General Information
Physiotherapy can help cancer patients with a range of general problems and issues specific to their particular cancer.
No matter where the cancer starts, fatigue pain and maintaining and regaining fitness are common problems. Muscles start to lose their bulk within days of being unused and for patients who have to stay in bed for prolonged periods, keeping joints mobile is another problem.
Pain can be a big problem in cancer care, potentially reinforced by failing to treat it, and there are many ways to combat it. These include specific exercises, postural re-education, massage, soft tissue mobilisation, trans-cutaneous electrical nerve stimulation (TENS) and the use of heat and cold packs, cognitive behaviour therapy, relaxation exercises plus analgesics.
Fatigue is a problem reported by a large proportion of cancer patients. Radiotherapy and chemotherapy can cause tiredness, but having to cope with cancer and its treatment is psychologically draining. In the past standard advice has been to rest and take things easy. But current evidence is that moderate intensity aerobic exercises – walking, cycling or using a treadmill, are the best means of combating fatigue. This also has the benefit of rebuilding muscle strength and fitness.
Helping patients to regain their mobility after treatment is a principal role of physiotherapists. Following an assessment, the physiotherapist can devise an appropriate exercise programme in order to maintain or regain muscle strength. For those who cannot walk unaided, physiotherapists assess for appropriate walking aids and advise on transfers to wheelchair or chair.
Patients with cord compression, or who have to stay in bed for other reasons benefit from a carefully planned exercise regime, designed to improve exercise tolerance and building up towards walking if possible. If not, then patients can be shown how to transfer from bed to wheelchair using a sliding board, or will be advised about being hoisted. It might be appropriate to continue rehabilitation with a physiotherapist following discharge from hospital.
Hydrotherapy is particularly useful for some patients. It provides a reduced gravity environment for patients to exercise and increase their range of movement, and can also be used as a form of resistance for patients to push against, perhaps with the use of floats. Hydrotherapy is contraindicated in patients who are immunosuppressed.
As in all areas of clinical practice, liaising with other members of the multidisciplinary team and continuity of care are important. Decisions on mobilisation will be made in consultation with the medical team, and discharge planning and continuing care after discharge requires liaison with community-based colleagues.
Patients and their carers can also be advised on how best to continue exercises once home, or how to make use of other facilities such as “Exercise on prescription”.
Feeling physically fitter has psychological benefits too. Being able to do things for yourself boosts self-esteem and makes you less dependent on others and so more secure.
In addition physiotherapists can help with specific problems, whether following brain surgery, head and neck surgery, bone marrow transplants, treatment for lung or breast cancer, cancers that have spread to the spine causing pressure on the spinal cord, or following treatment for sarcomas.
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Brain Tumours
Patients with brain tumours are likely to have quite a lot of contact with physiotherapists. In the immediate postoperative period, physiotherapy will focus on respiratory care, especially if ventilated, but also the need for exercises and stretches to maintain normal range of joint movement whilst on bed rest.
Care may often be required well after discharge, perhaps for as long as a year. This will also involve neurological rehabilitation and including exercises, sitting balance and walking re-education in order for the patient to achieve maximum function.
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Head and Neck Surgery
With head and neck cancers, surgery and radiotherapy can cause significant disability. Specialist centres will provide pre-operative assessments and immediate post-operative care aimed at helping breathing through exercises, encouraging early mobilisation, and in consultation with the surgical team stretching exercises to prevent soft tissue contractures. This treatment is likely to continue well beyond discharge perhaps for 6 to 12 months.
Swallowing may be a particular problem in head and neck cancers. A joint approach to the assessment and management of these problems with speech and language therapists can result in major improvements of the patient’s quality of life.
But swallowing rehabilitation techniques require the patient to be well motivated and prepared to practise exercises and strategies at home as well as in sessions with therapists.
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Breast Cancer
Common problems after surgery for breast cancer are painful, stiff shoulders and lymphoedema.
Exercises beginning as soon as surgeons will allow after surgery will assist in preventing stiffness and regaining a full range of movement.
Lymphoedema is a particular problem if axillary lymph nodes have been removed during surgery. Many centres now have established lymphoedma clinics where physiotherapists and other heath professionals advise on exercises to stimulate the lymphatic system and collateral lymph circulation, and to teach techniques of manual lymphatic drainage.
In some cases, the use of compression garments or the use of compression bandages proves useful. Bandages are normally used for a period of approximately 2 weeks, if the size or shape of the limb is unsuitable for a compression garment.
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Lung Cancer
For patients who undergo surgery, physiotherapy is particularly important in the immediate post-operative phase to secure adequate respiratory function, ensure that secretions are not allowed to build up in the lungs, infections are avoided, and the patient is mobilised as soon as possible.
Whether or not patients have had surgery, shortness of breath can be a real problem for patients with lung cancer. There are a number of ways of addressing shortness of breath, which the physiotherapist can advise you. These include breathing control, exercises, pacing yourself throughout the day and planning your activities including trips up and down stairs
Spinal Cord Compression
Spinal cord compression is a serious complication of bone metastases in the spine, but one where careful management including physiotherapy can result in good recovery. Thorough initial assessment to determine spinal stability and so the degree to which it is safe to mobilise the patient, followed by monitoring of progress is the key to success.
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Bone Marrow/Stem Cell Transplants
Patients undergoing bone marrow or stem cell transplants are usually in isolation for a period of 7 to 10 days. During this time it is essential to use aerobic exercises to maintain muscle bulk. An exercise bike in the room is one way of providing ready access to the right sort of exercise. Without exercise, quadriceps and other muscle groups can begin to waste after just a few days of inactivity.
Exercises should also be continued after discharge either using equipment at home or at a local gym – provided of course that the patient’s immune system is sufficiently robust.
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Sarcomas
Treatment for sarcoma may involve removal of the tumour and the surrounding margin, amputation and radiotherapy or chemotherapy or both.
Radical resection of a sarcoma may result in considerable distortion of the local anatomy and function, sometimes with reinsertion of muscle groups in new places, which requires the patient to relearn how to use them. This usually happens within a specialist centre.
Patients who have undergone amputation will require fitting with prostheses and help in getting used to them and physiotherapy will help these patients in becoming mobile again.
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Summary
Physiotherapists offer cancer patients assistance with a broad scope of clinical problems. Solving these can have profound psychological and quality of life effects, often on issues that patients, carers and sometimes other health professionals might think insuperable or something that the patient has to cope with. Physiotherapy intervention has something to offer throughout the whole cancer journey, including for patients who are not curable and whose life is limited.
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