Rehabilitation is a Key Part of Cancer Treatment

There’s a moment of triumph and celebration when cancer patients ring the bell to mark the end of their treatment. But then what?

Making sure patients have the best possible experience before, during and after their cancer treatment is the top concern of physiatrist Adrian Cristian, M.D., chief of Cancer Rehabilitation at Miami Cancer Institute.

Adrian Cristian, M.D., chief of Cancer Rehabilitation at Miami Cancer Institute.

“With the advent of earlier diagnosis and more treatment options, the number of cancer survivors has been increasing which is a great thing. However, many of these survivors are living longer with the impact of the cancer and its treatment on their physical function,” Dr. Cristian says. “As cancer survivors, they see an increase in the longevity of their life, however these physical impairments can have a profound impact on the quality of their life”.

Dr. Cristian is part of a growing specialty called oncology rehabilitation. He works with Romer Bismonte Orada, D.O., in Miami Cancer Institute’s Cancer Patient Support Center, which provides a broad range of services including physical rehabilitation and pain management, oncology nutrition counseling, mental health support, comprehensive survivorship care and integrative medicine such as acupuncture, massage therapy and exercise classes.

Rehabilitation should not be an afterthought in cancer treatment, Dr. Cristian says. The sooner rehabilitative strategies are implemented, the better the results.

“Very often a patient has beaten the cancer, but is so frail and has so many physical limitations that it is difficult for them to resume their work, education, hobbies and family life” he explains. “As cancer rehabilitation physicians, we can identify whom is at risk of developing a physical impairment as a result of a combination of their pre-existing medical conditions, cancer and cancer treatment and then introduce interventions to minimize their occurrence through a “pre-rehabilitation program” or treat them early through a a rehabilitation program to minimize the impact on the quality of their life. Early identification, intervention and surveillance into survivorship are key can maximize the patients’ function and quality of life.”

Cancer patients are eager to maintain or resume their lives, and they are sometimes taken by surprise by the difficulties even after treatment, Dr. Cristian says. “They may be unable to function at work due to fatigue from radiation treatments, general weakness or short term memory loss from chemotherapy or impact from cancer treatment on arm or leg function,” he explains. “The limitations may not have been apparent when they were undergoing treatment, however are more apparent to them and co-workers and families now that they are back in their life and are facing daily challenges. Many times these physical impairments are slow to develop and can be subtle initially, until something happens that brings them to medical attention — for example, a fall in a person with weakened legs.”

The limitations patients face depend on the type of cancer, cancer treatment and stage of cancer. For example, with head and neck cancers, patients can develop problems with swallowing, swelling of the neck, and difficulty opening the mouth. Breast cancer patients may experience shoulder pain, swelling of the arms, and hand weakness and pain. Treatment for prostate cancer can result in problems with balance, bowel and bladder dysfunction and swelling of the legs.

It has been estimated that by 2030 there will be approximately 22 million cancer survivors in the United States. That’s a lot of people potentially living with impairments from cancer and its treatment, Dr. Cristian notes. “The goal is to prevent these physical limitations in the first place — however, if that is not possible, to identify and treat them as early as possible.”

Miami Cancer Institute takes a holistic multidisciplinary approach, collaborating with physical therapists, occupational therapists, speech pathologists, nutritionists, exercise physiologists and massage therapists, just to name a few disciplines.

Patients should share their struggles with their physicians and ask for help, Dr. Cristian says.

“Most cancer patients are very grateful to be alive, so they accept a “new normal” of how they move and function, even if it is painful and difficult for them to do so. But that is not necessarily how it should be,” he says. “Many of these physical impairments can improve with rehabilitative interventions and cancer patients and survivors should proactively discuss their physical limitations with their cancer providers and seek out these services to address them — not to just accept that this is their new normal. There is an abundance of scientific literature supporting the important role of exercise and rehabilitation in cancer care and our goal is to maximize physical function and quality of life.”