Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & EMBASE  
     Home | Subscribe | Feedback  

[Download PDF
Year : 2001  |  Volume : 47  |  Issue : 1  |  Page : 62-5  

Rehabilitation of cancer patients.

M Pandey, BC Thomas 
 Department of Surgical Oncology, Regional Cancer Centre, Trivandrum, India. , India

Correspondence Address:
M Pandey
Department of Surgical Oncology, Regional Cancer Centre, Trivandrum, India.


With the developments in cancer treatment, more and more patients are surviving their disease. However, very little emphasis is being placed to rehabilitate these cancer survivors. Ignorance, social structure, stigma attached in seeking psychological help, and poor communication skills of oncology staff all contribute to poor rehabilitative efforts. The priority of governmental agencies and health efforts to fight rampant communicable diseases, malnutrition, maternal health, and the frequent natural calamities, puts rehabilitation movements in the back seat. Treatment and prevention of disability and its rehabilitation requires comprehensive and multidisciplinary approach. There is an urgent need to promote physical and psychological rehabilitation.

How to cite this article:
Pandey M, Thomas B C. Rehabilitation of cancer patients. J Postgrad Med 2001;47:62-5

How to cite this URL:
Pandey M, Thomas B C. Rehabilitation of cancer patients. J Postgrad Med [serial online] 2001 [cited 2022 Aug 16 ];47:62-5
Available from:

Full Text

To feel like a useful human being without any stigma attached, without any undue fears and pressure but with a sense of being needed and wanted, is what life is all about. Rehabilitative efforts among cancer patients should be directed towards this goal. The professional as well as the layman needs to be optimistic, without feeling any reservation and exude it contagiously. Yet, despite better treatment methods and higher survival rates today, the medical community has not been able to sufficiently change their attitudes toward cancer rehabilitation.[1] Disability is a significant problem for patients undergoing cancer treatment. This is often the result of local and distant effects of tumour as well as the treatment sequelae. Treatment and prevention of disability require comprehensive and multidisciplinary approaches. These approaches are frequently long-term, spanning several life stages. However, little is known about the rehabilitation outcomes over a longer period of time,[2] though current evidence strongly supports the provision of a well-organised, coordinated, multidisciplinary rehabilitation services based on a problem oriented approach.[3]

Rehabilitation is a dynamic process that should begin soon after the diagnosis and should continue for the duration of the illness and its treatment.[4] Specialists in rehabilitation attending to patients include psychiatrists, occupational, physical, and recreation therapists, speech-language specialists, audiologists, and vocational counsellors. Other healthcare professionals join the team as and when needed for the management of particular problems and these include orthotists and prosthetists, psychologists, and dieticians.[3] The cancer rehabilitation team needs to be committed to help the patient achieve his or her functional goals through all phases of the disease and its treatment.

Rehabilitation has recently seen many practical innovations and new evidence for specific interventions, but the major advances in rehabilitation are conceptual rather than practical. Firstly, the approach to patients has shifted from a predominantly medical to one where psychological and socio-cultural aspects find an important place. Secondly, the need for organised specialist rehabilitation services like that for neurological disabilities is being recognised.[5] Gerber et al.,[4] have identified the following areas that require attention in the process of physical rehabilitation:

? Immobility and its impact like generalized deconditioning, skin care and contractures.

? Upper extremity orthotic management.

? Metabolic problems.

? Myopathy as a result of direct tumour invasion of muscle and other soft tissues, paraneoplastic syndromes, carcinomatous myopathy, steroid myopathy, or carcinomatous neuromyopathy.

? Bone replacement by tumour along with prevention and management of pathologic fractures, spinal cord injury syndromes.

? Neuropathies and plexopathies.

? Lymphoedema and deep venous thrombosis.

? Bowel and bladder disorders.

Other areas requiring rehabilitative efforts are:

? Independence.

? Body image.

? Speech.

? Confidence.

? Sexuality.

? Dignity.

? Family.

? Use of prostheses.

? Physical appearance.

