The 5 Phases of Cancer Rehab: Start Where You Are.
PERSONALIZED REHAB TOOLS FOR ALL 5 CANCER REHAB STAGES
Each cancer journey is a stand-alone tale; the psychological and physical symptom burden varies immensely for each patient. A personalized approach to treatment is there for gold standard. Treatment needs to be tailored to the individual, as does the cancer rehabilitation plan. I spoke to this in my blog on personalized medicine in cancer.
As each cancer rehab journey looks a little different, I often get asked different questions such as “what is cancer physio exactly; is it just helping with stiffness, pain and returning to exercise after treatment is over? Isn’t cancer rehab only for after treatment is over?”. The traditional concept of physiotherapy includes pain management and much of the above but in the context of cancer rehabilitation, let’s re-imagine the role of rehab in cancer into 5 phases
Cancer physiotherapy or cancer rehab takes place along the entire cancer journey. Cancer rehab planning can start immediately after diagnosis, known as ‘Prehab’, continue into treatment and long into recovery. Often side-effects can be prevented or better yet diagnosable conditions, adding clinical valididty as to why you are experiencing a symptom burden. Feeling an absence of motivation, fatigue, pain, stiffness, trouble exercising or dizziness are all common and a cancer rehab plan can help.
Treatment related side effects are common, we call this the symptom burden. These symptoms are often diagnosable such as chemotherapy induced peripheral neuropathies, vestibular neuropathies, dopamine loss related symptoms, cancer related fatigue or hormone therapy related joint myalgia amongst others. Diagnoses matter when trying to return to work, returning to activity, or if you’re hoping to qualify for disability benefit.
CONDITIONS WE TREAT:
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Prehab concerns, post-operative swelling, post-operative pain,
muscle weakness, joint stiffness or pain (arthralgia and myalgia)
adhesive capsulitis, rotator cuff strain, axillary chording and thoracic chording
scar adhesions, scar related pain amongst others.
lymphedema risk management
concerns about return to work and sport
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neuropathies, neuropathic pain, chemotherapy induced peripheral neuropathies
spinal accessory nerve neuropraxia, long thoracic nerve palsy, spinal accessory nerve palsy
cranial nerve dysfunction and many others
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dizzyness, balance concerns, nausea, light-headedness, exertional/exercise sensitivities, chemotherapy induced vestibular neuropathies, BPPV, vertigo amongst others.
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Chemotherapy induced muscle wasting (cachexia), cardio-toxicity and neurotoxicity
cancer related fatigue
chemotherapy induced peripheral neuropathies, chemotherapy induced vestibular neuropathy, neutropenia/NADIR (other blood cell deficiencies)
concerns about return to work and sport
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radiation fibrosis syndrome including but not limited to: adhesive capsulitis/frozen shoulder, cording, scar tension/pain, shoulder stiffness/pain, neck stiffness/pain, lymphedema,
radiation induced vestibular neuropathy
pneumonitis, changes in bladder/bowel functioning,
neuropathies amongst others.
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AIMS (aromatase Inhibitor musculoskeletal syndrome):
nausea, hot flashes, sleep disturbances, joint pain/stiffness, osteopenia, sexual dysfunction,
concerns about return to work and sport
An accurate diagnosis of side effects can allow for the right cancer rehab plan, in addition to medical creditability and effective medical reporting when applying for short- or long-term disability status. Together, let’s demystify what cancer physiotherapy has to offer. Below is a summary of cancer rehab into 5 phases; we strongly believe we can help.
Find Your Phase; Start Where You Are.
PREHAB PHASE
Immediately after diagnosis and prior to treatment is considered within the prehab phase. Although many wonder why this phase is necessary, being prepared as opposed to crisis oriented can be very helpful. Think of it like having a trail map before you get lost; prehab is about having a sense of preparedness. According to cancer rehab research in the breast cancer population, prehab planning has important impact on preserving shoulder function and lessening treatment related complications.
Diagnostics are often included in this stage and may involve detailed imaging, blood work, genetic testing, tissue biopsies and a lumpectomy or lymph node dissection. You will likely obtain your cancer type, stage and grade. As an example, in the case of breast cancer, you may learn whether your tumour is estrogen, progesterone or HER 2+.
Questions may arise for you prior to treatment; together as part of the prehab phase we can discuss the possible impacts of treatment and provide you with a sense of preparedness. We may also discuss future planning rehab tools; post-operatively you may just not want to leave the house very much so it can be imperative to have a plan.
Often, it is within the prehab phase that the treatment plan is discussed with your medical oncologist; a personalized medicine approach and whether to pursue genetic analysis is often discussed. In the realm of breast cancer as an example, a genetics assessment may be warranted to determine whether susceptibility genes such as BRCA 1 or 2 amongst others, may be involved. The duration, genetics and intensity of treatment pathways vary. Accessing cancer physio support in the prehab phase can provide a sense of preparedness for what may be ahead and a sense of control right from the start.
