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Session 407: Rehab’s Role in Cancer SurvivorshipDebora Chasse, DPT, WCS, CLT‐LANA

Leading the Way in Continuing Education and Professional Development. www.Vyne.com

Learning Objectives

1. Describe how surgical procedures for cancer affect patients both physically and psychosocially.

2. Determine the short and long‐term effects of cancer treatments such as radiation and chemotherapy on patients’ functional levels

3. Investigate treatment modalities to alleviate the short and long‐term effects of cancer treatments and help patients improve functional strength and mobility. 

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Cancer is characterized by the uncontrolled growth and spread of abnormal cells. If the spread 

is not controlled, death will occur. 

New cancer cases predicted in 2017 in the U.S.

Female

Breast   252.710   30%

Lung      105,510    12%

Colon      64,010     8%

Uterine   61,380     7%

Thyroid   42,470     5%

Skin (M)  39,940    4%

Male

Prostate  161,360   19%

Lung         116,990   14%

Colon         71,420      9%

Bladder     60,490     7%

Skin             52,170      6%

Kidney        40,610     5%

Excess body weight

Physical inactivity

Excess alcohol consumption

Poor nutrition

Excess sun exposure

Over 50 years old (87% of all cancers)

The World Cancer Research Fund estimates that 20% of all cancers in US are caused by a 

combination of:

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Cancer Staging TMN to assess cancer growth and spread

Extent of the primary tumor (T)

Absence or presence of regional lymph node involvement (N)

Absence or presence of distance metastases (M)

Staging

0 in situ

I early

IV most advanced

Removal of the tumor and surrounding tissue. 

Removal of associated lymph nodes

Radiation to the affected site

Chemotherapy prior or following surgery

Hormone therapy if appropriate

Breast reconstruction

Breast cancer treatment

Risks & complications following breast cancer surgery

Bleeding

Infection

Seroma/hematoma

Reaction to meds

Permanent scarring

Shoulder pain/stiffness

Pain

Loss/altered sensation

Wound healing problems

Lymphedema

Anesthetic risks such as confusion, transient fatigue, muscle aches,vomiting. 

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Icepacks (indirect) for pain relief

Prescribed exercises to improve mobility, slowly

Proprioception stimulation

Use affected arm for ADL’s

Elevate your arm above your heart 45 mins 3‐5 times/day. While pumping hand 15‐25 times, flexing elbow 15‐25 times for lymph flow. 

Deep breathing ex to prevent pneumonia and increase lymph flow. 

Self care after surgery

Goal‐beams of intense energy to kill cancer cells. 

Cardiac and pulmonary toxicity

Difficulty swallowing, cough, shortness of breath

Burns, tissue damage

Lymphedema

Effects of radiation treatment on post‐mastectomy patients

Goal: destroy breast cancer cells through a drug delivered into a vein or as a pill. 

Destroys WBC, RBC, platelets

Neuropathy‐numbness, pain, burning, tingling, temperature sensitivity, weakness in extremities. 

Chemo brain‐short term memory/concentration

Hair loss, fatigue, loss of appetite, nausea/vomiting, constipation/diarrhea, mouth sores, skin/nail changes.

Risk of infection due to decrease WBC.  

Effects of chemotherapy on postmastectomy patients

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Chemotherapy long term side effects

Infertility

Early menopause

Osteoporosis

Heart damage 

Leukemia (cancer of blood cells

Fear, sadness, isolation

Psychological Effects ofCancer Treatment

Shock/disbelief

Fear/uncertainty

Guilt

Grief/sadness

Anxiety

Depression

Anger/frustration

Feelings of isolation

Vulnerability/helplessness

Focus on what you can change

Each persons cancer journey is unique and individualized.

Talk about your feelings. 

Seek out counseling.

Honor your need for rest, healthy food choices, exercise and recharging time.

Try mind‐body techniques.

