Rehabilitation in advanced cancer

摘要

Rehabilitation has much to offer cancer patients with physical functioning issues related to nervous and musculoskeletal problems, as well as the general debility that may be a feature of advanced cancer. Individual members of the rehabilitation team bring their skills to bear to improve the ability of patients to live their daily lives as independently as possible. Rehabilitation outcomes can be measured with standardised assessments, including Barthel Index and the Functional Independence Measure, which may form part of casemix algorithms. There are no randomised control studies of rehabilitation in advanced cancer. However, there are observational studies that provide level III evidence for the efficacy of rehabilitation programs for residual physical disability that may be present in patients after acute treatment of brain tumours, spinal tumours, bony metastases with fractures, and in patients with debility. Patients with brain tumours and spinal tumours can expect a response to therapy that is entirely comparable with that seen in ‘benign’ lesions, such as strokes, brain trauma or spinal trauma in similar anatomical locations. Rehabilitation also has a useful role to play in the debility that may be a feature of advanced cancer. Particular attention must be paid to rehabilitation for return to safe driving of motor vehicles after treatment of brain tumours, and the program generally involves medical and psychological review, as well as occupational therapy assessment of the patient in off-road and on-road settings. There is no place for therapeutic nihilism in the presence of physical disability in cancer patients, any more than there is in the presence of disability due to ‘benign’ illnesses.