Rehabilitation, Palliative Care, and Integrative Medicine Interventions in Cancer

Rehabilitation Interventions in Patients With Cancer

Introduction

For patients with a broad range of serious life-threatening illness, loss of function and independence is a common struggle and a significant contributor to diminished quality of life. Among the factors that can contribute to loss of function are prolonged hospitalization, deconditioning, pain, fatigue, depression, malnutrition, organ failure, neurologic injury, and musculoskeletal problems. Patients with cancer can additionally experience sarcopenia from direct tumor effects and fatigue from cancer treatment. Rehabilitation, even in the advanced phase of an illness, can help to maintain or restore function, permit patients to retain mobility and independence, and improve symptoms, all of which can contribute to a reduced burden on families and caregivers and improved quality of life. The main rehabilitation modalities are physical therapy, occupational therapy, and speech/ swallowing rehabilitation. Regular and open communication with patients and their families regarding the goals of rehabilitation is critical in designing a rehabilitation plan so that realistic goals can be identified. The rehabilitation plan must also consider the patient’s environment, existing functionality, and available resources. The measure of success of a palliative care rehabilitation program should not focus on length of survival but rather on enhancing quality of life, function/independence, and psychosocial well being. Patient condition and goals of care can shift dramatically while under palliative care, and therapists must maintain some flexibility, respecting patient choices and allowing for frequent interruptions in the rehabilitation treatment plan.

Multi-disciplinary Assessment

A thorough patient assessment for rehabilitation potential involves gathering information on disease location and stage, previous and current therapies, estimated life expectancy, comorbidities, pain and nonpain symptoms, medications, cognition, mood, nutritional status, and physical function. A complete physical examination with special attention to the neurologic and musculoskeletal system is essential to evaluate motor strength, sensory deficits, joint flexibility, gait pattern, and fall risk. An evaluation of the home environment, the availability of community resources, and financial resources should also be carried out. Using a systematized evaluation process will help to determine the patient’s current level of disability, previous level of functioning, and potential to regain function, which are all important components of rehabilitation planning. Ideally, patient evaluation and planning for rehabilitation should be performed by an interdisciplinary team led by a physiatrist/palliative care physician experienced in hospice and palliative medicine along with clinicians specializing in physical therapy, occupational therapy, speech therapy, nursing, nutrition, psychology, respiratory therapy, recreation therapy, and case management. A variety of functional assessment tools may be utilized to assess function during the planning process for rehabilitation therapy and palliative care.

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