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Table of Contents
REVIEW ARTICLE
Year : 2019  |  Volume : 12  |  Issue : 3  |  Page : 91-95

Physical medicine in cancer rehabilitation: A narrative review


Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria

Date of Submission05-May-2019
Date of Acceptance06-May-2019
Date of Web Publication23-Aug-2019

Correspondence Address:
Richard Crevenna
Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna
Austria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/HMJ.HMJ_38_19

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  Abstract 


Cancer rehabilitation improves functional status, quality of life, social participation and return to work of cancer survivors. This narrative review indicates the importance of physical medicine (PM) in cancer rehabilitation and describes the situation in a Middle European University Hospital Centre. Cancer rehabilitation includes information, psycho-oncology, nutrition and PM and it is an immanent team process. Rehabilitation goals can be restorative, supportive, preventive and sometimes palliative. The rehabilitation concept focuses on symptoms and sequelae of cancer and its treatment, enabling the patients to counteract these sequelae and side effects, to gain self-competence and to easier come back after cancer treatment. The field of PM and rehabilitation (R) is an essential part of cancer rehabilitation concerning the improvement of physical performance, quality of life, social participation and return to work. Physiatrists have competencies in diagnostics and therapy as well as of coordination of the rehabilitation team and are, therefore, important players in the concept of cancer rehabilitation. Cancer survivors benefit from cancer rehabilitation due to an improvement of physical performance, nutrition, mental stabilisation, quality of life and participation (social participation and workability). PM and R is an important part of it.

Keywords: Cancer rehabilitation, interdisciplinary, multi-professional, participation, physical medicine


How to cite this article:
Crevenna R. Physical medicine in cancer rehabilitation: A narrative review. Hamdan Med J 2019;12:91-5

How to cite this URL:
Crevenna R. Physical medicine in cancer rehabilitation: A narrative review. Hamdan Med J [serial online] 2019 [cited 2019 Nov 19];12:91-5. Available from: http://www.hamdanjournal.org/text.asp?2019/12/3/91/265252




  Introduction Top


As important part in the treatment and care of cancer survivors with the goal to improve functional status, quality of life and participation, cancer rehabilitation has to be early integrated into the cancer care continuum. It has been shown to enable cancer survivors to be integrated into their normal live, namely, to increase social participation and/or return to work (workability).[1],[2],[3],[4],[5],[6],[7],[8],[9],[10] What are the main parts of cancer rehabilitation? What about the cancer rehabilitation process, and What means the rehabilitation team? What about the relevance of the field of Physical Medicine and Rehabilitation (PM and R) in cancer rehabilitation?

The present narrative review aims to present the relevance of cancer rehabilitation, and of PM and R in the holistic field of cancer rehabilitation, and furthermore describes the situation in a Middle European University Hospital Centre (with comprehensive cancer centre [CCC]).[1],[2],[10] Furthermore, the importance of developing long-term exercise programmes and the use of the so-called 'new media' for this purpose will be mentioned as specific future aspects in the further development of cancer rehabilitation.


  Cancer Rehabilitation Top


Due to cancer itself and due to its treatment, there are general and specific functional deficits such as bodily pain, fatigue, loss of muscle mass (with decreased muscular strength), reduced endurance capacity, polyneuropathy with impaired sensorimotor functions and impaired flexibility leading to decreased mobility in cancer patients.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10] Furthermore, they can show lymphoedema, incontinence, sexual dysfunctions, nutritional deficits, mucositis, hand-foot syndrome, cognitive deficits, dysthymia and depression, which all can lead to impairment of quality of life and participation.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10] Cancer rehabilitation includes several parts, namely, information, psycho-oncology, nutrition and PM and has to be adapted to the individual needs of the individual cancer patient by using an individual approach[Table 1].[1],[2],[3],[4],[5],[6],[7],[8],[9],[10] The individual rehabilitation plan/concept focuses on symptoms and sequelae of cancer and its – for the survival – necessary treatment (chemotherapy, surgery, radiation therapy and modern oncologic cancer treatment) enabling the patients to counteract these sequelae and side effects, to gain self-competence and to easier come back after cancer treatment.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10] Cancer rehabilitation is an immanent team process[Table 2].[1],[2],[3],[4],[5],[6],[7],[8],[9],[10] Rehabilitation goals can be restorative, supportive, preventive and sometimes palliative.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10] All parts of cancer rehabilitation have to be evaluated (effects on bodily, mental and psychosocial functions and on return to work and participation outcomes) by using modern outcome research measurement tools. Long-term analyses of effectiveness and of efficiency of cancer rehabilitation will be needed in the future.[1],[3]
Table 1: The main parts of cancer rehabilitation

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Table 2: Members of the interdisciplinary and multi-professional cancer rehabilitation team

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  Physical Medicine and Rehabilitation Top


