by Julie Silver, MD
If you or someone you love has been diagnosed with cancer, there’s a good chance – scientifically speaking – that rehabilitation can help improve your daily function and reduce treatment-related side effects. There’s also a good chance that no one has fully explained these benefits to you.
Not too long ago, I was invited to take part in a government-led taskforce that looked at how healthcare professionals could do a better job of helping survivors with their rehabilitation needs. One of the recommendations we made was simply to tell survivors about cancer rehabilitation and how these services, which are generally covered by health insurance, might help them.
I know that sounds obvious, but here’s a question for you: How much information have you and your family been given about cancer rehabilitation?
My colleagues and I wanted to test our theory that survivors don’t get enough information about this important therapy that can significantly improve their health and ability to function. So, we did a study and looked at whether large, government accredited cancer centers provided information on their websites about rehabilitation. We found that more than 90 percent of NCI-designated cancer centers did not have an easily identifiable patient-focused description of or link to cancer rehabilitation services on their website.
One of the leading causes of distress in cancer survivors is physical disability.
Wow! We had hypothesized that cancer survivors needed more information, but even we were surprised at the results of our study. Although I hope your healthcare team has already talked to you about cancer rehabilitation (this short article can’t provide you with all the information you need, so please talk to your team), here are four things every survivor should know about cancer rehabilitation.
1 Survivors need rehabilitation.
According to research, most survivors have physical problems due to their cancer or its treatment and would benefit from rehabilitation. These problems, called impairments, can appear in a variety of ways. For example, many head and neck cancer survivors have lost some of their ability to turn their heads to the side due to surgery and other treatments. Technically, the impairment is a loss of cervical range of motion. Practically speaking, it may result in disability; for example, many head and neck cancer survivors have difficulty driving, as they are unable to turn their heads to see oncoming traffic.
2 You should get started as soon as possible.
When I was diagnosed with cancer in my 30s, I remember my initial shock. I also recall that I had to wait to start treatment. I had medical appointments during that period, but I had plenty of time to worry as well. As a rehabilitation physician, I know there is a better way to use this critical window of time between diagnosis and the beginning of treatment – and it’s called prehabilitation.
Cancer prehabilitation should be standard care for most newly diagnosed individuals. The goal of prehabilitation is to prepare a person – both physically and emotionally – for upcoming surgery and other cancer treatments. For example, if you’re newly diagnosed with prostate cancer, you would attend a prehabilitation workshop where you would learn pelvic floor muscle exercises to decrease the potential for post-operative urinary incontinence. You would also learn strategies to reduce anxiety and lower stress.
In prehabilitation, it’s ideal to combine emotional support techniques with physical strategies for improving general strength and endurance, as well as more focused physiological outcomes, such as shoulder range-of-motion exercises for a woman about to have a mastectomy or swallowing exercises for a man facing head and neck cancer treatment. This tag team of emotional and physical support through scientifically proven interventions is designed to improve both your treatment experience and your health outcomes. If you’re newly diagnosed with cancer, ask your doctor how prehabilitation might benefit you.
How Do I Know if I Need Cancer Rehabilitation?
Ask your doctor about cancer rehabilitation if you aren’t able to do some of the things you were able to do before your diagnosis. And if you …
⇒ have pain, including headaches or joint, muscle, or nerve pain
⇒ aren’t able to walk or run as well as you did before your diagnosis – including, but not limited to, tripping or falling
⇒ feel tired or weak
⇒ have difficulty thinking, concentrating, or remembering things
⇒ are worried about choking or are having other swallowing problems
⇒ are not speaking as well as you used to
⇒ can’t lift your arms over your head as well as you used to
⇒ aren’t able to turn your head well, especially while driving and checking for oncoming traffic
⇒ have any other problems that are keeping you from feeling comfortable
3 Your mood improves when you physically feel stronger.
A cancer diagnosis affects both your physical and emotional health, and the relationship between the two is strong. In other words, it’s likely that the better you feel physically, the better you will feel emotionally, and vice versa.
It’s no surprise studies have found that cancer survivors have a worse quality of life due to physical or emotional problems than do people who haven’t had cancer. One study even found that more survivors had a reduced quality of life because of physical problems rather than emotional ones. Other studies have shown that one of the leading causes of distress in cancer survivors is physical disability. The obvious conclusion is that if we prevent physical problems early on through prehabilitation or early rehabilitation interventions, many cancer survivors will feel better both physically and emotionally.
4 You deserve to feel better.
Too often, cancer survivors struggle more than they need to. They may have a cluster of side effects, including pain, fatigue, and stress, that feed off each other, making it hard to sleep at night and function during the day. While each side effect might not be a big problem on its own, together, they can cause significant physical and emotional disability.
Rehabilitation teams work together to address several cancer-related issues at once. This has a synergistic healing effect that can markedly improve how survivors feel and function in a relatively short period. Prehabilitation and rehabilitation can help survivors, of all types and stages of cancer, function at a higher level and feel better. If you haven’t had cancer rehabilitation, please share this article with your healthcare team and ask them how rehabilitation might help you.
Dr. Julie Silver is the director of Cancer Rehabilitation, as well as an associate professor and associate chair in the department of Physical Medicine and Rehabilitation, at Harvard Medical School and Spaulding Rehabilitation Hospital in Boston, MA. She is the author of What Helped Get Me Through: Cancer Survivors Share Wisdom and Hope (American Cancer Society).
You can follow Dr. Silver, and learn more about cancer rehabilitation, on Twitter @JulieSilverMD.
This article was published in Coping® with Cancer magazine, May/June 2017.