Cancer Rehabilitation

Cancer rehabilitation addresses physical impairments and progressive disablement at all stages of cancer diagnosis and treatment. Although a majority of impairments are directly related to cancer or its treatment, the rapid aging of the population has led to more patients presenting with functional morbidity at the time of cancer diagnosis. As a consequence, cancer rehabilitation has become integral to the management of geriatric oncology patients. Recent expansions have additionally occurred to address patients' rehabilitation needs during the survivorship, palliative, and prehabilitation phases of cancer. Cancer presents with a staggering array of prognoses, differential treatment approaches, and patterns of metastatic spread. Against the complex backdrop of shifting treatments, toxicities, and prognoses, patients with cancer generally experience multiple, rather than discrete, impairments. Symptom burden, particularly pain, is also a key consideration in the development of individualized rehabilitation plans. A patient's functional goals and rehabilitative potential should align with these defining aspects of their cancer. In addition to acute cancer- and treatment-related impairments, many patients experience late effects that may present years after the completion of cancer treatment. Impairments that affect neuromuscular integrity are common, ranging from joint contractures and pathologic fractures to malignant spinal cord compression. Conventional rehabilitation approaches can benefit affected patients but should be adapted as required for patients' prognoses and symptoms. Motivation and meaning are also important considerations given the potentially terminal nature of patients' disease. Some cancer populations (e.g., breast, head and neck, sarcoma, and bone marrow transplantation) have unique needs such as lymphedema and limb loss. Validated physical performance and self-report measures should be used to assess relevant functional domains in order to individualize therapy and evaluate treatment response.