Cancer treatments save lives. But as we all know, they can have many side effects. Many cancer patients feel perfectly fine when they are diagnosed, but feel terrible after they are treated. Cancer can cause fatigue. Surgery can cause pain and immobility. Chemotherapy can affect your nerves. Radiation can affect the skin and cause stiffness and scar tissue. Hormone medications can cause joint and muscle pain.
Cancer patients are often told to accept their “new normal” after treatment. They are often counseled to be happy that they survived their cancer, and to adapt to the new side effects of their treatment. Many patients that I see tell me they talked to their doctors, nurses, and social workers about their symptoms and receive sympathy, but no treatment plan. Patients who have strokes or heart attacks standardly receive rehabilitation. It is time for rehabilitation to become a standard part of treatment for cancer patients. There are now over 13 million cancer survivors in the United States, most of whom would benefit from rehabilitation services. I believe this “new normal” should not be accepted.
Physiatrists, like me, are medical doctors who specialize in physical medicine and rehabilitation. We are doctors who specialize in improving patients’ function and quality of life. We are experts in the non-surgical management of problems with bone, muscle, and nerve. We can help with cancer related symptoms by prescribing exercise, specific rehabilitation prescriptions, equipment, medications, and sometimes injections. We can use EMG’s and ultrasound to help diagnose problems with nerves and muscles. Physiatrists work closely with other allied health professionals like physical, occupational, and speech therapists to improve patients’ quality of life.
Let’s discuss some common examples of how a physiatrist like me would help a patient:
Post-mastectomy pain: I frequently see woman with chronic pain after breast cancer surgery. The first and most important thing I do is determine exactly what is causing the pain. Pain could be coming from the incision, from a nerve in the armpit, from the rotator cuff, from muscle around the neck or shoulder, from spasm around the implant after reconstruction, or from stiffness (fibrosis) caused by radiation. Once I have a specific diagnosis, I can develop an appropriate rehabilitation plan which might include specific physical therapy and exercise, oral or topical medications for pain and spasm, or if needed, injections for pain and spasm. In addition, I often see pain caused by tamoxifen or aromatase-inhibitors, which are the hormone medications given to women with certain types of breast cancers. There are several different approaches that can be helpful for these symptoms.
Fatigue: Fatigue is the most common symptom reported by cancer survivors. There are many reasons for fatigue, and some are poorly understood. Fatigue in cancer is typically not relieved by resting. It may seem counterintuitive, but the best treatment for fatigue is exercise. The key is having an exercise program under the guidance of a physiatrist. In addition, you may need to be taught an energy conservation program, that will help you learn how to properly utilize your energy throughout the day.
Neuropathy: This can be one of the most debilitating cancer treatment related side effects. Neuropathy can cause numbness, tingling, and burning pain. It can affect walking and balance, leading to the risk of falls. In addition, it can cause some strange symptoms like changes in blood pressure, heat intolerance, and dizziness, which we call autonomic neuropathy. The first step is to be evaluated by a physiatrist that can determine if you indeed have neuropathy, and if so how it is affecting you. My treatment plan for neuropathy includes ensuring you are safe by assessing and treating your balance. I will treat the pain/tingling with oral or topical medications, or even possibly fancy electrical stimulation devices. There are also things that can be done for the strange autonomic symptoms I mentioned.
Chemo-brain: This is a very common symptom that can be debilitating. The first and most important thing is to ensure that your difficulty with thinking is only related to chemotherapy and not any other underlying problem. The good news is that these symptoms typically improve after the chemotherapy stops. I have found the best treatment for these symptoms, is to develop an interdisciplinary treatment plan with my speech therapists who can help patients compensate for these cognitive problems so they can work, function, and live their lives effectively and safely.
Prevention: One of my favorite roles is to get involved with a cancer patient immediately after diagnosis. When I see a patient early, I can assess them for any pre-existing impairments (like a shoulder problem or carpal tunnel syndrome). I will try to improve this problem to help ensure it doesn’t get worse during treatment. In addition, I can do a pre-surgical assessment for lymphedema if the patient will be at risk for this condition after lymph nodes are removed. This will allow me to catch lymphedema early after treatment to prevent it from becoming a big problem. At this stage I can also discuss exercise and how it can be helpful to reduce side effects from cancer treatments and also decrease the chance of cancer coming back. I also love to work with patients with head and neck cancers to help prevent and treat problems with eating, swallowing, communication, and pain.
As you can see, there can be many helpful roles of a physiatrist in cancer care. The patients, oncologists, and surgeons that I work with are very appreciative of all that rehabilitation can do to help. If you or a loved one has dealt with cancer, ask your doctors to refer you to a physiatrist to help you with your symptoms. To find a physiatrist near you, visit http://www.aapmr.org/patients/findphysician/Pages/default.aspx