Physiatrists have competencies in diagnostics and therapy as well as of coordination of the rehabilitation team and are, therefore, important players in the concept of cancer rehabilitation.[1],[10] From the viewpoint of multidisciplinary and interdisciplinary healthcare, the field of PM and R has its place in all fields and phases of medical care.[1],[10] PM and R is represented from the prevention and treatment (including rehabilitation) of diseases until palliative medicine, and especially cancer rehabilitation includes many interventions and treatment approaches from PM and R.[1],[10] Thus, PM and R has been shown to be an essential part of cancer rehabilitation, especially concerning the improvement of physical performance, quality of life, social participation and return to work.[1],[10]


  Physical Modalities and Therapies Top


Physical modalities include mechanotherapy, electrotherapy, thermotherapy, phototherapy, balneology and climatic therapy [Table 3].[1],[10]
Table 3: Systematic of physical modalities and therapies (with several examples for mechanotherapy)

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These treatment modalities include the application of (a) Mechanical forces (mechanotherapy such as exercise, physiotherapy, water and immersion therapy, occupational therapy, massages and special massages such as lymphatic massage, ultrasound, shock-wave treatment and extension), (b) Electrical currents (low frequency, middle frequency and high-frequency electrical therapy such as transcutaneous electrical nerve stimulation, 'Hochtontherapie,' galvanic baths and short-wave diathermy), (c) The application of different (heat or cold) temperatures, (d) Phototherapy (ultraviolet light, cooled red light and near-infrared light and infrared light) or (e) Balneological (mud, fango and baths) and different climatic conditions [Table 3].[1],[10] Medical exercise (or regular physical activity), physiotherapy and occupational therapy, but also massage, lymphatic massage and different other modalities to improve function (for example, electrotherapy and ultrasound) are typically applied in cancer rehabilitation [Table 3].[1],[10] They focus on functional improvement. Medical exercise improves the activities of daily living by improving muscular strength, endurance capacity, sensorimotor functions, structural flexibility and furthermore functional status, quality of live and participation. Physiotherapy improves the activities of daily living by improving structural flexibility and functional status. Exercises, ergonomics and complex decongestive therapy (lymphatic massage and compression) are typical parts of physiotherapy in cancer rehabilitation. Biofeedback therapy improves the activities of daily living with stress and anxiety management, pain reduction, ergonomics and biofeedback-assisted physiotherapy. Occupational therapy improves the activities of daily living, improves and assists upper limb function, cognition and other functions. Ergonomics and splint supply are typical parts of occupational therapy in cancer rehabilitation. Massage therapy includes classic and special massages (such as lymphatic massage) and improves activities of daily living by muscular detonisation/relaxation, pain reduction and reduction of lymphoedema[Table 3].[1],[10]


  Typical Examples for Cancer Rehabilitation Concepts Top


The next four examples such as reduced performance capacity, chemotherapy-induced peripheral neuropathy (CIPN), lymphoedema and incontinence represent typical indications for rehabilitative interventions in cancer survivors. Nevertheless, several other dysfunctions such as sexual dysfunctions, nutritional deficits, mucositis, hand-foot syndrome, cognitive deficits, dysthymia and depression can occur and impair quality of life and participation of cancer survivors and should therefore also be rehabilitated.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10]

Reduced physical (performance) capacity

In the past two decades, exercise has been shown to be an effective and safe (!) method in cancer treatment and rehabilitation. Exercise seems to have many benefits – also on cardiac and cancer-specific survival-and enables cancer survivors to gain independence from others help and to improve quality of life and participation, by increasing endurance capacity, muscle strength (and muscle mass), sensorimotor functions and flexibility.[1],[11],[12] Before starting exercise for planning and receipting individual exercise programmes, medical history, clinical examination, different laboratory parameters, electrocardiography, echocardiograph findings, exercise testing, spirometry, radiographic findings and bone scans are needed.[1],[10],[13] For patients suffering from metastatic bone disease (or multiple myeloma) with the risk of fractures, regular physical activity and exercise are possible, when contraindications and individual clinical features are carefully considered.[1],[10],[13] Almost every cancer patients would benefit from regular physical activity and would be able to exercise – it only depends on medical know-how.[1],[10],[13] Regular physical activity of cancer patients can include the application of neuromuscular electrical stimulation (NMES), biofeedback-assisted exercises, aerobic exercise, strength exercise, exercises to improve sensorimotor functions, sports therapy, physiotherapy and sports-up to competitions.[1],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34],[35],[36],[37],[38],[39],[40],[41],[42],[43],[44],[45],[46],[47],[48],[49]

