What is Cancer Rehab?
If you’ve been diagnosed with cancer, you will likely work with a lot of different people who make up your cancer care team. Think of these providers as your “dream team” - they each specialize in a particular area to manage different aspects of your care.
Depending on the type of cancer you were diagnosed with, what treatment was recommended, and what your particular needs are, you may work with oncologists, radiation oncologists, surgeons, social workers, dietitians, mental health providers, or rehabilitation providers including physical therapists.
Oncology physical therapy (PT), or cancer rehabilitation, is focused on improving and optimizing physical function before (called prehabilitation), during, and after cancer treatment. There is more and more research supporting the role of PT for people living with cancer, but unfortunately, many people still aren’t aware that PT can help decrease the severity of side effects from cancer and cancer treatment.
Originally recognized as a specialty area by the American Physical Therapy Association (APTA) in 1983, oncologic PT is a newer specialty area. However, it is a growing field with over 1,400 practitioners in the APTA Academy of Oncologic Physical Therapy and as of 2019, the American Board of Physical Therapy Specialists approved the Board-Certification in Oncologic Physical Therapy. Onwards and upwards!
What conditions are treated in oncology PT?
Because the effects of cancer and cancer treatment can be experienced both acutely and long-term, PT can help at all time points throughout your cancer survivorship, starting from the point of diagnosis. There are various areas within oncology that PT’s can specialize in, from working with kids who are living with cancer, to treating lymphedema, to working with people who are getting treatment in the hospital (acute care). Since I treat adults in the outpatient setting, I will be focusing on commonly seen outpatient conditions. This is not an all-inclusive list, but the more common diagnoses and symptoms related to cancer and cancer treatment are:
Lymphedema
Pain
Weakness
Deconditioning
Decreased range of motion and flexibility
Difficulty with mobility including walking
Balance issues
Pelvic health concerns: bladder and bowel dysfunction, pelvic pain, sexual dysfunction
Radiation fibrosis
Neuropathy including Chemotherapy Induced Peripheral Neuropathy (CIPN)
Axillary web syndrome (cording)
Scar tissue
Fatigue
What should I expect at my first visit with an oncology PT?
At the initial evaluation with your oncology PT, a thorough discussion about your medical and surgical history as well as specifics about your past cancer history and treatments will be performed. It’s important to bring the following information with you to your first visit:
Your previous or current cancer diagnosis including the stage
Previous or current cancer treatment
Any upcoming cancer treatment
Your oncology PT will ask questions about your symptoms including:
What are the main difficulties and limitations you are experiencing?
When did the symptoms start?
What makes your symptoms better or worse?
After the subjective history is complete, a physical musculoskeletal examination is performed which may include looking at:
Posture
Functional movements like squatting, lifting, bending, getting in and out of bed
Strength testing
Flexibility and range of motion
Cardiovascular fitness
Joint mobility
Balance
Sensation and reflexes
Palpation (touching) structures like muscles, scars, ligaments, tendons, and bones
Breathing mechanics
Skin and tissue health
Special tests to rule in or rule out certain conditions
Once the musculoskeletal examination is complete, an additional assessment for lymphedema may be performed. A lymphedema examination can include:
Measuring the affected and unaffected limbs (arm or leg) to compare their sizes, or measuring the affected area (head and neck, chest, or abdomen)
A thorough assessment of the tissues and type of swelling to determine the stage of lymphedema (how severe it is)
What kind of treatment is performed with oncology PT?
The type of interventions and treatments recommended will depend on your symptoms and what the examination findings are. Treatment may include:
Education on:
Condition and prognosis (the predicted course of your condition and symptoms)
Dietary considerations
Pain science (what is your pain experience, how does it impact you, and how to manage it)
Posture and ergonomics
Behavioral and lifestyle recommendations
Complete Decongestive Therapy - this is the gold standard treatment for lymphedema (stay tuned for a future blog post all about lymphedema treatment!)
Stretching and mobility exercises
Strengthening and stabilization exercises
Pelvic floor muscle exercises (kegels, reverse kegels, functional kegels) if you’re having pelvic health concerns
Manual therapy to address joint and soft tissue restrictions, cording, and radiation fibrosis
Electrical stimulation to help with pain or strengthening
Balance exercises
Orthotic and prosthetic training
Functional and job duty re-training
How do I find a specialized oncology physical therapist near me?
Because this is still a small (but fast-growing!) specialty area, it can be difficult to find a qualified therapist. Here are some great resources to get you started:
American Physical Therapy Association (APTA) - any physical therapist or physical therapist assistant who has additional training in cancer rehab
American Board of Physical Therapy Specialties (ABPTS) - Board-Certified Oncologic Physical Therapists
Lymphology Association of North America (LANA) - therapists specializing in treating lymphedema
Given all the benefits of working with a PT as a cancer survivor, make sure you’ve got a qualified PT on your “dream team”!