Improving your psychological well‐being

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Rest

Exercise

Nutrition 

Avoid infection 

Laughter

Image health

Minimize stress

Meditation, relaxation,  breathing. 

Self care recommendations

Goal: to treat BC’s that are sensitive to hormones. It prevents hormones from attaching to cancer cells or by decreasing the production of hormones. 

Often used after surgery to reduce cancer regrowth.

Prior to surgery to decrease tumor size.

Prevents metastasis. 

Some cancers are fueled by estrogen or progesterone

In the form of medication, surgery or radiation.

Hormone therapy for breast cancer

Hormone therapy side effects

More common:

Hot flashes 

Vaginal irritation

Fatigue

Nausea

Joint & muscle pain

Less common

Blood clots in veins

Endometrial or uterine CA

Cataracts

Stroke

Osteoporosis

Heart disease

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What is the rehab role in cancer

Therapy can reverse cancer related disability 

Determine QOL goals as well as short and long term outcomes

Spirituality

Physical pleasure

Cognitive function

Life satisfaction

Social participation

Balance

Functional status

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Spirituality

Many people return to God during significant illness. 

Gerotranscendence

Morbidity & mortality

Decreased risk of suicide and depression

Spiritual pain can prevent healing. 

Physical pleasure

Enjoy beauty

Restfulness

Human touch

Cognitive stimulation

Physical energy

Cognitive function

Memory

Attention

Organization

Information‐processing speed

Loss of independence

Emotional health

Implement  cognitive strategies

Task related performance

Create  individualized systems to set reminders for meds, appts, home tasks, navigation. 

Physical exercise

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Life Satisfaction

Sexual relationships

Exercise decreases cortisol and improves QOL. 

Mind body Exercise 

Quality of life

Balance

Fall prevention

Home modifications

Adaptations

Balance training

Functional Improvements

Dressing

Bathing

Toileting

Cooking

Organizing day

Balancing checkbook

Caring for children

Improved QOL

Active coping

Yoga practice

Improved mood

Improved sleep

Decrease treatment related side effects. 

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Upper extremity function

ADL’s

AROM

Pain

Numbness

Scar tissue

Lymphedema

Exercises

Stretching

Modalities to improve AROM

Strengthening

Increase functional tasks

Adaptation

Lymphedema

Skin care health

Weight modifications

Self MLD and flexitouch

Complete Decongestive Therapy

Visceral Manipulation

Matrix Repatterning

Chemotherapy induced peripheral neuropathy (PN)

Meds that cause PN

Diterpenes

Weakness 

Numbness 

Tingling 

Pain

Causes

Functional disability Housekeeping, tactile 

agnosia

Dependence on others

OT for adaptation

Remediation through sensory & functional activities

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Has patient fallen in past 6 mos

Has patient experienced difficulty with ADL’s over past several weeks

Are there new UE flexibility restrictions or pain limiting everyday activities?

Has patient experienced new limitation in leisure or social activities?

Has the patient experienced changes in memory, attention, focus that have impacted participation in routine daily activities

Getting a PT/OT referral

Brief geriatric assessment. 

Measure functional status, falls, physical health cognition

Patient Reported Outcomes Measurement Information System (PROMIS) assess QOL, functional status, participation in social activities. 

Disabilities of arm, shoulder, hand assessment

Function Independence Measure

Functional Impairment tools

Hospital

Skilled nursing 

Rehab and subacute

Home care

Outpatient

Physical therapy

Occupational therapy

Speech therapy

Therapy settings

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Physician

Nurse Practioner

Physician’s Assistant

Social worker Outpatient 

Home care 

Check to see if insurance covers services

Medicare Part B covers outpatient therapy

Supplemental also covers services

Referrals

Cancer survivors are more likely to report being in fair or poor health

3+ chronic comorbidity conditions

Psychological problems

1+ limitations in ADL’s

Poorer functional status compared with same age adults without cancer. 

National Health Interview Survey