? Finances, etc.

Physical rehabilitation of the cancer patient has its own ingrained problems - especially if the programme is to be initiated in a developing country. ‘Technology transfer’ is merely not enough, as only a limited few will have the means to afford it. State of the art physical restoration services like artificial larynx, breast prostheses, and colostomy bags, are available in India, however, they are priced high and only a few can afford them. The technical expertise too is limited to a few select cities. Newer approaches to the concept of rehabilitation in the Indian setting needs be defined and these should take into account the financial aspects as well as easy availability.

The utilisation of a psycho-social rehabilitative facility however, is more involving. Ignorance of the availability or the impact of a psycho-social intervention,[6],[7] as well as the stigma attached in seeking help from a psychotherapist, impinges on such rehabilitative efforts in a developing country. Developing countries have poor infrastructure and lack proper treatment facilities at most centres. This leads to poor survival rates, and hence, more emphasis is placed on attaining quantity of life rather than quality.[8]

Factors that influence the patient’s need for a psycho-social rehabilitation programme have been described in detail in literature. These are social support,[9] availability of information,[10] and communication amongst multi-disciplinary staff, thereby facilitating a better rehabilitative process.[11] The type of cancer is a decisive factor in determining the degree of difficulty faced by the patient and its impact of rehabilitation,[1] e.g. speech, presentability, nutrition, etc., in head and neck cancers;[12],[13],[14],[15],[16],[17],[18],[19],[20],[21] social, and sexual issues faced by patients with cancer of the breast;[22],[23],[24],[25],[26],[27],[28],[29] and cervix, prostate, and genital area.[30],[31],[32],[33],[34],[35],[36],[37],[38]

Razavi in a number of his studies[39],[40],[41] has emphasized the need for a comprehensive psycho-social support of cancer patients and their families taking into account the prevalence of psychosocial problems and psychiatric disturbances observed amongst them. He further stated that psychosocial interventions designed for this need should be divided into five categories namely prevention, early detection, restoration, support, and palliation. The fourth stage should involve supportive rehabilitation to lessen disabilities related to chronic diseases characterized by numerous cancer illness or its treatment, i.e. remission, progression, and active treatment. Other studies where the patients were interviewed or assessed for their specific needs concerning post-cancer treatment showed that a significant number desired professional help.[42],[43] The desire for professional help concentrated significantly on role performance, cognition, control, family relations, and psychologic and somatic aspects. Focus group discussions and interviews revealed that patients preferred a rehabilitation programme with focus on reducing fatigue, coping with social aspects, dietary aspects and finding new life targets.

The results of rehabilitation have been noted by various authors. Seifert et al., in their study stated that rehabilitation in a sports group improves the individual’s subjective quality of life.[44] Similarly, patients in the study by Berglund et al, improved with respect to physical strength and increased their physical training and social activities more than the patients who did not participate in the rehabilitation programme.[45] Other advantages of having a rehabilitation programme associated with cancer care are improved personal confidence,[46] especially in the patients with head and neck cancers undergoing surgical treatment facilitating better adherence to or acceptance of prescribed procedures.[47]

Various types of rehabilitation methods like teleconferencing,[48] use of sport therapy,[49] use of family-oriented-rehabilitation programs especially in the paediatric cancers,[50] exercise rehabilitative training,[51] and most importantly involvement of cancer survivors in the rehabilitation programme and improvements in communication skills between the practitioner and the patients[52] have been described earlier.

A meta-analysis of data from trials of rehabilitation in stroke units has shown that rehabilitation services in such units are effective at reducing both mortality and morbidity possibly without extra resources.[53] Furthermore, these benefits can be achieved in routine practice,[54] and last for many years.[55] The meta-analysis was specially important as it helped to characterise the probably important ingredients of rehabilitation: i.e. coordination, expertise, and education.