Cancer Rehab Can Help in the Prehab Phase
Cancer rehab support in prehab may include the following:
Baseline assessments (orthopaedic, function, balance, cardiovascular and neurological)
Future planning: providing a personalized rehab plan to optimize outcomes prior to treatment
Time to answer questions
Reaching out for rehab support during the prehab phase can help you feel assured that you’ve made informed decisions and feel prepared for what may be ahead.
Experience Preparedness
TREATMENT PHASE
The treatment phase is personalized according to cancer type, stage, grade and at times genetics. For some, it may start with a lumpectomy or lymph node biopsy around the area of concern. For others it may start immediately with systemic chemotherapy or targeted therapies.
Treatment may include surgery, radiation, chemotherapy and hormone therapy amongst others. This phase is often coupled with a symptom burden and the need for support. Difficulty can arise when there is great need for support, but energy is little. When undergoing treatment, patients often struggle finding the stamina to reach out for help.
Cancer rehab Telehealth support can be very helpful for those that feel stuck at home and overwhelmed. Cancer rehab support through Telehealth or In-Clinic, can provide rehab planning to support the following:
Joint or muscle pain
De-conditioning and breathlessness
Dizziness and lightheadedness
numbness, tingling or pain in the fingers or feet
Fatigue
Neutropenia, radiation side effects and more
Cancer Rehab Can Help with Chemotherapy
Chemotherapy is often a very challenging time for most patients. Systemic chemotherapies may cause neutropenia, cardio-toxicity, chemotherapy induced peripheral neuropathies, nausea, vestibular neuropathies and cancer related fatigue amongst other conditions. Targeted chemotherapies may cause symptoms such as mucosal irritation, gastritis, soft tissue inflammation and joint pain.
Despite this being a very difficult phase, a personalized rehab plan help. We offer vestibular assessments for any concerns with dizziness or unsteadiness, neuropathy assessments for any concerns relating to sensory changes and orthopaedic assessments for cancer related pain, de-conditioning or fatigue.
A post chemotherapy assessment can be very helpful in obtaining baseline information on how the chemotherapy treatments may have effected you. You have some changes to your vestibular system, causing you to ‘feel like you’re on a boat’, or some persistent numbness in your hands and feet. An assessment can allow us to diagnosis appropriately, track change and provide a rehab plan personalized to your needs.
Cancer Rehab Can Help with Radiation Treatment
The treatment phase may also involve radiation. During radiation, mobility of the treatment area, and the health of the underlying soft tissue and/or viscera may be impacted. A rehab plan offers clinical monitoring for possible complications while optimizing outcomes. Post radiation, while in the proliferation phase of healing, rehab is very important to prevent the onset of radiation fibrosis syndrome. Risk of complication continues post radiation up to 2-6 months post hence rehabilitation continues to have a vital role.
Cancer Rehab Can Help with Hormone Therapy
Hormone therapy may be part of your treatment pathway and impacts patients very differently. The most reported symptoms from a survey of over 6000 cancer patients was fatigue, hot flashes and joint pain. It’s good to understand statistics and aim for preparedness, yet still take it one step at a time. If needed, a cancer rehab plan can help better manage fatigue, nausea, joint arthralgia, sleep hygiene and other symptoms.
Cancer rehab support in the treatment phase may include:
Baseline assessments (orthopaedic, function, balance, cardiovascular and neurological)
Post-chemotherapy assessment
Future planning: a personalized rehab plan provided proactively to optimize treatment related outcomes of surgery, chemotherapy, radiation, or other treatment(s).
Time to answer questions, relating to current symptom burden or future planning.
Personalized rehab plan to manage the current symptom burden.
Salient goal setting, safe exercise and working within your energy envelope.
Treatment can feel riddled with setbacks; reaching out for cancer rehab support via Telehealth can help provide diagnoses for these cancer related conditions, tools to better manage it. We will meet you where you are at, with clinical expertise and care whatever your treatment pathway looks like.
RECOVERY PHASE
The term ‘recovery’ is fluid; it often refers to when patients have completed their treatment pathway (surgery, chemo and/or radiation). In addition, scans may have been completed indicating that the cancer responded favourably to treatment. While in the recovery phase, some patients may start new medications such as Tamoxifen, Anastrozole and other hormone therapies or start taking medications such as bisphosphonates.
The term ‘recovery’ can feel misleading for many patients as the cancer journey and symptoms continue. For some patients there is a clear transition from treatment to recovery, and outcomes that bring optimism while others may find the transition to recovery unclear. Recovery for many may still involve regular diagnostics, long term medication and a heavy symptom burden.
