Cancer survivors can benefit from rehabilitation programs offered by hospitals

Last spring, at a seminar for survivors of head and neck cancer in Minneapolis, Mary Harder looked around the room with some dismay.

Many people at nearby tables relied on feeding tubes because cancer treatments had left them unable to swallow. Others suffered from substantial impairments, such as the inability to turn their head.

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“There were several people who had exactly the same cancer as me, but their lives were much different because they hadn’t had any rehabilitation,” said Harder, 64, who eats on her own and moves her upper body with relative ease after undergoing surgery, chemotherapy and radiation for neck cancer.

Cancer rehabilitation focuses on problems that patients often experience after treatment, including fatigue, unsteadiness, pain, muscle weakness, swelling in their arms and legs, difficulty swallowing, numbness in the hands and feet, and cognitive changes.

Under guidance from therapists, patients can do such things as learn special exercises, practice walking or maintaining their balance, get deep massages that loosen scar tissue, and obtain devices that help with ordinary activities.

That kind of help can mean the difference between just surviving cancer and being able to return to work and live independently. For Harder, several months of intensive speech and physical therapy “made me feel I could do things and I had my life back again.”

As advances in cancer treatment have prolonged lives — transforming the disease for many people into a chronic condition — rehabilitation is becoming more important. Yet it remains widely underused, medical experts say, because oncologists don’t routinely ask patients about their ability to perform ordinary activities or refer patients for services. Also, while insurance plans might not limit a cancer patient’s doctor visits or tests, they often limit payments for physical, speech or occupational therapies or restrict the number of rehabilitation visits.

In a 2008 study of 202 cancer patients at the Mayo Clinic in Rochester, Minn., researchers observed that 66 percent reported a functional impairment — most commonly, a problem with walking or balance. But only 6 percent of these deficits were documented by physicians in patients’ medical charts, and only two patients received referrals to rehabilitation services.

Similarly, a 2008 study of 150 patients impaired by metastatic breast cancer found that only 21 percent of the impairments — including weakness, swelling, muscle scarring or shoulder pain — received physical or occupational therapies.

Potential for improvement

“We don’t systematically screen for functional problems,” said Andrea Cheville, director of cancer programs in the department of physical medicine and rehabilitation at the Mayo Clinic, and, as a result, cancer survivors’ issues aren’t being addressed early on, when opportunities for improvement are most significant.

Research is just beginning to document how much potential for improvement actually exists.

In a notable finding published in 2009 in the New England Journal of Medicine, Cheville and researchers at the University of Pennsylvania looked at breast cancer patients with lymphedema, a type of swelling caused when the lymph nodes are damaged or removed in the cancer treatment. They found that patients who lifted weights in a structured rehabilitation program experienced improved strength and had fewer symptoms compared with a control group.