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UAB Cancer Rehab Program Helps Patients Overcome Complications

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Rehabilitation therapy helps people recover from many medical conditions, such as stroke, heart attack, and injury. Rehab for patients with cancer is equally valuable, but it isn’t often used in the United States. The new Cancer Rehabilitation Program, developed by physicians in the UAB Department of Physical Medicine and Rehabilitation, seeks to change that at UAB Medicine.

Numerous national health organizations and researchers now recognize rehabilitation as a necessary part of cancer care. Cancer and its treatment often cause physical and mental problems that can lead to long-term disability, additional health conditions, and a lower quality of life. Rehabilitation helps cancer survivors and their families deal with the complications that arise from those issues.

Studies show that multidisciplinary cancer rehabilitation — which often involves a team of rehabilitation specialists that includes physiatrists (rehab physicians), physical therapists, occupational therapists, speech-language pathologists, and rehabilitation nurses — improves pain control, physical and mental function, and emotional wellness.

UAB Physical Medicine and Rehabilitation physician and Interim Department Chair Danielle Powell, MD, MSPH, says rehab is not used often enough in cancer care, despite the proven benefits.

“Nationally, we still face the issue that most survivors are not referred to rehabilitation services,” Dr. Powell says. “One study of patients with metastatic breast cancer indicated that 92% of them had one or more impairments that would benefit from cancer rehab, but only 47% were actually referred to a rehabilitation clinic. Part of our goal with this new program is to make sure that oncologists know our service is available and that they refer patients accordingly.”

Beyond Managing Symptoms

As the program has developed over the past year, Dr. Powell has been seeing patients referred by oncologists at her outpatient clinic in UAB Spain Rehabilitation Center. These patients have functional issues due to pain, reduced mobility, and fatigue, which are common complaints among cancer survivors. Some develop neuropathy (a nerve condition that causes pain, numbness, and muscle weakness), which is among the most common side effects from chemotherapy and other cancer treatment regimens. Patients undergoing treatment of pelvic cancers (such as cervical, uterine, and prostate cancer) often require restorative care for incontinence, pelvic pain, and impaired sexual function.

The role of rehabilitation in cancer care goes beyond symptom management. Restoring a patient’s ability to tolerate physical stress can sometimes mean the difference between receiving treatment to control their disease versus shifting to end-of-life care. Additionally, rehabilitation can help preserve dignity and independence by teaching patients and their caretakers how to safely accomplish the tasks of daily care, allowing them to continue their cancer journey at home rather than in a hospital. Dr. Powell helps patients and families accomplish this goal.

Rehabilitation at All Stages

Recent research shows that older patients and people with existing physical limitations who have cancer often benefit from evaluation and specialized care before cancer treatment begins. Known as pre-habilitation, this type of care can reduce or eliminate many cancer-related impairments and disabilities by assessing strength and mobility before problems start.

“Through that subset of treatments that we call pre-habilitation, we prepare those who already had functional limitations for the effects of chemotherapy or radiation,” Dr. Powell says. “We can start as soon as a patient is diagnosed. Cancer patients can become sedentary during and after treatment, and often they are physically weakened by the lack of activity, so we provide rehab while they are undergoing chemotherapy. Some studies show that more active patients may get better outcomes, so we also have that in mind as we begin cancer rehabilitation before, during, or after treatment and recovery. We have a plan for all stages.”

The side effects of chemotherapy also make it difficult for patients to muster the physical energy and mental willpower to do the exercises that are part of cancer rehabilitation. In these cases, the program uses a team of rehab specialists who regularly treat cancer patients and understand their unique needs and challenges. Dr. Powell says this approach helps patients achieve the desired outcomes of treatment.

“We want to help our patients with cancer who are avoiding dealing with so many functional limitations, since they are already facing the challenges of cancer itself,” Dr. Powell says. “We want to avoid situations in which a patient in survivorship has daily reminders, such as pain or weakness, of what they have been through. And we especially don’t want them facing those difficulties knowing they could have undergone rehab to prevent them.”