Cancer Rehabilitation

• Patients with cancer are living longer due to early detection, better treatment options, and improved medical management.
• Cancer is the second leading cause of death in the US and the Philippines.
• The most common cancers include breast, lung, colorectal, liver, and prostate.
• 189 out of every 100,000 Filipinos are afflicted with cancer.
• Cancer is the 13th most common cause of self-reported disability.
• Throughout the years, detection and treatment of cancer has improved, leading to increased survival rates.
• Rehabilitation goals for cancer patients include restorative, supportive, preventive, and palliative care.

Functional Decline in Palliative Care

• The disease progresses, some patients get well, but some decline.
• The vertical axis represents functioning, while the horizontal axis represents life as the condition progresses.
• A significant medical event can cause a patient's functioning to decline, but treatment may improve it, or it may continue to decline until death.
• Supportive and Palliative goals target chronic or life-limiting illnesses.
• Restorative rehab aims to return patients to a previous level of function.
• Preventive rehab attempts to prevent avoidable deterioration in function related to disease or treatment.
• Supportive rehab maximizes functioning, independence, and participation in meaningful activities
• Palliative rehab supports people in adapting to irreversible changes in function and helps them 'habilitate' to their new reality.
• A goal of modern palliative care is to enable patients to live as actively as possible
• The prognosis and the patient's tolerance should factor into decisions about inpatient rehab.
• Even with a poor prognosis, inpatient rehab can be beneficial if functional gains are expected.
• Functional gains for patients in advanced stages should include family/caregiver training.
• Cancer occurs more often in individuals older than 65.
• As people age, cancer cells are more likely to activate.
• Relative survival rates for cancer have increased significantly between the 1950s and the late 1990s.

Karnofsky Scale

• The Karnofsky Scale classifies functional impairments and performance status in serious illnesses.
• The Australia-modified Karnofsky Performance Status (AKPS) is used for more accuracy, differing only in description.
• Functional gains from inpatient rehab can be maintained three months after discharge.
• Initial improvements can be expected to continue for at least three months after discharge.
• Chemotherapy, radiation therapy, and specific tumor type do not have adverse effects on rehabilitation outcome
• Cancer patients have a higher incidence of transfer back to acute care from rehab

Rehabilitation Priorities

• Rehab priorities during cancer treatment include initial diagnosis, surveillance, recurrence, and temporization.
• Initial diagnosis focuses on detecting and managing acute morbidities, addressing physical impairments, and assessing patient strengths and limitations.
• Surveillance involves physical reconditioning, detecting and addressing delayed toxicities, and promoting reentry into vocational, social, and family roles.
• Recurrence includes screening for cancer treatment toxicities and proactively managing early-stage impairments.
• Temporization involves controlling symptoms and preventing and proactively addressing disablement.

Rehabilitation Priorities During Treatment

• Palliative care aims to preserve community integration and provide support and education for caregivers and family members.
• The goal is to maintain functional autonomy as much as possible.
• Prognosis and patient tolerance should be considered when making inpatient rehab decisions.
• Poor expected long-term survival is not a contraindication if functional gains are expected.
• Functional training should include family/caregiver training

Five-Year Survival Statistics

• Five-year survival rates vary for different cancers, with rates decreasing significantly when metastasis occurs.
• Breast cancer has a high five-year survival rate if it doesn't metastasize, while prostrate cancer has good prognosis in geriatric patients.
• Rehabilitation addresses musculoskeletal problems like lymphedema, contracture, pain, mobility, ADLs, and self-care.

Biofeedback

• Biofeedback training helps individuals control their brain and body's stress responses through special sensors and real-time feedback.
• Stress responses will improve automatically with regular practice.
• Biofeedback training can help with anxiety, depression, chronic pain, headaches, and irritable bowel syndrome.
• Biofeedback can aide certain conditions

Bony Metastatic Disease

• Metastasis to the skeleton is problematic for clinicians.
• Metastasis makes movement difficult and painful.
• 80% of bone metastasis is attributed to breast, lung, prostate, kidney, and thyroid cancers.
• Osteolytic bone metastases destroy bone, while osteoblastic bone metastases cause bone to become denser.
• The highest rate of osteoclastic activities can occur in lymphoma, myeloma, thyroid, and renal cell malignancies.
• Metastatic bone pain is insidious, unrelenting, and not associated with trauma or activity.
• Common areas include the thoracic spine and shaft of femur.

Bone Scans

• Bone scans help detect and identify bony metastasis
• MRI is used for patients with localized pain, equivocal scan, or neurologic impairment.
• PET scans are used when the lesion is osteoclastic.
• Survival rate after metastasis is from 21-33 months.
• Management: protection, pain control, energy conservation, and maintenance of function.
• Exercise should focus on strength, endurance and function.
• The three phases of bone imaging evaluate vascular flow, blood pool activity, and delayed bone uptake.

Cancer-Related Fatigue

• Cancer-related fatigue is a great challenge for PTs as patients may not meet high activity levels.
• Fatigue should be assessed and treated.
• The FACIT Fatigue Scale is used to measure the impact of fatigue on ADLs with higher scores indicating better QOL.
• Common factors include pain, emotional distress, sleep disturbance, anemia, nutritional deficiencies, deconditioning, and medical comorbidities.
• Strengthening endurance programs, nutritional management, and sleep optimization can all help

Precautions for Fatigue

• Reversible sources of cancer fatigue include anemia, insomnia, cytokine release, hypothyroidism, hypogonadism, and depression.
• Interventions are not exclusive for any professional.
• Exercise helps improve CV endurance, VO2max, quality of life, depression, anxiety, and immune functions.

Exercise For Cancer Patients

• Obesity has been associated with increased risk of death for cancer
• Adults are recommended to get 30 minutes of moderately vigorous exercise on 5 or more days of the week with a min of 150 per week
• Cycle ergometry is favored due to being less weight bearing and easier.
• Unrestricted exercises can be pursued with >30-50k platelet count.
• If platelet count is lower, we have to be more careful.
• Active therapy should not be advocated with platelet count <10k due to possible bleeding issues.
• Chemotherapy patients can sustain premature cardiac damage, leading to reduced exercise, abnormal waves and exercise induced hypertension.

Neurologic Complications of Cancer

• Metastatic brain disease is a common catastrophic neurologic impairment in cancer patients.
• It occurs most frequently with lung, breast, colorectal, melanoma, and genitourinary cancers.
• Spinal cord involvement occurs is some patients.
• Polyneuropathy can be chemotherapy-induced

Radiation-Induced Tissue Damage

• Radiation Therapy has acute and delay side effects that can affect different parts of the body
• Lymphedema is associated with malignancy.
• Skin care, stretching, and soft tissue mobilization to proximal limbs is important

Cancer and Nutrition

• Serum albumin <3g/dL is cause of malnutrition
• More commonly a side effect of treatment

Breast Cancer

• Most common malignancy in women
• Post Surgical Pain

Head and Neck Cancer

• Head and neck cancer presents as Squamous cell carcinoma where alcohol and tobacco use are main cause
• Causes Swallowing dysfunction → loss of oral intake, weight loss, fatigue, decreased survival
• Radiation treatment side effects are Mucositis and Xerostomia

This lesson covers various aspects of cancer rehabilitation, including Karnofsky scale interpretation, rehabilitation goals tailored to specific patient needs, focus during different treatment phases, biofeedback applications, exercise program considerations and appropriate imaging techniques.