Evidence in support of specialised coordinated rehabilitation services is less strong in other fields, but trials have shown benefits for patients with multiple sclerosis,[56],[57] mild or moderate head injury,[58] and back pain.[59] Consequently the presumption should be that most patients with disability will benefit from being seen by a specialist, and coordinated rehabilitation service. It is no longer tenable to depict rehabilitation as an expensive placebo service.

The evidence for each part of the process of rehabilitation is much more difficult to identify and evaluate. The evidence in favour of assessment and goal planning has been reviewed recently.[60],[61] Even though it is not subjected to meta analysis, and is difficult to systematically review it, there is reasonable support for these aspects of the process.

Rehabilitation in India had been amongst the least priority areas. However, efforts by the likes of the Indian Cancer Society have been able to provide specific and comprehensive rehabilitation services to many cancer patients and their families every year.[62] Several studies from India have highlighted the need and prospect of rehabilitative procedures,[8],[63],[64],[65],[66],[67],[68] use of a prosthesis,[69],[70] screening procedure,[71] bioengineering future,[72] and phenotypic classification for visual acuity.[73]

The health priority of the country focuses on communicable diseases, (malaria, kala azar, filariasis, dengue, tuberculosis, leprosy, etc.) malnutrition in children, women’s health, etc. National Cancer Control Programme during the 7th and 8th five-year plans had focus on tobacco-related cancers providing facilities for treatment and early detection of cancer. The priority is on improving patients’ quantity, and quality of life - let alone rehabilitation - if often ignored.[74] The limited allocation of funds to the health sector is also used for relief at the time of natural calamities. Specialised cancer treatment facilities are few and are located in major cities and metros. Taking all these factors into account, India has a long way to go before cancer treatment and rehabilitation can be provided to its population. A feasible solution would be for the psycho-social and community oriented services to be taken up by the non-government voluntary organisations and these could be provided in association with existing treatment centres. These efforts may bridge the gap between cancer survival and rehabilitation thereby lessening sufferings of the patients and hastening the road to recovery.