Cancer Rehab Can Help in the Recovery Phase
Often when the pace of treatment comes to a standstill, the symptom burden comes to the forefront. I often hear from patients that it is treatment ends that the toll of it all becomes more apparent. Conditions such as radiation induced fibrosis, adhesive capsulitis, chemotherapy induced peripheral neuropathies, vestibular neuropathies and cancer related fatigue may have a delayed onset.
Together we can assess any symptoms that you may have such as dizziness, fatigue, pain or numbness and diagnose your condition. Together we can then personalize your rehab plan.
Although it’s optimal to have started cancer rehab in the prehab phase, it’s never too early to get support or to late!
Post-Chemotherapy Assessment= Understand Your Condition + Get Personalized Rehab Tools
RETURN TO WORK PHASE
Discussions around returning to work can be exciting but also overwhelming. Sometimes the focus on treatment can mean that rehabilitation was put a side and you may be left with symptoms; feeling confused about how to approach returning to work.
Returning to work may seem like a daunting task especially if when you are feeling de-conditioned, fatigued or limited by other symptoms. Together we can work with your insurance provider to create a graded return to work plan providing medical reports. Even with little symptom burden, returning to work can involve a steep adjustment that is best suited with a gradual return.
Cancer Rehab Can Help in the Return to Work Phase
Often health insurance providers, Canadian Pension Plan (CPP), Service Canada and employers require documentation from you about your disability/diagnosis and want you to prepare for a return to work. They may ask that you to complete various functional evaluations, medical reports or a return-to-work plan.
Together, at the cancer physio we can collaborate completing the needed medical reports, providing accurate diagnoses representing any conditions that you may have. Sometimes patients are not aware of their poor stamina, physical de-conditioning, or vestibular neuropathies and benefit from a functional evaluation that makes for a safe and realistic return to work plan.
Together we can assess your current physical abilities and create a return-to-work plan that is right for you.
In some cases, a cancer journey may have significant symptom burden, creating many long term functional, physical and mental barriers. Therefor, some patients qualify for long term disability and have chosen not to return to work for 6 months or more. At times, patients try to return to work and have unmanageable difficulty doing so.
In the above scenarios, you may qualify for long term disability from your health insurance provider, employer or CPP. As an example, Service Canada may offer a long-term disability benefit that you can apply for online. They will also request a medical report for Canadian Pension Plan Disability Benefit (ISP-2519). After having completed a cancer rehab initial assessment, we can complete the ISP-2519 report, outlining your diagnoses associated with your treatment side effects. We can spend 60 min one: one completing baseline assessments (orthopaedic, function, balance, cardiovascular and neurological) assuring that your physical ability and disability is comprehensively documented.
Medical Reports Provided:
ISP-2529 CPP Disability Benefit
GRTW planning for Canada Life, Sunlife, Pacific Blue Cross and other extended health case managers
Physician and oncology progress reports
Letter to employers on GRTW, modified duties and modified scheduling
Functional evaluations for return to work
Whether you are wanting to return to work or concerned about doing so, together we can create a return to work plan or disability report that is personalized to you.
ACTIVE LIVING PHASE
Completing treatment can feel exhausting; hence after some time spent in recovery, often patients then have the mental and physical energy to start finding themselves again. This can take the form of exploring activity, returning to a sport they once enjoyed, or setting new physical goals.
At times there are some side effects and symptoms that aren’t in the forefront but upon exertion or with exercise can resurface. The Guidelines on exercising safely with cancer (link to download document) whether in treatment or in recovery requires some monitoring. I answered many common questions on exercise and cancer in a previous blog. As an example, hormone therapy may cause joint arthralgia, chemotherapy may have a cardio-toxic effect or cause dizziness and radiation can impact lymphatic drainage and joint mobility. Symptoms that may occur with a return to exercise may be but aren’t limited to:
Breathlessness
Poor balance
Abnormal heart rate response
Abnormal resting heart rate
Increased joint pain
Light headedness or dizziness
Fatigue or push/crash cycling
Clinical support can be effective in managing the above symptom burden. Yet so, some patients find themselves feeling good after treatment and don’t have a need for a rehab plan. At times some patients are only need some clinical support with exercising safely or support with making exercise a habit.
Whether your symptom burden is limiting or not, together we can get you back to the activities you love such as walking your dog, cross fit, cycling or paddle boarding.
Cancer rehab support in the active living phase may include:
Baseline assessments (orthopaedic, function, balance, cardiovascular and neurological)
Time to answer questions
One: one access to an oncology physiotherapist and cancer exercise specialist
Personalized rehab plan and/or safe exercise guidance
Goal setting, setting short- and long-term activity goals.
Whichever of the 5 phases cancer rehab that you may find yourself in, start as you are. Let’s take it one step at time, team up and find some tools that work.
Thank you for your interest in science and rehab,
Kindly, The Cancer Physio
