Cancer is a disease that is close to everyone’s hearts, with many people having loved ones fighting this tough battle or fighting it themselves.
It is a disease that doesn’t discriminate based on age, sex or person, and has many negative effects on the person and their loved ones.
Luckily however, there have been many advances in the treatment and detection of different types of cancers. This means that cancer survival rates have improved and people are being diagnosed with their cancer earlier.
But with many of the treatments for cancer involving surgery, radiotherapy and chemotherapy, often the person with cancer can develop significant side effects and complications.
Some of these complications include pain, fatigue, decreased mobility, decreased ability for self care activities, reduced quality of life, reduced cardiorespiratory capacity, impaired nutrition, and neurological impairments, to name a few. And these complications don’t even take into account the psychological and emotional effects of cancer and cancer treatment such as depression and anxiety (Gilchrist et al. 2009; Mauk 2012).
Often just by having cancer and undergoing treatment, it predisposes cancer survivors to further health conditions and increases their risk of an early mortality rate (Midtgaard et al. 2013).
This is where cancer rehabilitation comes in and why the role of rehabilitation in cancer treatment is beginning to be recognised more and more.
What is Cancer Rehabilitation?
‘Cancer rehabilitation aims to allow the patient to achieve optimal physical, social, physiological and vocational functioning within the limits imposed by the disease and its treatment’
(Mauk 2012 pp. 363)
Cancer rehabilitation has been found to improve the symptom control, physical function, psychological wellbeing and quality of life of patients during and following their cancer diagnosis and treatment (Chasen et al. 2013; Gandon et al. 2013). As with any rehabilitation program, it looks at the patient holistically and involves the care and treatment of a multidisciplinary team.
Often treatment will involve assisting the patient to regain strength and minimise functional loss, recover from surgery, learn to live with an altered body image and also address the psychological and emotional impacts it has had on them (Gilchrist 2009; Mauk 2012).
An important part of any rehabilitation program is goal setting. Goal setting for patients with cancer can often be challenging, and should be made while taking into account the patient’s age, the type of cancer they have, the stage of the cancer, co-morbid medical conditions, and their functional status (Mauk 2012).
Goals for cancer rehabilitation are generally set according to what stage of cancer treatment they are in and what type of rehabilitation they will be receiving, described as:
- Restorative rehabilitation: Returning the patient to their pre-morbid functional status. This will occur when there is little or no long-term impairment predicted following the diagnosis and treatment of the cancer
- Supportive rehabilitation: Maximising function after the person experiences permanent impairments following cancer and its treatment
- Preventative rehabilitation: Attempting to prevent any functional decline caused by cancer and its treatment
- Palliative rehabilitation: Maximising independence and symptom control in patient with advanced cancer
Support and Education
Another important part of cancer rehabilitation is patient and family education. Nurses are on the forefront of patient education and are often present with the patient when other members of the team are not.
They provide support to the patient through issues relating to their psychosocial health and wellbeing and help to coach the patient through times when they may be adjusting to a different level of function or an altered sense of self. Nurses also help the patient to develop coping strategies to help with their adjustment to the disease and its treatment.
Cancer rehabilitation allows the patient to experience increased social support. This can occur not only through their family and loved ones but also with the friendships that they develop with their peers during their multidisciplinary sessions and support groups.
Social support of the patient with cancer has been found to help with adjustment to their illness, adherent to their treatment and also has beneficial effects on their general wellbeing, stress and immunity.
These positive effects can be attributed to the patient finding a sense of belonging during this phase of their life and by helping them bypass the initial difficulties of cancer rehabilitation, which include feelings of decreased motivation, being deconditioned, and the difficulties of incorporating regular exercise into their routine (Chasen 2013).
Cancer Related Pain
Approximately 70% of people with cancer will have cancer-related pain from either the cancer itself or as a side effect of its treatment (Gilchrist 2009; Mauk 2012). Pain management and control is a huge component of any cancer rehabilitation program.
