Feb. 08, 2024
The continuum of care that cancer rehabilitation team members provide includes preventive, restorative, supportive and palliative rehabilitation. In this Q&A, Mayo Clinic cancer rehabilitation specialists Andrea L. Cheville, M.D., and Toure Barksdale, M.D., answer key questions about this discipline and its evolving role in the management of patients with cancer. Drs. Cheville and Barksdale are physiatrists at Mayo Clinic in Rochester, Minnesota, and have board certifications in physical medicine and rehabilitation, and hospice and palliative medicine. They provide care for patients with cancer and conduct research related to cancer rehabilitation, lymphedema and end-of-life care. Dr. Cheville also is certified in pain medicine and serves as research chair for Physical Medicine and Rehabilitation and chief of the Cancer Rehabilitation and Lymphedema Program at Mayo Clinic's campus in Minnesota.
What's your definition of cancer rehabilitation, and what goals do cancer rehabilitation staff members at Mayo Clinic use to guide the care they provide for patients?
Dr. Cheville: Cancer rehabilitation is a large collection of clinical approaches that all share the common goal of helping patients maintain and restore function. And, more broadly, cancer rehabilitation strives to help patients maintain personhood and resume meaningful, fulfilling lives during and after they have completed their cancer treatment.
Our role includes assisting our patients' return to activities of daily living and, at times, helping them experience a fuller, quicker recovery. It's too often assumed that becoming weak, giving up valued hobbies, not working and experiencing pain are the norm or inevitable in people with cancer. And that is simply not true. Obviously, parts of the cancer journey can be unpleasant. But that doesn't mean an individual has to defer comfort and function until the cancer is fully addressed. There often are treatments or solutions to many of these problems. And for some patients, the cancer will never be fully addressed. But our role is to ensure that the life our patients have is as comfortable and as meaningful as it can be.
How broad is the need for cancer rehabilitation services today?
Dr. Barksdale: We estimate that there are almost 16 million cancer survivors currently residing in the United States. And by the year 2032, that population is expected to increase to around 22 million people. If we're having this many cancer survivors, what do we know about the impairments these patients are experiencing that go along with cancer and its treatment? We know that the rates of impairments vary and depend on what type of cancer individuals have. And while this is a very heterogeneous population, we do know that around one-fifth of childhood cancer survivors and one-half of adult cancer survivors report a limitation in their ability to function, whether it's from the cancer itself or the treatment of cancer they're experiencing. At least two-thirds of breast cancer survivors have experienced one or more long-term advanced sequelae from the cancer and the treatment of cancer. On top of that, physical impairments increase as cancer gets more advanced in this patient population as well.
We're very good at treating cancer, but what about the person experiencing the cancer as well? And what about their function and quality of life that goes along with that? Unfortunately, we're not there yet. Despite the amount of cancer-related impairment, nationwide treatment rates for even simple and treatable physical impairments are reported to be as low as 1% to 2%. That's a staggering number when you think about all those cancer survivors out there right now.
What specific types of services and program elements are typically offered to patients during cancer rehabilitation?
Dr. Cheville: The specific elements involved in a typical program depend on the patient. It's important for patients to think about what they want, what's impairing their ability to function or fully engage in the things that give meaning to their life. And then they need to discuss this information and any goals with their care team.
For example, let's look at a patient with a gastrointestinal cancer. Many times, patients with these cancers present at a later stage. If a patient needs to receive chemotherapy and radiation to shrink the tumor so that surgery becomes feasible, we can partner with them going through this aggressive therapy. Because this process is incredibly demanding, our job is to support the patient's nutritional and exercise needs, and to help them manage their stress. Additionally, we try to reduce the morbidity or mitigate any negative consequences associated with their treatment, and to help them make it to surgery and fully thrive after surgery. And then, once the demands of cancer treatment start to diminish, we help them reenter their careers, to remain employed, so that they can reengage in the life-defining roles that are meaningful to them. And these are different for every patient. So we deliver prehabilitation before or during chemotherapy and radiation. We partner with them in the hospital during their surgery, and then we walk with them afterwards. Our goal is to walk with them every step of the way.
For more information
Mayo Clinic Physical Medicine and Rehabilitation Medical Professionals Resources
Refer a patient to Mayo Clinic.