Studies Show Cancer Survivors’ Physical and Emotional Problems Often Go UntreatedMay 24, 2013
Cancer survivors don’t have to suffer through many of the physical and emotional side effects that often linger after treatment ends, researchers say. A new review of scientific studies finds that physical therapy and other types of rehabilitation can improve survivors’ quality of life, and urges doctors to ask patients about long-term problems they may be having so they can be addressed.
The review, published early online May 17, 2013 in CA: A Cancer Journal for Clinicians, finds that most cancer survivors are living with some kind of physical and/or emotional problem, which often goes undetected and, therefore, untreated. According to the review, such impairments can decrease survivors’ quality of life and may result in permanent disability. CA is an American Cancer Society journal.
According to recent data, 1 in 4 cancer survivors report poor physical health and 1 in 10 cancer survivors report poor mental health. In one study of 163 women with advanced breast cancer, 92% had one or more physical impairment, but fewer than 30% received rehabilitation care. Another study found that 63% of survivors of the 10 most common cancers reported the need for at least 1 rehabilitation service.
Lead author, Julie K. Silver, MD, said, “Health care professionals need to do a better job screening patients for physical and emotional help for problems they may be having. It is often up to the survivor to self-identify. We want to shift the burden away from patients and onto health care professionals.”
Rehabilitation improves quality of life
Impairments can result from cancer treatment or from the cancer itself. Common problems include pain, fatigue, nervous system dysfunction including peripheral neuropathy, bone lesions, and lymphedema (severe swelling). Patients and survivors with these problems can experience difficulty with a number of common daily activities, such as dressing, bathing, performing household chores, going to the grocery store, swallowing, and driving. If left untreated, these problems can lead to disability, inability to work, and dependence on others. The evidence shows that physical disability is likely the leading cause of emotional distress in cancer survivors.
Silver said it’s important that survivors know that care is available and is usually covered by health insurance.
She said, “Don’t accept the ‘new normal’ too soon. Make sure you are healed as well as possible – whether you’re in remission or living with a chronic condition. You want to function at the highest possible level. It’s important to advocate for yourself because there may be help you have access to.”
Studies show that rehabilitation improves pain, function, and quality of life in cancer survivors and can lessen physical and mental impairments at every stage of treatment. In one case cited in the review, a man with head and neck cancer stopped driving after he lost range of motion in his neck during treatment. With physical therapy, medication, and occupational therapy including larger mirrors and sensors that alerted when he backed up or changed lanes, he was able to resume driving.
Rehabilitation can occur before, during, and after treatment
The authors propose a model that includes screening for impairments – and treating them – beginning shortly after a cancer diagnosis and continuing even years after cancer treatment ends. The authors say survivors should be screened for both psychological and physical problems and then referred to trained rehabilitation health care professionals.
Care can be given before an upcoming cancer treatment in anticipation of a problem that is likely to occur. Examples of "prehabilitation" care include aerobic exercises, strength training, breathing exercises, nutritional counseling, and anxiety reduction therapy. The goal is to improve both physical and emotional health before cancer treatment so that people can tolerate it with fewer problems.
Silver said it’s important for doctors to ask survivors about any impairments or difficulties they may be having, because they often under-report symptoms.
She said, “Survivors tend to feel grateful to their oncology team and don’t want to be viewed as complaining too much. They may not realize there are things that can be done to help them.”
The studies show that cancer rehabilitation with a team of different kinds of rehabilitation professionals can improve pain control, physical function, and quality of life in cancer survivors. These teams typically include physiatrists (nerve, muscle, and bone experts), physical therapists, occupational therapists, speech-language pathologists, and rehabilitation nurses.
Impairment-Driven Cancer Rehabilitation: An Essential Component of Quality Care and Survivorship. Published early online May 17, 2013 in CA: A Cancer Journal for Clinicians. First author: Julie K. Silver, MD, Harvard Medical School, Boston, Mass.