Contributor: Sree Battu, MD, Physical Medicine and Rehabilitation
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You’re a cancer survivor. You beat it, and you want to get back to life. Yet the cancer, and its treatment, can take a toll. Even after you’re declared “cancer-free,” there can be aftershocks – lingering fatigue and other symptoms. What many cancer patients do not realize is that there is support at this stage of recovery. There are doctors specially trained in cancer rehabilitation who work with therapists to improve your quality of life – your energy and overall health.
Physical Medicine and Rehabilitation physicians can diagnose musculoskeletal issues and prescribe patient-centered therapies. They work with physical and occupational therapists, who vary widely in their experiences and scope of practice.
Together, these doctors and therapists:
- Evaluate problems
- Design exercise programs
- Monitor changes in function
- Teach you how to self-monitor for late effects
The physicians largely diagnose issues. They determine what interventions could help you, including therapy, medication, orthotics or a combination of all of these. At times, they find it makes sense to treat a symptom before starting therapy.
For example, as part of rehabilitation, you may be prescribed a specific exercise program designed within the context of your health history. The exercises can help you stay at an ideal weight and reduce your risk of various problems: lymphedema, recurrence of certain cancers, and cardiovascular disease (if you are a woman).
Do you need an evaluation?
You may seek a rehabilitation evaluation if you develop functional decline: fatigue, falls, inability to do things you used to do and decreased memory/attention.
Other reasons to seek an evaluation include physical signs: new weakness, balance trouble, decreased range of motion of joints, increased muscle tone, numbness which does not go away and decreased coordination.
How rehabilitation works
Physical Medicine and Rehabilitation doctors diagnose musculoskeletal issues that limit people’s functions. Various co-existing conditions can often affect rehabilitation treatments.
For example, a patient with breast cancer came to see me wanting help for fatigue and decreased memory and attention. We performed cognitive testing and found her cognition to be intact.
However, we discovered that a long-standing history of depression, anxiety and untreated obstructive sleep apnea were leading to her fatigue. To treat it, I started her on an aerobic exercise program, and I reached out to colleagues specializing in sleep medicine. We also changed her depression and anxiety medications.
Other patients can have the same symptoms but for different reasons.
Another patient with breast cancer came to me with severe fatigue and post-mastectomy pain syndrome. In this case, her fatigue was cancer-related. What helped was a neurostimulant medication, as well as medication to regulate her sleep/wake cycles.
For her pain, she learned manual lymph drainage and energy conservation techniques in therapy prescribed individually for her needs. She also required oral pain medications for neuropathic and cancer-related pain, and a pain stimulator for neuropathic pain.
A patient with breast cancer came in with joint pain. Through her lab work, we found she had rheumatoid arthritis, and we referred her to rheumatology for long-term treatment with immunosuppressive medication and steroids. We also prescribed joint protection exercises and recommended using different adaptive tools to help with her work.
Enjoying your life
It’s important to remember that cancer treatment does not need to stop when you reach remission. For fatigue, pain or other common problems that can be part of recovery, there are doctors and therapists who are there to support your full recovery. They want you to be able to enjoy your life, feeling good and cancer-free.