First off, an in-depth pain assessment must be completed of the individual to evaluate the location, severity and quality of pain.
Treatment of the pain will generally be multimodal and include pharmacological and non-pharmacological interventions (Mauk 2012).
Pain must be effectively treated in order to decrease any further negative impacts that uncontrolled pain has on level of mobility and the psychological wellbeing of the individual (Gilchrist 2009).
Cancer Related Fatigue
Fatigue is one of the most common, and also generally the most significant, side effect for patients who are receiving cancer treatment, and often persists long after the treatment has concluded.
Rehabilitation interventions aim to provide education regarding energy conservation, minimising any potential deconditioning, and incorporating exercise strategies into the daily schedule to assist in fatigue management (Mauk 2012). However, fatigue management in cancer patients can also be a bit of a ‘catch 22’ situation.
Although exercise has been found to be an effective intervention for cancer-related fatigue, the feelings of fatigue can greatly limit the patient’s ability to participate in the exercise program (Gilchrist 2009).
Mobility Level of Function
Maintaining exercise during and following cancer treatment has been shown to improve not only functional capacity, but to also decrease fatigue, prevent muscle wasting and improve overall quality of life (Mauk 2012).
Patients can experience deficits in their range of motion due to disuse, scar tissue, surgery, chemotherapy or radiotherapy, as well as cachexia or muscle wasting and gait and balance disruptions (Gilchrist 2009). This is where a physical therapy exercise program is essential to assist with these deficits.
Nursing Implications for Cancer Rehabilitation
There are many important implications for nurses who are looking after the patient undergoing cancer rehabilitation.
Nurses play many pivotal roles in cancer rehabilitation and are there when other members of the team are not. They not only support the patient through this time emotionally and psychologically, they also provide education to the patient and family and assess any symptoms and implement strategies for symptom control, such as pain and fatigue management.
It is also essential for nurses to be aware of what the patient’s rehabilitation goals are so they can assist the patient during their journey and continue their support in reaching these goals.
- Chasen, MR, Feldstain, A, Gravelle, D, MacDonald, N & Pereira, J 2013, ‘Cancer rehabilitation and survivorship: An interprofessional palliative care oncology rehabilitation program: Effects on function and predictors of program completion’, Current Oncology, vol. 20, no. 6, viewed 1 March 2017, http://www.current-oncology.com/index.php/oncology/article/view/1607/1349
- Gagnon, B, Murphy, J, Eades, M, Lemoignan, J, Jelowicki, M, Carney, S, Amdouni, S, Chasen, M & MacDonald, N 2013, ‘Cancer rehabilitation and survivorship: A prospective evaluation of an interdisciplinary nutrition-rehabilitation program for patients with advanced cancer’, Current Oncology, vol. 20, no. 6, viewed 1 March 2017, http://www.current-oncology.com/index.php/oncology/article/view/1612/1350
- Gilchrist, L, Galantino, ML, Wampler, M, Marchese, VG, Morris, GS & Ness, KK 2009, ‘A framework for assessment in oncology rehabilitation’, Journal of the American Physical Therapy Association, vol. 89, no. 3, pp. 286-306, viewed 1 March 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2967778/
- Mauk KL 2012, Rehabilitation Nursing: A contemporary approach to practice, Jones & Bartlett Learning, Sudbury.
- Midtgaard, J, Christensen, JF, Tolver, A, Jones, LW, Uth, J, Rasmussen, B, Tang, L, Adamsen, L & Rorth, M 2013, ‘Efficacy of multimodal exercise-based rehabilitation on physical activity, cardiorespiratory fitness, and patient-reported outcomes in cancer survivors: A randomized, controlled trial’, Annuals of Oncology, vol. 24, no. 9, pp. 2267-73, viewed 1 March 2017, https://academic.oup.com/annonc/article/24/9/2267/201867/Efficacy-of-multimodal-exercise-based
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