1 Baker CA. Factors associated with rehabilitation in head and neck cancer. Cancer Nurs 1992; 15:395-400.
2De Boer MF, McCormick LK, Pruyn JFA, Ryckman RM, Van Den Borne BW. Physical and psychosocial correlates of head and neck cancer: a review of the literature. Otolaryngol Head Neck Surg 1999; 120:427-436.
3Stroke Unit Trialists’ Collaboration. Collaborative systematic review of the randomised trial of organised inpatient (stroke unit) care after stroke. BMJ 1997; 314:1151-1159.
4Gerber L, Hicks J, Klaiman M, Thornton B, Parks R, Robertson S, et a. Rehabilitation of the cancer patient. 5, Chapter 56, 2925-2956. 1997. Philadelphia, Lippincott-Raven. Cancer: Principles and Practice of Oncology. De Vita, V. T., Hellman, S., and Rosenberg, S. A.
5Wade DT, de Jong BA. Recent advances in rehabilitation. BMJ 2000; 320:1385-1388.
6Lancaster J. Women’s experiences of gynaecological cancer treated with radiation. Curationis 1993; 16:37-42.
7von Eschenbach AC, Schover LR. The role of sexual rehabilitation in the treatment of patients with cancer. Cancer 1984: 54:2662-2667.
8Pandey M, Singh SP, Behere PB, Roy SK, Singh S, Shukla VK. Quality of life in patients with early and advanced carcinoma of the breast. Eur J Surg Oncol 2000; 26:20-24.
9Omne PM, Holmberg L, Bergstrom R, Sjoden PO, Burns T. Psychosocial adjustment among husbands of women treated for breast cancer; mastectomy vs. breast-conserving surgery. Eur J Cancer 1993; 29:1393-1397.
10Charavel M, Bremond A, Courtial I. Psychosocial profile of women seeking breast reconstruction. Eur J Obstet Gynecol 1997; 74:31-35.
11Deshmane VH, Parikh HK, Pinni S, Parikh DM, Rao RS. Laryngectomy: a quality of life assessment. Indian J Cancer 1995; 32:121-130.
12Hammerlid E, Bjordal K, Ahlner-Elmqvist M, et al. A prospective study of quality of life in head and neck cancer patients. Part I: at diagnosis Laryngoscope 2001; 111:669-680.
13Dropkin MJ. Anxiety, coping strategies, and coping behaviors in patients undergoing head and neck cancer surgery. Cancer Nurs 2001; 24:143-148.
14Hammerlid E, Silander E, Hornestam L, Sullivan M. Health-related quality of life three years after diagnosis of head and neck cancer-a longitudinal study. Head Neck 2001; 23:113-125.
15Kinishi M, Amatsu M, Tahara S. Further experience with tracheojejunal shunt speech after pharyngolaryngoesophagectomy. Ann Otol Rhinol Laryngol 2001; 110:41-44.
16Zuydam AC, Rogers SN, Brown JS, Vaughan ED, Magennis P. Swallowing rehabilitation after oro-pharyngeal resection for squamous cell carcinoma. Br J Oral Maxillofac Surg 2000; 38:513-518.
17Kugaya A, Akechi T, Okuyama T, et al. Prevalence, predictive factors, and screening for psychologic distress in patients with newly diagnosed head and neck cancer. Cancer 2000; 88:2817-2823.
18Hilgers FJ, van Dam FS, Keyzers S, Koster MN, van As CJ, Muller MJ. Rehabilitation of olfaction after laryngectomy by means of a nasal airflow-inducing manoeuvre: the “polite yawning” technique. Arch Otolaryngol Head Neck Surg 2000; 126:726-732.
19de Graeff A, de Leeuw JR, Ros WJ, Hordijk GJ, Blijham GH, Winnubst JA. Pretreatment factors predicting quality of life after treatment for head and neck cancer. Head Neck 2000; 22:398-407.
20Netscher DT, Meade RA, Goodman CM, Alford EL, Stewart MG. Quality of life and disease-specific functional status following microvascular reconstruction for advanced (T3 and T4) oropharyngeal cancers. Plast Reconstr Surg 2000; 105:1628-1634.
21Sherman AC, Simonton S, Adams DC, Vural E, Owens B, Hanna E. Assessing quality of life in patients with head and neck cancer: cross-validation of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Head and Neck module (QLQ-H & N35). Arch Otolaryngol Head Neck Surg 2000; 126:459-467.
22Tran NV, Chang DW, Gupta A, Kroll SS, Robb GL. Comparison of immediate and delayed free TRAM flap breast reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg 2001; 108:78-82.
23Polednak AP. How frequent is postmastectomy breast reconstructive surgery? A study linking two statewide databases. Plast Reconstr Surg 2001; 108:73-77.
