What Exactly is “Cancer Rehab”?


Cheryl Guarna, PT, MPT, CLT, STAR/C

It has long been understood that exercise is beneficial for everyone. It is also agreed that medically directed exercise offered in rehab can help greatly after someone has had a stroke, surgery, heart attack, back injury and more. Rehab is also routinely ordered for someone who has had a joint replacement, sports injury or developed a neurological disease among other things. Historically, patients who have had cancer have been told “go home, rest, your treatment is finished, resume your life.” Cancer patients are often left weakened, scarred, truly ill and unable to resume their life, or resume their life as prior to cancer. While some patients may be referred for therapy, a vast majority are not. The reason for this is multifaceted, but research studies are showing two dominating factors for the lack of referral and follow through with rehabilitation.

First, there is an overall knowledge gap related to rehab for cancer patients. It is a new area of specialization and the community (cancer community and the medical community) does not know it exists. Secondly, cancer patients are often hesitant to “complain” to their oncologists about what they view as non-essential life limiting impairments. Because they are so focused on the treatment of their cancer (or relieved that it is over), they don’t want to bring up the fact that they cannot lift their arm high enough to do their hair, or the numbness in their feet is not enabling them to drive anymore; or they are too weak and fatigued to play with their children or participate in social activities they use to enjoy.

It is estimated that 65% – 90% of cancer patients develop life limiting impairments. It is also estimated that only 20% – 30% of those patients are referred to and receive therapy to address these impairments. As cancer survival rates continue to increase, the number of patients being left with life changing limitations is growing as well. Cancer rehab is becoming a critical need as more and more patients are surviving. Quality of life (QOL) issues need to be addressed and survivors need to be given the chance to live the life they did before cancer. They need to be given the opportunity to live the best life they can, even if it may be different than before cancer. They need to be given the tools needed to address their new functional “normal”, not left to adapt to limitations that can usually be improved. Cancer patients need to be routinely screened at intervals before, during and after their cancer treatment. The early identification of impairments can lead to much better outcomes. Leaving certain issues and not addressing them early can lead to permanent disability, pain and diminished QOL.

If you had a heart attack and needed rehab you would be referred for cardiac rehab. Cardiac rehab is medically supervised, progressive exercise provided by rehab professionals who are trained and often certified in cardiopulmonary rehab. If you had a stroke, you would be referred to a therapist (or multiple therapists) for rehabilitation. Again, the therapy is directed by rehab professionals who are specialists in the treatment of neurological impairments. Same goes for a patient after a sports injury or orthopedic surgery. They are often referred to an Orthopedic therapist. Rehab professionals receive a broad based education, encompassing many different disciplines while in therapy school. They graduate as generalist therapists. Not unlike some physicians, therapists at some point in their medical career, find their niche and further their education in a certain specialty area. While some do remain generalist therapists, (same as for some physicians) some will find a certain passion for a select field of therapy and focus their professional career on a specific area of interest. They attend continuing education courses, receive specialized training, gain specialist certifications, attend conferences related to the field and network with like minded medical professionals. This is true for clinicians who choose cancer rehab as their focus.

Some examples of cancer or cancer treatment related impairments are:

  1. Lymphedema, an abnormal, often debilitating swelling that can occur after surgery for cancer, especially if lymph node biopsy or node removal are necessary. If lymphedema is identified and treated early it may be reversible. Not treating it in its earliest stages will lead to a lifetime of distress and difficult management.
  2. A patient with shoulder limitations, postural issues post breast cancer surgery can lead to more painful and limiting issues such as frozen shoulder. Patients with frozen shoulder often cannot lift their upper extremity high enough to use it functionally. Movement of the arm is often very painful. However, identifying and addressing shoulder movement problems early can often fully rehabilitate the shoulder and return the patient to normal function.

So, back to the original question. What exactly is cancer rehab? Cancer rehab is rehabilitation for cancer patients and survivors, directed by therapists who have received post therapy school education, training and specialty certifications in the identification and rehabilitation of impairments related to cancer and its treatments. They are knowledgeable in treatment protocols for specific impairments and problems that cancer patients often present with. They also understand the vast side effects of cancer treatments (cardiac issues, respiratory problems, blood pressure regulation issues, neuropathy, radiation burns and radiation fibrosis, and lymphedema to name a few). These side effects can greatly affect the outcome of cancer patients and can adversely affect the ability to safely exercise. Improper or inadequate treatment of some of these impairments can negatively affect patients’ outcomes and possibly cause long term functional impairments. So, while many clinics and hospitals will advertise they have “cancer rehab” it may be rehab provided by a generalist therapist who may not have the advanced education or certification in oncology rehab.

So, you find out you have cancer. Do you remain under the care of only your primary care/generalist MD or are you referred to an oncologist? When you have a heart attack you are referred to a cardiologist. When you have a fracture or need a joint replacement you are referred to an orthopedist. Wouldn’t you be best served then by finding a rehabilitation therapist that specializes in cancer rehab?

NEXT WEEK’S BLOG: “How to Find a Cancer Rehab Therapist”