Road to Recovery: Cancer Rehab Defines the New Normal

The growing importance of rehabilitation after cancer is changing the field of survivorship.

The rehabilitation area at Aurora Sinai Medical Center in Milwaukee looks like a playground for grown-ups. The front of a bus comes out of one wall with the stairs inviting someone to step aboard—only to find that the bus lurches much like the real thing. In the middle of the room, securely bolted to a waist-high wall, sits a two-door Pontiac Grand Prix. Around the edge of the room, a bedroom, porch, living room and kitchen have been re-created.

It’s here that patients have to show physical therapist Leslie J. Waltke that they can complete the daily tasks they performed before cancer. Can they lift a bag of groceries out of the trunk of the car and carry them up the porch stairs and through the door? Is their balance good enough to get on a bus with its erratic movement?

What good is it to cure a patient’s cancer if the process leaves him or her incapable of living life?

Waltke opened Cancer Rehabilitation Specialists in 1998, and as word spread among patients, oncologists also became aware of their patients’ progress. In 2005, Waltke joined Aurora Health Care as Cancer Rehabilitation Coordinator and now oversees 40 licensed physical, occupational and speech therapists throughout the Aurora Health Care system in Wisconsin, where cancer rehabilitation begins as soon as possible during treatment and may last well into survivorship, depending on a patient’s needs.

Despite advances in recognizing the importance of cancer rehabilitation, the vast majority of patients and survivors are still grossly undertreated for deficits common with cancer treatment. This is due, in part, to the lack of training physical therapists receive about the needs of cancer patients, Waltke says.

“We would never walk into the room of a patient who has had surgery to repair a rotator cuff the day after surgery and say, ‘Here are your exercises,’ and walk out,” Waltke says. “We would never hand a paper of exercises to stroke patients. So why are we treating our cancer patients like that?”

The World Health Organization (WHO) has defined rehabilitation as “a process intended to enable people with disabilities to reach and maintain optimal physical, sensory, intellectual, psychological and social function.”

The increasing number of cancer survivors has brought more attention to quality-of-life issues for these patients, who may end treatment with physical and cognitive limitations related to inactivity, surgery, radiation or chemotherapy.

Inactivity related to cancer and its treatment can contribute to systemic problems, including loss of strength and muscle torque as well as negative effects on the respiratory and cardiovascular systems.

And, while exercise is often heralded as the answer to everything from treatment side effects such as depression and fatigue to preventing recurrence, rehabilitation professionals strongly suggest that patients who are newly released from acute treatment first be assessed for any number of problems that could contribute to a less than successful exercise experience that could even be dangerous.

Indeed, rehabilitation is now listed among the services that must be made available by cancer centers accredited by the American College of Surgeons’ Commission on Cancer (CoC), which certifies more than 1,500 cancer programs in the U.S. and Puerto Rico. 

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