Oncology & Palliative Physiotherapy

Cancer biology and treatment remains a relatively new field, one in which the condition itself has only really become understood more fully in the past 20 years or so. New modes of treatment and therapy are constantly being developed, and physical therapy in the field is evolving at the same pace. Palliative care is an important aspect of cancer care because while advances are being made all the time, there are still very many cases in which the only care that can be provided is palliative, and physiotherapy can be an important part of that.

Cancer and its implications

Cancers develop as a consequence of genetic abnormalities in the ‘blueprint of life’, your DNA. Changes called mutations occur within some cells, resulting in abnormal growth and spread which may be either malignant or benign. The latter is essentially a growth that is harmless and more or less self-contained. Malignant growths (or tumours) however are dramatically different, in the event of this type of condition, the abnormal cells proliferate rapidly and with detrimental effects on the surrounding normal tissue. This becomes a cancer that grows and spreads, impinging on normal function and resulting in a host of symptoms that depend purely on the site of the illness.

The symptoms of cancers are hugely variable, some well known and others less so. Tumours can press on nerves resulting in reduced mobility and coordination, reduce cardiac or lung efficiency by impinging on the structure’s normal function resulting in breathlessness and fatigue. These are only a couple of examples of what is a myriad of possible presentations that can result from the disease.

A treatment issue unique to cancer is the consequence of anti-cancer drugs. Treating the disease remains at a relatively early stage, and at present the most efficient and widely practiced methods are chemo- and radiotherapy, both of which can have dire physiological effects of their own. Chemotherapy utilises drugs that are toxic to cells, and the treatment boils down to trying to kill more cancer cells than normal ones. The selectivity of these chemicals in terms of distinguishing between normal and cancer cells, while improving remains poor. Radiotherapy operates on a similar principle but uses radiation as opposed to drugs. What the nature of these treatments mean is that patients suffer during and between treatments, and often require physiotherapy to go through the fatigue, loss of mobility, and other consequences of treatment.

Where the disease is far too malignant, as is the case in some brain tumours and pancreatic cancers, for effective treatment, the only option left is palliative care. This is often difficult for both healthcare professionals and the patient and will always be a sensitive area. There is however an integral role for physiotherapy in palliative care.

Physiotherapy in oncology and palliative care: Treatments, methods, and issues

Treating such a complex condition involves many stages, of which physiotherapy is now an established part. The goals of a physiotherapist within this specialty are not unlike the objectives of physios in other fields, namely to improve mobility, independence, and quality of life. As cancer is hugely variable and will be completely different from one patient to the next, a physio in this field needs to be able to adapt their ongoing rehabilitation plan. Your well being is as dependent on the success of your medical treatment as it is on your functionality and self-sufficiency, all these factors contribute to your state of mind which is key to fighting a disease like cancer.

CRF, or Cancer Related Fatigue, is a widely spread consequence of cancer which can affect patients between and during their treatment. Chemo- and radiotherapy, as discussed above, can be very physically and mentally taxing, and as such is a serious obstacle in physiotherapy. The challenge lies in motivating a patient to perform exercises that they need to maintain their health and functionality despite CRF. While physios will have an exercise programme in hand, it is down to their creativity and experience to work the patient and help them stick to it despite CRF and the cancer itself.

The importance of this task lies in how critical it is to maintain their fitness throughout the different stages of their therapy. Regular exercises as prescribed by a professional physiotherapist can have vast mental and physical health benefits, with a growing body of research providing convincing evidence that maintaining activity levels help cope with the symptoms of cancer and the side effects of chemotherapy.

A physiotherapist’s exercise regime will always be based on a full assessment of your abilities and condition. The focus will always be to maintain your lifestyle as much as possible while you are receiving your treatment sessions, and on improving your fitness and strength between them. The purpose of this is to avoid taxing your body too much while it is receiving a therapy that is in itself physically tiring. This programme will always be goal orientated, with objectives discussed and agreed upon with you, the patient, before commencement of the regime. While there is plan to be followed, it is not set in stone, and your therapist will constantly be reassessing your condition and progress to make any necessary adjustments.

Physical therapy is of great benefit to cancer patients in terms of pain management. The first step in this process is establishing the exact nature and position of the pain you are experiencing to best inform your physio’s choice of treatment. The therapist will then proceed to use different interventions like massage, postural adjustments, temperature therapy (hot and cold treatments) and therapeutic exercise. Other less conventional methods with proven efficacy are acupuncture and TENS (Transcutaneous Electrical Nerve Stimulation).

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