Q&A Cancer Rehab Can Help You Heal

with Julie Silver, MD

If you are a cancer survivor, there’s a good chance that you’ve been discharged from treatment without a referral for cancer rehabilitation. It is also likely that you’ve been told to accept a “new normal.” While accepting a “new normal” may sound like reasonable advice, it often undermines survivors’ efforts to heal and recover as well as possible.

Imagine someone who had a stroke being advised to accept a “new normal” without the benefit of rehabilitation medicine. That would not be very good medical practice, yet it’s exactly what many cancer survivors are told.

So, before you decide to accept a “new normal,” consider whether you are functioning as well as possible. Ask yourself whether cancer rehab services might help. If you aren’t sure, keep reading.

What is cancer rehabilitation?

Cancer rehab is very similar to other forms of rehab after a serious illness or injury. Services should include consultations with appropriate board-certified or licensed clinicians in rehabilitation medicine, including physiatrists (doctors who specialize in rehabilitation medicine), rehabilitation nurses, and physical, occupational, and speech therapists.

Will my insurance cover cancer rehabilitation services?

Yes, medical insurance, including Medicare, usually covers rehabilitation medicine consultations and services so long as they are provided by rehabilitation healthcare professionals (as listed above). As with all insurance issues, check with your carrier about deductibles and co-pays.

Which problems can be addressed through rehabilitation?

Rehab professionals can help with a wide variety of treatment-related conditions and their symptoms. Here are examples of those that can occur in breast cancer survivors:

  • Pain
  • Weakness
  • Fatigue
  • Scar tissue adhesions
  • Shoulder problems
  • Balance and gait problems
  • Memory and concentration issues
  • Lymphedema
  • Post-mastectomy pain syndrome
  • Radiation fibrosis syndrome
  • Brachial plexopathy
  • Chemotherapy-induced peripheral neuropathy
  • Difficulty with daily activities  such as dressing, chores, and shopping
  • Difficulty returning to work
  • Difficulty returning to recreational or community activities

One way to think about the role of a rehab clinician is to consider our motto: Focus on function. Focusing on function is the primary goal in all rehabilitation medicine interventions, so one of the first questions we are taught to ask our patients is, “What were you able to do before you were diagnosed with cancer that you aren’t able to do now?” Of course, there is no guarantee that you will be able to function in the same way you did prior to your diagnosis, but it’s important to consider your precancer functional status and compare that with your current functional status. Then your clinician needs to evaluate what interventions might be helpful in improving your daily function.

What types of cancer rehab interventions can help?

Because cancer survivors encounter many different problems—depending on their health status before the diagnosis, the type of cancer, and the treatment choices—there are many solutions to consider. Some are very sophisticated and require procedures that are usually performed only by highly skilled physiatrists with a subspecialty interest in cancer rehabilitation. For example, botulinum toxin injections are sometimes used to treat radiation fibrosis syndrome or post-mastectomy pain syndrome. Physiatrists may also administer other interventions such as trigger point injections to decrease muscle spasm and pain. Some patients benefit from oral or topical prescription medications to help treat pain or address fatigue issues.

Physical therapists who are specifically trained in cancer rehabilitation work with survivors to address pain, fatigue, and musculoskeletal problems as well as to recommend the right exercise program. Occupational therapists focus on upper-body problems and frequently recommend specialized equipment for home or work that helps survivors function better. Speech/language pathologists address swallowing and speech problems.

Can cancer rehabilitation help with “chemo brain”?

Cognitive rehab interventions can certainly help people with “chemo brain,” the medical term for which is mild cognitive impairment. Problems with memory, concentration, and other cognitive issues are best addressed by clinicians who have expertise in cancer rehabilitation. Consultations with occupational and speech therapists who are experts in cancer rehabilitation and neurocognitive rehabilitation can be extremely helpful in improving survivors’ ability to function at home and work.

How do I find cancer rehab experts?

Talk with your healthcare providers about what is available in your community. You should expect a high level of services and healthcare professionals trained in rehabilitation medicine. If you have medical insurance, this care should be covered; with the exception of deductibles, co-pays, and some other insurance restrictions, rehabilitation medicine treatment is typically covered.

Cancer rehabilitation is becoming an increasingly important part of the survivorship care continuum. Some hospitals and cancer centers are now offering excellent cancer rehab services in a well-coordinated effort between the oncology and rehabilitation medicine departments. A growing number of hospitals and cancer centers are Survivorship Training and Rehabilitation (STAR) certified. This is a best-practice model that offers multidisciplinary cancer rehab care that is generally covered by medical insurance. STAR Programs and STAR Clinical Groups are staffed by rehabilitation healthcare professionals who have undergone extensive training in cancer rehabilitation.

Rhode Island is the first state in the country to make cancer rehabilitation geographically available to all of its survivors. In October 2011 the state announced that 20 facilities would become STAR certified so that survivors will have access to high-quality cancer rehab services. For more information about finding a STAR-certified institution near you, visit www.oncrehab.com.

What is the future of cancer rehabilitation?

The future of cancer rehabilitation is very bright! More and more hospitals and cancer centers are investing in excellent survivorship care and implementing new or improved cancer rehab services. If cancer rehabilitation hasn’t come to your town yet, talk to your healthcare providers about how valuable it would be to offer these services to survivors. The goal in rehabilitation medicine is always to help people function at the highest possible level, no matter what their diagnosis or current state of health—and helping people achieve the best possible level of health is everyone’s goal in medicine.

Julie Silver, MD, is an assistant professor at Harvard Medical School in the Department of Physical Medicine and Rehabilitation. She is the founder of Oncology Rehab Partners (www.oncrehab.com) and the creator of STAR (Survivorship Training and Rehabilitation) certifications, which enable hospitals and cancer centers to deliver a best-practice model of cancer rehabilitation services. Dr. Silver encourages patients with serious illness or injury to be proactive in facilitating their own recoveries, and she offers healing strategies in her new book, You Can Heal Yourself (St. Martin’s, 2012). She also believes it is critical for patients to work with an experienced and knowledgeable healthcare team that can offer evidence-based rehab medicine treatments typically covered by medical insurance.