Chemotherapy-induced peripheral neuropathy

CIPN can be a side effect of necessary cancer treatment and show symptoms such as pain and dysaesthesia and sensorimotor dysfunction with reduced balance control. These symptoms are very unpleasant and impair quality of life of patients and participation.[1],[40],[41],[42],[43] The combination of dysaesthesia with disturbed sleep quality and sensorimotor dysfunction with coordination deficits can lead to different severe consequences. The first one is impaired mental health with depression and anxiety.[1],[40],[41],[42],[43] The fear of falls leads to fear of motion and to reduced physical activity and physical performance capacity.[1],[40],[41],[42],[43] Multidisciplinary and multimodal cancer rehabilitation concepts aim to counteract these symptoms. For this purpose, there are used medications and different physical modalities.[1],[40],[41],[42],[43]

Lymphoedema

Lymphoedema is a typical symptom after, for example, breast cancer surgery and radiation. Treatment and rehabilitation of lymphoedema, namely, the so-called complex decongestive therapy consists of two phases, the acute phase and the maintenance phase.[1],[44],[45],[46] Parts of the complex decongestive therapy are manual lymphatic massage (drainage) and compression therapy, exercise (with compression), skin care, psychology, nutrition and education.[1],[44],[45],[46]

Incontinence

In post-prostatectomy, stress urinary incontinence, modalities from PM and R have been described to serve as effective additive, non-invasive treatment options and to be able to help patients in regaining continence.[1],[10],[47] Programmes for pelvic floor reeducation include physical modalities such as physiotherapeutic exercises (pelvic floor exercise), as well as whole-body vibration therapy, electrotherapy and magnetotherapy, biofeedback and electro- and multichannel biofeedback.[1],[10],[47]


  Cancer Rehabilitation in a Middle European University-Hospital Centre (Austria) Top


In Austria, the Department of PM, Rehabilitation and Occupational Medicine of the Medical University of Vienna is part of the CCC, Vienna and has a kind of 'Pioneer-Status' (from the viewpoint of PM and R) concerning cancer rehabilitation in Austria.[1],[10] At this department, the 'First Austrian Exercise Group of Breast Cancer Patients' during adjuvant chemotherapy has been performed and studied in 1999.[1],[13],[18] After this, the staffs were able to publish the 'Worldwide first Endurance Exercise in Metastatic Bone Disease' in 2000.[1],[23] In the same year, the 'First Austrian Out-patient Clinic for Cancer Rehabilitation' has been implemented there. In 2002, the 'Worldwide first NMES in patients suffering from metastatic bone and brain disease' has been published.[1],[24] In November 2010, the worldwide first and until yet unique interdisciplinary and multi-professional 'CCC-Tumour Board for Cancer Rehabilitation' has been implemented, where challenging cases of cancer patients are discussed with the goal to plan their rehabilitation but treatment of their cancer.[1],[10] This special tumour board has found good very acceptance and become an important interdisciplinary and multi-professional help to plan rehabilitation.[1],[10] In 2015, the so-called 'CCC-Platform for Side Effects-Management, Supportive Care and Rehabilitation' has been implemented with the intention to improve quality of care by integrating all different medical disciplines involved in cancer-specific issues and integrating different existing services.[1],[10]


  Conclusion and Future Aspects Top


Cancer rehabilitation helps cancer survivors to increase social participation and/or workability and has, therefore, to be early integrated into the cancer care continuum. It includes specific nutrition programmes, psychological strategies (psycho-oncology) and different modalities and therapies from PM and R such as exercise and the application of physical modalities.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10] Nevertheless, in the broad field of cancer rehabilitation, there are several important issues (workability and return to work, online conference tools, online exercise tools and effects and efficacy of single physical and rehabilitation interventions and of the whole-cancer rehabilitation) to study and to further develop in the future. From these, there are four shortly presented as follows:

Return to work

Many cancer survivors are able and willing to work following a cancer diagnosis. Therefore, return to work and an optimal return-to-work process is an important issue for many for cancer survivors. Cancer rehabilitation (with the field of PM and R) is a very important and necessary milestone on this way back to work.[12],[46],[48],[49],[50],[51],[52]

Online conference tools

Online conference tools, with the goal of providing competent answers, information and support from experts in their fields, about diagnosis, treatment and rehabilitation in cancer patients will be the near future for all of us to reach our patients.[53]

Online exercise tools

It seems to be essential to address barriers to exercise to plan and implement effective exercise interventions, for example, (a) in people living in dislocated regions who are not able to perform exercise in in-patient or out-patient rehabilitation centre or (b) for specific minorities (such as Turkish female breast cancer patients in Vienna) by implementing easily accessible online-exercise tools.[54]

Effects and efficacy

Cancer rehabilitation is an important issue for cancer survivors to benefit from the improvement of physical performance, nutrition, mental stabilisation and sufficient pain medicine as well as from long-term prevention and reintegration (social participation and return to work) effects.[1] Nevertheless, the effects and efficacy of single physical and rehabilitation interventions – and there is a wide range of treatment modalities – and of the whole intervention 'cancer rehabilitation' have to be studied and analysed for clinical benefits in a standardised and structured way in the future.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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