Rehabilitation
Lessens Functional Morbidity of Cancer
November / December 2004
Virtually all cancer treatment has the potential to compromise
a patient’s function due to its effect on the nerves
and muscular skeletal system. Because eradicating cancer is
generally the focus of treatment, function (such as ability
to participate in vocational, mobility and self-care activities)
is often a secondary consideration. Penn cancer rehabilitation
specialists work closely with other cancer
specialists to
ensure that patients develop minimal impairment and functional
decline during their primary anticancer therapy.
“People are living longer with their cancer diagnoses
which changes the emphasis of treatment from acute interventions
to the management of a chronic disease,” says Deborah
Julie Franklin, MD, PhD, assistant professor of rehabilitation
medicine at the Hospital of the University of Pennsylvania.
Dr. Franklin provides care for patients through the Joan Karnell
Cancer Center at Pennsylvania Hospital. “The cancer
and its treatment can cause mobility, self-care, cognitive
and other deficits, as well as increased pain.”
“By intervening early, we can minimize the long-term
functional consequences of cancer treatment and prevent complications
that can be difficult to treat later,” says Andrea
L. Cheville, MD, assistant professor of physical medicine
and rehabilitation and director of the cancer rehabilitation
program at the Abramson Cancer Center of the University of
Pennsylvania. “For patients with metastatic disease,
our goal is to keep them functional, and vocationally and
socially viable. We assist cancer survivors with fatigue,
neuropathy, lymphedema and muscle contractures from radiation.”
Several studies have shown that women with breast cancer
who are engaged in an exercise program while undergoing chemotherapy
have less fatigue, less depression, and less overall symptomatic
complaints. After surgery for breast cancer, many patients
have some degree of shoulder tightness due to the formation
of scar tissue in their armpits and chest walls. Regular stretching
and strengthening programs before and during radiation therapy
can prevent this tightness. Chemotherapy-related neuropathies
cause some patients to lose their ability to perform daily
activities such as walking and dressing. If rehabilitation
begins early, normal gait patterns can be preserved. Cancer
patients commonly report fatigue during and after treatment.
If patients participate in a regular strengthening and exercise
program while undergoing chemotherapy, fatigue is less problematic.
Penn's lymphedema program is one of the largest in the country
and its physical therapists have received advanced training
in complex decongestive therapy (CDT), a highly-successful
technique for controlling lymphedema. “CDT consists
of lymphatic massage, short-stretch bandaging, skin care,
exercise, and provision with a special garment to wear after
the swelling is significantly reduced,” says Lora Packel,
MS, PT, coordinator of cancer rehabilitation at the Abramson
Cancer Center of the University of Pennsylvania. In combination
with nutritionists, the cancer rehabilitation program offers
educational information on cancer fatigue and deconditioning.
A weight management program for women with breast and gynecologic
cancers, two cancers often associated with weight gain, is
also available.
Patients can be treated in various settings such as an acute
rehabilitation, a skilled care facility, or followed as outpatients.
Colleague Matthew
Schwartz, MD, assistant professor of physical and rehabilitation
medicine at the Hospital of the University of Pennsylvania,
is experienced in the diagnosis and management of various
cancer-related pain syndromes, including post-thoracotomy
and post-axillary dissection pain, as well as functional impairments
related to breast cancer, head and neck cancer, skeletal metastasis,
and lymphedema.
Current research includes a study on hyperbaric oxygen therapy
for radiation induced lymphedema and a clinical trial investigating
exercise in older women with breast cancer receiving chemotherapy.
“The prevalence of many cancers increases with age and
elderly patients are at greatest risk for long-term functional
problems. Because they often have functional deficits at diagnosis,
the side effects of their therapy can be devastating,”
adds Dr. Cheville. “We are starting to learn more about
how cancer treatment may affect the musculoskeletal system
and contribute to early arthritis, osteoarthritis and other
painful problems.”
“In our field, there has been more awareness that quality
of life matters as much, or perhaps more, than quantity of
life. With an increasing focus on rehabilitation, patients
are able to have quality of life during and after their cancer
treatment,” adds Dr. Franklin.
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