It’s About Living Well
by Michael D. Stubblefield, MD
There are nearly 14 million cancer survivors in the United States. This number is expected to increase to nearly 18 million by the year 2020 thanks to better cancer screening and more effective treatments. However, the ever-increasing effectiveness of modern cancer therapies does not always translate into fewer side effects. The price of cure or prolonged cancer survival is often high.
Fortunately, help is available for those who are dealing with the complications of cancer and its treatment. The field of cancer rehabilitation is the medical subspecialty dedicated to helping those who have had difficulty coping with cancer treatment try to get back to their pretreatment level of function and independence. Cancer rehabilitation physicians (also known as physiatrists) are experts at identifying, evaluating, and treating a wide variety of neuromuscular (nerve and muscle) and musculoskeletal (muscle and skeletal) issues, pain, and functional disorders. They also treat other conditions common to cancer survivors, such as lymphedema and fatigue. Additionally, cancer rehabilitation physicians must understand how medical problems that are unrelated to cancer, such as arthritis, heart disease, and diabetes, can worsen and affect survivors during and after the course of their cancer treatment.
The range of ailments seen by a cancer rehabilitation physician is extensive. For instance, up to half of all breast cancer survivors will experience restricted shoulder motion following treatment with surgery and radiation. Breast cancer survivors can also have lymphedema (arm swelling), neuropathy, treatment-related memory problems, joint aches, and a host of other issues. A cancer rehabilitation physician is there to work with you, your oncology team, and other healthcare professionals, such as physical, occupational, or lymphedema therapists, to optimize cancer survivorship.
The ultimate goal of the cancer rehabilitation physician is to restore function and quality of life.
Each cancer survivor may experience difficulties that are unique to his or her specific disease and treatment. Head and neck cancer survivors may experience not only shoulder issues but also neck problems, facial lymphedema, trismus (inability to open the mouth), and a number of other painful and function-limiting conditions. While the list of potential problems may be different for each type of cancer and its treatment, the ultimate goal of the cancer rehabilitation physician remains the same: restore function and quality of life.
The first step in this process is to perform a comprehensive evaluation that includes a detailed medical history and physical examination, as well as imaging, such as an MRI, and laboratory studies if needed. This allows the physician not only to diagnose the obvious causes of pain and dysfunction but also to get to the root of additional problems, such as pinched nerves in the neck, arthritis in the shoulder, carpel tunnel syndrome, or undiagnosed diabetes. These unrecognized conditions can be responsible for some survivors’ poor tolerance of cancer treatments and may be the reason they continue to have difficulties long after the treatments have ended. The cancer rehabilitation physician would then work with you to choose treatments designed to provide the greatest benefit with the least amount of side effects. The most common treatments prescribed by a rehabilitation physician are physical, occupational, and lymphedema therapies. These therapies are often very specialized and tailored to each individual’s needs. Ideally, therapists with experience in treating cancer survivors should perform them.
Medications intended to calm nerve pain, relieve inflammation, diminish muscle spasms, or treat other conditions are sometimes necessary. Many cancer rehabilitation physicians are experts in administering injections that help treat these conditions. For instance, some may administer botulinum toxin injections to relieve the painful neck and jaw spasms in head and neck cancer survivors or the painful chest wall spasms in certain breast cancer survivors. Others may administer joint, spine, or deep muscle injections to relieve pain.
Many major cancer centers have developed large comprehensive cancer rehabilitation programs to provide for the needs of the fast growing survivorship community. Unfortunately, not all major cancer centers have cancer rehabilitation physicians or even specialized therapists on staff. If your cancer center does not have a cancer rehabilitation program, ask for a referral from your doctor to a cancer rehabilitation physician in your area. It may be an important first step in improving your quality of life.
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Dr. Michael Stubblefield is the chief of the Rehabilitation Medicine Service at Memorial Sloan-Kettering Cancer Center in New York, NY. He is a leader in the field of cancer rehabilitation and uses his diagnostic and therapeutic medical skills to restore function and quality of life to cancer survivors. He is also the senior editor of the textbook Principles and Practice of Cancer Rehabilitation.
This article was published in Coping® with Cancer magazine, September/October 2013.