The roles of physical therapists are diagnosing functional limitations, participation restrictions, and other impairments in cancer patients. They also provide interventions that play a significant role in preventing restrictions or compensating for permanent deficits, says Shari Berthold, DPT, of Susquehanna Health in Williamsport, Pennsylvania, during the 2nd Annual Oncology Nurse Advisor Navigation Summit in 2016.
The Importance of Physical Therapy in Cancer Recovery
“Many people think of physical therapy as an intervention for sports-related activities or muscle and bone injuries,” explained Sharlynn Tuohy, PT, DPT, MBA, the Director of Rehabilitation at Memorial Sloan Kettering Cancer Center, to Cancer.Net. “However, physical therapists are adept at treating a variety of functional impairments related to issues with the heart and lungs, nerves, skin, pelvic floor, and inner ear,” she added. In general, physical therapists can provide cancer patients and survivors with a variety of individualized interventions to help improve their quality of life.
The Effect of Physical Disabilities in Cancer Survivors
A major cause of emotional distress among cancer patients is physical impairment. In fact, being disabled contributes to higher levels of emotional distress compared to receiving a diagnosis of cancer. Physical therapy focuses on optimizing health by improving an individual’s ability to move. Furthermore, physical therapists customize interventions based on each patient’s ability and level of function.
“One of the most important things I inherently do for my patients is to read the situation I am walking into without them needing to explain,” shared Jean Kotkiewicz, PT, DPT, CLT, supervisor and inpatient physical therapist at MSKCC. “I tailor my treatments accordingly. I allow them to have control over their goals in a setting where their control over the situation is vastly limited. I listen, and I hear. I am creative. I ask what is important to them. I have respect.”
Barriers That Prevent Patients From Seeking Physical Therapy
According to Berthold, oncology or cancer rehabilitation is cost-effective since it reduces both direct and indirect expenses, as well as improves a patient’s physical and psychological quality of life. However, Berthold expressed her concerns about the many unmet rehabilitation needs of cancer patients.
- The patient-centered barriers that lead some cancer patients to omit participation in rehabilitation services are often associated with the patient’s cancer symptoms (loss of appetite, fatigue, incontinence, etc.), certain treatments for cancer (radiotherapy-related skin sensitivities, immunosuppression, poor body image, etc.), as well as a general lack of time due to attending multiple doctor’s appointments.
- The clinician-related roadblocks to oncology rehabilitation include underdiagnosis of impairments, reliance on the patient to identify impairments on their own, and failure to screen at baseline. A weak or nonexistent interface between cancer and rehabilitation services can cause a patient to exclude the need for rehabilitation in their palliative care plans.
- The other barriers include having insufficient physical therapists and facilities near the patient, the costs of using rehabilitation services, and excessive co-pays. Some patients may feel overwhelmed and are unsure of how to get started.
Despite the hindrances, a clear and simple recommendation from a patient’s doctor to exercise may encourage participation. The availability of a program overseen by trained professionals in a hospital may provide patients a push in the right direction, especially if their lifestyles were previously sedentary. Support groups and having one or more exercise partners can likewise help facilitate participation in beneficial physical activities.
The Stages of Effective Physical Therapy
Berthold explained that rehabilitation is effective at three stages: (1) the time between diagnosis and initiation of treatment (prehabilitation); (2) during active treatment; (3) while managing the patient’s disorder as a chronic condition following active treatment.
- Prehabilitation intervention in between diagnosis and before treatment begins can help identify a baseline and foresee future impairments. It also reduces feelings of fear and anxiety, builds reserve, and helps establish a healthy relationship between a patient and their therapist. Furthermore, prehabilitation is an opportunity for physical therapists to educate patients on adverse signs and preventive strategies. For example, evidence suggests that swallowing exercises may be beneficial to patients with head and neck cancers. A physical therapist can instruct a patient on how to perform such exercises before treatment begins.
- During active treatment. The many benefits of physical therapy during cancer treatment include better aerobic capacity, improved strength and range of motion, less pain, more energy, and reduced shortness of breath. The psychological benefits include improved mood and emotional well-being, increased self-efficacy, less anxiety and depression, and higher self-esteem. Moreover, physical therapy reduces the risk of bone loss, recurrence of cancer, and secondary disorders such as diabetes and cardiovascular disease.
- Physical therapy during chronic care helps prevent anticipated declines in quality of life. Early mobilization leads to less postoperative pain, quicker return to daily activities, and fewer complications.
How Often to See a Physical Therapist
Some cancers and their treatments can lead to loss of functional ability and reduced quality of life. To manage cancer as a chronic condition, patients need to meet the recommended 150 minutes a week of moderate activity with strength training at least twice a week. A physical therapist can help achieve this goal.
How Physical Therapy Benefits Cancer Patients
Rehabilitation helps patients move away from illnesses and toward healing and recovery. It also allows patients to regain a sense of normalcy and rebuild structure in their daily life. Survivors who work with physical therapists and see improvements in their mobility also have lower rates of cancer recurrence and enhanced quality of life.
“Physical therapists provide a healing touch,” said Tuohy. “We also help an individual regain their confidence. Being diagnosed with cancer creates a vulnerability that may not have existed before, and it can really shake an individual’s confidence. Individuals benefit from achieving small successes through my positive and encouraging attitude.”
Do You Need a Physical Therapist?
Physical therapy should be a standard part of your treatment program. If you are looking for an alternative cancer treatment facility with an in-house physical therapist who can help you regain your bodily functions pre-diagnosis, New Hope Unlimited can provide the medical care you need and more. Call us today at 480-666-1403 to schedule a consultation with our team.