24Schwartz AL, Mori M, Gao R, Nail LM, King ME. Exercise reduces daily fatigue in women with breast cancer receiving chemotherapy. Med Sci Sports Exerc 2001; 33:718-723.
25Nissen MJ, Swenson KK, Ritz LJ, Farrell JB, Sladek ML, Lally RM. Quality of life after breast carcinoma surgery: a comparison of three surgical procedures. Cancer 2001; 91:1238-1246.
26Lillberg K, Verkasalo PK, Kaprio J, Teppo L, Helenius H, Koskenvuo M. Stress of daily activities and risk of breast cancer: a prospective cohort study in Finland. Int J Cancer 2001; 91:888-893.
27Wyrwich KW, Wolinsky FD. Physical activity, disability, and the risk of hospitalization for breast cancer among older women. J Gerontol A Biol Sci Med Sci 2000; 55:418-421.
28Cohen L, Hack TF, de Moor C, Katz J, Goss PE. The effects of type of surgery and time on psychological adjustment in women after breast cancer treatment. Ann Surg Oncol 2000; 7:427-434.
29David JA. A study of the role of the rehabilitation team. Eur J Cancer Care 1993; 2:129-133.
30Shell JA, Miller ME. The cancer amputee and sexuality. Orthop Nurs 1999; 18:53-57, 62-64.
31Hardt J, Filipas D, Hohenfellner R, Egle UT. Quality of life in patients with bladder carcinoma after cystectomy: first results of a prospective study. Qual Life Res 2000; 9:1-12.
32Hanson Frost M, Suman VJ, Rummans TA, et al. Physical, psychological and social well-being of women with breast cancer: the influence of disease phase. Psychooncology 2000; 9:221-231.
33Gallo-Silver L. The sexual rehabilitation of persons with cancer. Cancer Pract 2000; 8:10-15.
34Bonevski B, Sanson-Fisher R, Girgis A, Burton L, Cook P, Boyes A. Evaluation of an instrument to assess the needs of patients with cancer: Supportive Care Review Group. Cancer 2000; 88:217-225.
35Rullier E, McBride T, Zerbib F, Caudry M, Saric J. Total anorectal and partial vaginal reconstruction with dynamic graciloplasty and colonic vaginoplasty after extended abdominoperineal resection: report of a case. Dis Colon Rectum 1999; 42:1097-1101.
36Stead ML, Crocombe WD, Fallowfield LJ, et al. Sexual activity questionnaires in clinical trials: acceptability to patients with gynaecological disorders. Br J Obstet Gynaecol 1999; 106:50-54.
37Fransson P, Widmark A. Late side effects unchanged 4-8 years after radiotherapy for prostate carcinoma: A comparison with age-matched controls. Cancer 1999; 85:678-688.
38Litwin MS, McGuigan KA, Shpall AI, Dhanani N. Recovery of health related quality of life in the year after radical prostatectomy: early experience. J Urol 1999; 161:515-519.
39Razavi D. Medico-psychosocial rehabilitation of patients with cancer. Rev Med Brux 1991; 12:19-25.
40Razavi D. Depression and Cancer. Encephale 1994; 20:647-655.
41Razavi D, Delvaux N. The psychiatrist’s perspective on quality of life and quality of care in oncology: concepts, symptom management, communication issues. Eur J Cancer 1995; 31:S25-S29.
42Van Harten WH, Van Noort O, Warmerdam R, Hendricks H, Seidel E. Assessment of rehabilitation needs in cancer patients. Int J Rehabil Res 1998; 21:247-257.
43Bonninghaus JS, Jackisch C, Schneider HPG. Acceptance of hospital social work in gynaecological oncology. Zentralbl Gynakol 1999; 121:513-521.
44Seifert E, Ewert S, Werle J. Physical training in the aftercare of patients with cancer of head and neck. Rehabilitation Gfr 1992; 31:33-37.
45Berglund G, Bolund C, Gustavsson UL, Sjoden PO. Starting again: A comparison study of a group rehabilitation program for cancer patients. Acta Oncol 1993; 32:15-21.
46Miyata R. Self presentation of patients disfigured by head and neck cancer. Kango Kenkyu 1996; 29:485-496.
47Schaube J, Scharf P, Herz R, Schumpelick V. Quality of life after total rectal resection for carcinoma. Dtsch Med Wochenschr 1996; 121:153-158.
48Glajchen M, Moul JW. Teleconferencing as a method of educating men about managing advanced prostate cancer and pain. J Psychosoc Oncol 1996; 14:73-87.
49Schule K. Sports therapy and rehabilitation sports - A health policy responsibility of rehabilitation. Rehabilitation Stuttg 1996; 35:23-28.
