must be taken to reduce the risk of onset/worsening of the condition.
Cancer rehab for lung cancer focuses on learning breathing techniques to keep your oxygen levels high, expand your lung capacity, and make sure you have enough energy to get through the day.
Surgery for breast cancer causes many changes in the biomechanics of your upper body and shoulder that need to be safely addressed – to prevent the risk of injury. People who undergo mastectomies often have weakness, post-surgical tightness, and pain, as well as limited mobility in their arms and shoulders after surgery, making every day activities quite challenging. Cancer rehab for breast cancer focuses specifically on these areas, while understanding the unique changes to body structure resulting from surgery so that the cancer survivor can retain (or regain) maximum mobility safely.
Which brings me to another note. While physical therapy after a stroke or broken bone is necessary after hospital treatment, cancer rehab therapy can begin before your treatment. In fact, beginning therapy before chemotherapy, surgery, or radiation improves your chance of getting a better outcome and will reduce the time you spend recovering.
On a more logistical note, cancer rehab clinics often differ from normal physical therapy clinics because cancer survivors need more personalized attention than a typical client. Each person has unique challenges and goals related to the type of cancer they survived as well as the combination of treatments they went through. In clinics that see athletes or other patients that don’t have as many needed safety precautions to safely complete exercise, a therapist may see multiple patients concurrently, leaving patients working independently for some part of their therapy.
My oncologist hasn’t recommended a physical therapist to me. Do I need a referral or can I sign up myself?
Your oncologist may not have referred you to a cancer rehab specialist, but this doesn’t mean you can’t initiate the conversation. You can speak with your doctor about pursuing a cancer rehab consult or evaluation. Also, in the state of Virginia (and many others across the US), patients can be seen by a physical therapist without obtaining a referral. This also doesn’t mean, though, that you are on your own, or that insurance won’t pay for it.
At ORW, our billing department verifies your insurance benefits prior to your first visit and will notify you if any special referrals or authorizations will be needed. We are also in-network with most major insurance providers . We always recommend patients have an advocate, so our patients are welcome to have their caregivers and medical advocates accompany you. (Please note that during the COVID crisis we are currently restricting this to one person. All patients and caregivers are screened prior to entry.)
In addition, our physical therapists work closely with your cancer care team even if you self-refer. Once your therapist develops a plan with you, they send that plan to your doctor to ensure they are onboard with your therapists’ recommended treatment plan. If there are any special concerns, our therapists reach out directly to your MD/care team prior to initiating your treatment plan.
Need help fast? Know that Oncology Rehab and Wellness strives to get patients scheduled for their meeting with the PT within five days, sooner if there is an urgent matter.
If you would like to get started, learn more about how we can work with your cancer care team, or learn more about how cancer rehab can help your recovery specifically, give us a call. My team offers free 15-minute consultations where we can meet each other and you can tell me about your goals. From there we can discuss if cancer rehab would be a good fit for you.
Call and schedule an appointment to get started. Our clinic number is (703) 789-0367.