The Role of Physiotherapy in Oncology and Palliative Care
Physiotherapy in the field of Oncology and Palliative Care is a continuously evolving and developing specialty, both in Malignant and non-malignant disease. Rehabilitation for both groups of patients is now recognised as an essential part of the clinical pathway, as earlier diagnosis and new treatments are enabling patients to live longer. It is generally accepted that patients should have access to an appropriate level of rehabilitation, sothat they can function at a minimum level of dependency and optimise their Quality of life, regardless of their life expectancy. By working as part of a multi-disciplinary team, the Physiotherapist’s core skills - especially their ability to set realistic goals and their patient-centred, problem solving approach - can help people adapt to their changing condition. The Physiotherapist’s role is to anticipate and prepare for potential disease progression and to facilitate and support independence and successful discharge from the acute sector for the patient and their carers. This is essential to support the Government’s emphasis on developing community care and the increasing desire of many patients to die at home.
A person’s well-being is dependent on many factors such as the control of symptoms, level of independence, functional ability, ability to communicate, psychological and emotional state, degree of self confidence and self-esteem and the ability to cope.
Physiotherapists, as rehabilitation practitioners, aim to maximise independence and dignity and reduce the extent to which Cancer and other life-limiting illness interferes with an individual’s physical, psycho-social and economic functioning. Whilst physiotherapy focuses on the care and treatment of a wide range of physical problems (which may result from the illness or its treatment) the physiotherapy approach also offers patients and their carers, the opportunity to develop coping skills and strategies that can assist in managing a changing physical status as disease progresses. This is in addition to addressing significant psycho-emotional issues such as anxiety, loss of confidence or low self-esteem. Physiotherapists are uniquely placed to encourage patients in developing a constructive approach to living with illness and/or the effects of treatment and thereby impacting positively on well-being and quality of life.
Lymphoedema is a chronic, incurable condition observed as swelling of the body tissues (usually in the arms and legs) caused by failure of the lymphatics either as a result of localised trauma e.g. postbreast surgery or as a congenital dysfunction. Early intervention in the acute stage can produce dramatic changes and reduce both physical and psycho-social problems. This is resource-efficient and reduces the risk of potential cellulitis infections and hospital admissions. The chronic condition requires more intensive management. It is therefore essential that timely treatment is accessible. As a chronic condition, prevalence rates increase faster than incidence, and regular life-long reviews (including compression garment provision) are an essential part of the treatment package.
Cancer-Related Fatigue (CRF) is recognised as one of the most common and distressing symptoms of cancer, affecting 70-100% of patients during and post anti-cancer treatments. CRF impacts on the functional ability of patients and therefore is a primary concern to physiotherapists. Currently exercise has the strongest evidence base for treating CRF and decreased activity levels are a contributing factor of this symptom. Therefore, physiotherapists have a key role in screening patients for fatigue, assessing current activity levels and providing exercise advice and initiating exercise programmes with patients. Exercise prescriptions are designed based on patients’ unique medical and demographic characteristics and associated anticancer treatments and side effects.
It is important for cancer patients and survivors to maintain a basic fitness level both during and after their cancer treatment(s). The message delivered to patients has often been ‘rest is best’ but we now know that this is not helpful. Many studies have demonstrated the physical and psychological benefits of well designed exercise programmes. It is clear that exercise can help combat the many side-effects of cancer treatments and help patients improve their quality of life and functioning. Evidence also exists regarding the benefits of exercise in patients with non-malignant disease such as Chronic Obstructive Pulmonary Disease (COPD). Physiotherapists, as experts in human movement, have an important role in advising patients on suitable exercise programmes and monitoring their progress at all stages in the ‘patient pathway’. The key principles of exercise prescription are:
- individualised and based on comprehensive assessment
- focusing on maintenance during treatment and on improvement post-treatment
- concentrating on all aspects of fitness and ‘whole-body’ workouts
- based on moderate intensity levels
- working towards goals identified by the patient
- to include regular re-assessment and review
Pain is complex and multi-dimensional and requires a multi-disciplinary team approach to address the many different dimensions of the pain experience. Physiotherapists have an important role in patient management and have specific skills which enable them to be patient-focused and holistic. The essential components of a physiotherapy assessment include a description of the pain, responses to the pain and the impact of pain on both patient and care-givers. It is essential to consider the main functional restrictions the patient experiences and to focus on what the patient identifies as the main goals of management. A range of interventions can be utilised by the Physiotherapist and include therapeutic exercise, graded and purposeful activity, postural reeducation, massage and soft tissue mobilisation, Transcutaneous Electrical Nerve Stimulation (TENS) and simple heat and cold packs. A range of other approaches can also be employed e.g. relaxation, but some approaches may require additional training, e.g. Cognitive-behavioural therapy or Acupuncture. The key to a successful outcome is timely and appropriate intervention and the use of suitable outcome measures.
Intractable breathlessness can be a devastating and common symptom in advanced cancer and a number of non-malignant conditions, such as chronic lung disease, heart failure and neuro-muscular disorders. The symptom is often poorly controlled, causing significant distress to patients, carers and families. Interventions aimed at symptom palliation may include a range of pharmacological and non-pharmacological techniques including the use of a hand-held fan, relaxation techniques, positioning, advice regarding pacing and activity and anxiety management tools, together with the appropriate use of breathing techniques. Physiotherapists working within the field of Cancer Care are able to offer comprehensive assessment and advice regarding the management of many different symptoms both in the acute and primary care setting.
This article has been reproduced with the kind permission of the Association of Chartered Physioptherapists in Oncology and Palliative Care