50Haberle H, Schwarz R, Mathes L. Family-oriented management of children and adolescents with cancer. Prax Kinderpsychol Kinderpsychiatr 1997; 46:405-419.
51Schulz KH, Szlovak C, Schulz H, Gold S, Brechtel L, Braumann M, Koch U. Implementation and evaluation of an ambulatory exercise therapy based rehabilitation program for breast cancer patients. Psychother Psychosom Med Psychol 1998; 48:398-407.
52Demin EV. Breast cancer as a social problem and common aspects with other oncologic patients. Vopr Onkol 1998; 44:240-245.
53Stroke Unit Trialists’ Collaboration. Collaborative systematic review of the randomised trial of organised inpatient (stroke unit) care after stroke. BMJ 1997; 314:1151-1159.
54Rudd AG, Irwin P, Rutledge Z, Lowe D, Morris R, Pearson MG. The national sentinel audit of stroke: a tool for raising standards of care. J R Coll Physicians Lond 1999; 33:160-164.
55Indreavik B, Bakke F, Slordhal SA, Rokseth R, Haheim LL. Stroke unit treatment improves long-term qualityt of life. A randomised controlled trial. Stroke 1998; 29:895-899.
56Freeman JA, Langdon DW, Hobart JC, Thompson AJ. The impact of inpatient rehabilitation on progressive multiple sclerosis. Ann Neurol 1997; 12:236-244.
57Di Fabio RP, Soderberg J, Choi T Hansen CR, Schapiro RT. Extended outpatient rehabilitation: its influence on symptom frequency, fatigue, and functional status for persons with progressive multiple sclerosis. Arch Phys Med Rehab 1998; 79:141-146.
58Wade DT, King NS, Wenden FJ, Crawford S, Caldwell FE. Routine follow-up after head injury: a second randomised controlled trial. J Neurol Neurosurg Psychiatry 1998; 65:177-183.
59Van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low back pain. In: Cochrane Collaboration. Cochrane Library. Issue 3. Oxford: Update Software, 1999.
60Wade DT. Evidence relating to goal planning in rehabilitation. Clin Rehabil 1998; 12:273-275.
61Wade DT. Evidence relating to assessment in rehabilitation. Clin Rehabil 1998; 12:183-186.
62UICC International Directory of Cancer Institutes and Organisations Indian Cancer Society. URL: directory/inicslr.html [Accessed on June 21, 2001].
63Anand J, Sivaraman Nair KP, Taly AB, Murali T. Spontaneous expulsion of large vesicle calculi in a woman with paraparesis. Spinal Cord 1999; 37:737-738.
64Khubalkar R, Khubalkar M. Mastectomized Indian women: Psychological sequelae and dynamics of underutilization prosthesis. Indian J Cancer 1999; 36:120-126.
65Yeole BB. Trends and predictions of cancer incidence cases by site and sex for Mumbai. Indian J Cancer 1999; 36:163-178.
66Gavarasana S, Gorty PV, Allam A. Illiteracy, ignorance, and willingness to quit smoking among villagers in India. Jpn J Cancer Res 1992; 83:340-343.
67Tobias JS. Cancer of the head and neck. BMJ 1994; 308:961-966.
68Jussawalla DJ. Avenues leading to cancer control-the Indian scene. Indian J Cancer 1978; 15:1-5.
69Shenoy AM, Plinkert PK, Nanjundappa N, Premalata S, Arunodhay GR. Functional utility and oncologic safety of near-total laryngectomy with tracheopharyngeal speech shunt in a Third World oncologic center. Eur Arch Otorhinolaryngol 1997; 254:128-132.
7070. Mehta AR, Sarkar S, Mehta SA, Bachher GK. The Indian experience with immediate tracheoesophageal puncture for voice restoration. Eur Arch Otorhinolaryngol 1995; 252:209-214.
71Satyanarayana G. Seven warning signals of cancer (SWSC) and screening for cancer. Indian J Cancer 1989; 26:115-119.
72Ranu HS. Bioengineering in the millennium. J Biomater Appl 1998; 13:100-110.
73Hornby SJ, Adolph S, Gilbert CE, Dandona L, Foster A. Visual acuity in children with coloboma: clinical features and a new phenotypic classification system. Ophthalmology 2000; 107:511-520.
74Pandey M, Sebastian P, Ahamed IM, Ramdas K, Thomas BC, Nair MK. A case-control study into the quality of life of women with breast cancer. Cancer Strategy 2000; 2:61-68.

Tuesday, August 16, 2022
 Site Map | Home | Contact Us | Feedback | Copyright  and disclaimer