Getting well: Cancer rehab

CURE invited Julie Silver, MD, cancer survivor and rehabilitation specialist, to offer suggestions on healing physically after cancer.One of the questions I am often asked is, "What exactly is cancer rehab?" Since rehab has not traditionally been part of the cancer care continuum, it's not surprising that many people are confused about what it might involve. However, if someone has a stroke, then most people understand that rehab involves doctors who can order tests and prescribe medications and other treatments. Rehab also usually involves physical therapy and may involve occupational and speech therapy as well. An individual with a hip replacement usually requires orthopedic rehab with physician involvement and physical therapy at a minimum. Cancer rehab is very similar to all other kinds of rehab. The goals are the same--help someone function at the highest possible level by building up their strength and stamina, reducing pain and fatigue, improving problems with balance, gait swallowing, joint range of motion and a host of other problems.In short, rehab is a critical part of cancer care. But, few survivors ever get it. Why? There are probably a lot of reasons why cancer survivors don't get rehab, but the one that people often cite (which simply isn't true) is that in the past there weren't survivors to treat. That hasn't been an issue for more than half a century. Sure, every year acute cancer treatments get better and better, but surviving cancer is not a new phenomenon. Unfortunately, offering cancer rehab to survivors is. Even though cancer rehab has been around for a long time, it is not usually part of the care continuum, so few survivors ever get it.Indeed, developments in and acceptance of cardiac rehab and other forms of physical retaliation are many decades ahead of cancer rehab. And, cancer survivors are needlessly suffering. Being told over and over again to "accept a new normal" when instead they should be referred for appropriate rehabilitation interventions and offered the opportunity to heal as well as possible.So, the next time someone tells you to accept a new normal, try asking them if they've heard about the growing movement in cancer care--cancer rehab. If they need more information, here are some quick facts:Who are the main cancer rehab experts? Physiatrists (doctors in physical medicine and rehabilitation or PM&R) and physical/occupational/speech therapists. There are many others who contribute to rehabilitation care, but start your rehab with these experts.What are the benefits of cancer rehab? Improving your physical--and emotional--function.Why is cancer rehab needed? Because it's not fair to survivors to tell them to accept a new normal when there is proven medical care that can help.How do I know if cancer rehab will help me?If you would benefit from one or more of the things on this list, talk to your doctor about cancer rehab:

> Improve endurance and cardiovascular conditioning

> Increase muscular strength

> Improve joint range of motion

> Decrease pain

> Lessen fatigue

> Improve swallowing

> Improve speech

> Assist with surgical recovery

> Improve immune function

> Increase bone density

> Manage lymphedema

> Improve physical function

> Improve balance and coordination

> Improve quality of life

> Decrease psychological distressWhy isn't cancer rehab part of my cancer center or hospital? Good question, ask your oncologist! It should be.How is that changing? The rehabilitation community is becoming much more award of the need for advocacy for cancer rehab. Survivors are beginning to realize that is can be made available to them if they insist on it. My own work involved helping hospitals, cancer centers, group practices and individual clinicians develop and implement cancer rehab services. You can find out more about my work at www.OncRehab.com or www.JulieSilverMD.com. What can I do to help?Talk to the members of your oncology team and ask what rehab services are available to you and other cancer survivors. Tell them to check out www.OncRehab.com for information about the STAR (Survivorship Training and Rehab) Program. Don't accept "rehab" as a referral to an exercise physiologist or acupuncturist or any other provider who is not an expert specifically in rehabilitation medicine. Keep in mind that insurance companies pay for clinical care that is provided by rehabilitation experts such as physiatrists and physical/occupational/speech therapists. They don't pay for cancer rehab that is not provided by trained clinicians in rehabilitation medicine.How can I find cancer rehab if my health care providers don't know where to refer me? Contact the American Academy of PM&R for a referral to a physiatrist (www.aapmr.org). Other cancer rehab experts can be found through their professional associations (physical therapists: www.apta.org; occupational therapists: www.aota.org; speech and language pathologists: www.asha.org). Keep in mind when contacting any of these professional organizations that not all rehabilitation professionals work with cancer survivors. Specifically ask for information about those who do. Also ask your physiatrist or therapist about his/her experience in cancer rehab.