Our aim is to assist the person with cancer in achieving maximum physical functioning within the limits imposed by their disease or treatment.
The role of physiotherapy in oncologic rehabilitation includes restoring function, reducing pain, reducing disability, increasing endurance and mobility and ultimately, improving quality of life. It is vital to the holistic care of the patient to address the physical and psychological complications.
Management is very dependent on the patient’s gender, age, occupation and the location of the cancer.
Physiotherapy in the field of oncology is a continuously evolving and developing specialty. We work as part of a multi-disciplinary team and set realistic goals with the patient. We also help people to adapt to their changing condition.
Well-being
A person’s well-being is dependent on many factors. They include the control of symptoms, the level of independence, functional ability, a patient’s ability to communicate, her psychological and emotional state, her degree of selfconfidence and self-esteem and her ability to cope.
Physiotherapists aim to maximise a patient’s independence and reduce the extent to which cancer interferes with a person’s physical, psycho-social and economic functioning.
They also offer patients and their carers the opportunity to develop coping skills and strategies that can assist in managing a changing physical status as the disease progresses.
This is in addition to addressing significant psycho-emotional issues such as anxiety, loss of confidence or low self-esteem. Physiotherapists encourage patients to develop a constructive approach to living with illness and/or the effects of treatment. This impacts positively on her well-being and her quality of life.
Lymphoedema
Lymphoedema is a common complication in patients post mastectomy, trauma and post-radiation fibrosis. It is the collection of lymph fluid in the connective tissue and results in pain and limitation of movement.
Physiotherapy management of lymphoedema includes:
Massage – Oedema massage facilitates the movement of lymph fluid to the nearest lymph nodes for drainage.
Exercise – Muscle contraction facilitates the movement of fluids proximally.
Kinesio taping, this is very beneficial in the treatment of lymphoedema.
Cancer-Related Fatigue
Cancer-Related Fatigue (CRF) is one of the most common and distressing symptoms of cancer. It affects 70-100% of patients. Because CRF impacts on the functional ability of patients, it is a primary concern to physiotherapists.
Studies have shown that exercise has the strongest evidence base for treating CRF. Decreased activity levels are a contributing factor of this symptom. Physiotherapists screen patients for fatigue, and assess activity levels. Exercise advice and initiating exercise programmes is done with patients.
Exercise
It is important to maintain a basic fitness level, both during and after any cancer treatment(s). It has always been believed that ‘rest is best’. Many studies have demonstrated the physical and psychological benefits of a well designed exercise programme. Exercise can also help alleviate the many side-effects of cancer treatments and help patients improve their quality of life and functioning.
Exercise programmes should be:
• Individualised and based on comprehensive assessment.
• Focused on maintenance during treatment and on improvement post-treatment.
• Concentrated on all aspects of fitness and ‘whole-body’ workouts.
• Based on moderate intensity levels.
• Working towards goals identified by the patient.
• Include regular re-assessment and review.
Pain
Pain is complex and multi-dimensional and requires a multi-disciplinary team approach. Physiotherapists play an important role in pain management. The physiotherapy assessment includes a description of the pain, responses to the pain and the impact of pain on both patient and care-givers. The physiotherapist will take into consideration the main functional restrictions of the patient and focus on what the patient identifies as the main goals of management. Treatment techniques include:
• Therapeutic exercise.
• Postural re-education.
• Massage and soft tissue mobilisation.
• Transcutaneous Electrical Nerve Stimulation.
• Heat and cold packs.
• Dry needling.
• Relaxation techniques.
• Cognitive-behavioural therapy.
Breathlessness
Breathlessness is a devastating and common symptom in advanced cancer. This is usually poorly controlled and causes significant distress to patients, carers and families. Interventions may include:
• Non-pharmacological techniques including the use of a hand-held fan.
• Relaxation techniques.
• Adjustment positioning.
Written by Nicole Redman