Rehabilitation Services

Treatment for cancer can be very hard on your body. Physical rehabilitation can help your body recover from cancer, treatment and other physical changes you may experience.

Rehabilitation Services: Detailed Information

This information is meant to be a general introduction to this topic. The purpose is to provide a starting point for you to become more informed about important matters that may be affecting your life as a survivor and to provide ideas about steps you can take to learn more. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Suggestions and Additional Resources documents for questions to ask and for more resources.

Cancer rehabilitation services utilize a wide variety of health care experts, resources, and healing techniques to help people recover physically and emotionally from serious illnesses and injuries. A primary care provider, oncologist, or physiatrist (rehabilitation physician) may coordinate care for a survivor with other rehabilitation professionals.

Health care providers in rehabilitation medicine often work as a team to maximize a cancer survivor's physical and emotional recovery. The rehabilitation team members may vary depending on the cancer diagnosis, treatment, and other medical problems such as side effects or aftereffects.

Who can benefit from rehabilitation services?

Cancer and treatment can cause physical problems including, but not limited to, pain, fatigue, and muscle weakness. These may then interfere with life in a variety of ways physically, emotionally and practically. While not all cancer survivors need rehabilitation services that are guided by health care professionals, most will need to at least work on improving strength and stamina.

Expert advice and guidance may help to improve health and ability to function as normally as possible more quickly and to a greater degree. There are many resources and therapies to help cancer survivors with fatigue, pain, and overall ability to function. Survivors who want to continue to work or return to employment may benefit from rehabilitation services to help them do so.

What should be included in a plan for rehabilitation?

Rehabilitation medicine deals with prevention, diagnosis, treatment, and maximizing recovery from a serious illness or injury. An overall plan for rehabilitation services and activities should be developed by the health care provider and patient. The plan is then carried out by the patient and appropriate members of the rehabilitation team.

A plan for rehabilitation can help a survivor to move forward while being as active as possible. In order to develop a plan, your health care team will ask you questions about pain and fatigue, , physical challenges, emotional concerns, and practical issues such as your ability to work. Make a list of needs and concerns that you have before you meet with your health care provider to help develop your plan for rehabilitation.

Each member of the rehabilitation team will work with you to develop a plan for his/her specific area of expertise. For example, a physical therapist will develop a plan to help you recover physical strength and mobility. An occupational therapist can help you with returning to your usual activities at home, work and in the community. A speech-language pathologist assists with speech and/or swallowing problems. A vocational specialist may work with you to develop a plan to successfully return to work.

Who provides rehabilitation services?

Rehabilitation services may be prescribed by any medical or osteopathic doctor including an oncologist, primary care provider, or physiatrist. The medical specialty of rehabilitation medicine is led by physiatrists who are medical doctors who have specialized in rehabilitation. Physiatrists go through medical school as well as at least four more years of training to specialize in Physical Medicine and Rehabilitation (PM&R).

Physiatrists diagnose and treat pain and work to restore the highest possible level of functioning following a loss through illness, injury or disability. Physiatrists provide non-surgical treatments and work on prevention. Some have expertise in cancer rehabilitation and work with survivors to help them heal during and after cancer treatments.

Many other types of health care professionals also provide rehabilitation services including occupational and physical therapists, rehabilitation nurses, speech therapists, and mental health professionals.

The following table provides an overview of some of these professionals and what they do:

Professional	What They Do
Physician (physiatrist or other type of medical or osteopathic doctor)	The doctor who leads the team will decide what diagnostic tests should be done and what treatment should be prescribed.
Physical Therapist	The physical therapist is primarily involved in helping someone recover strength, flexibility, endurance and mobility. They also treat pain and some can manage conditions such as lymphedema. Many physical therapists specialize in certain types of medical problems such as orthopedic or neurologic.
Occupational Therapist	The primary goal of occupational therapy is to help someone resume doing his or her usual daily activities such as bathing, dressing and even returning to work. Occupational therapists devote considerable efforts to improving the functional use of the arm including helping to improve arm strength, coordination and range of motion. They can also treat pain and some are certified in lymphedema therapy.
Speech and Language Pathologist	This type of therapist concentrates on problems that have to do with language comprehension or expression as well as swallowing issues.
Rehabilitation Nurse	These health care specialists are always available in inpatient rehabilitation settings but often work in outpatient settings as well. Rehabilitation nurses perform all of the usual nursing functions but also focus on helping patients with bowel and bladder function, sexuality issues, and providing education and support for the family. Rehabilitation nurses can also help people regain the ability to move, speak and swallow by reinforcing what the therapy team is working on.
Vocational Rehabilitation Specialist	This professional evaluates whether someone can return to work and if so how best to accomplish this. This may involve the use of special equipment such as a one-handed computer keyboard. If it is necessary for the cancer survivor to work in an entirely new occupation, vocational retraining may be offered.
Therapeutic Recreational Therapist	These therapists are not always found in rehabilitation settings, but many hospitals have at least one therapeutic recreational therapist on staff. This specialist helps people to embrace leisure and educational activities that are part of having a good quality of life. These activities may include cooking, gardening and playing sports.
Mental Health Counselor	Most rehabilitation settings will have some type of mental health counseling available. This might include a consultation with a doctor who specializes in psychiatry or an evaluation with a psychologist or clinical social worker. These specialists have a lot of experience in helping people psychologically adjust to a life that may be different from what they had previously experienced.
Neuropsychologist	This is a specific type of mental health specialist who is responsible for conducting testing to determine cognitive problems in people who are experiencing issues with memory, concentration and other brain functions.
Registered Dietician	A registered dietician helps to figure out the best diet for someone going through cancer treatment and/or rehabilitation. A dietician can offer guidance as to how to gain or lose weight and improve energy through nutrition.
Orthotist	This professional who has training in how to fit and make braces. Braces are sometimes necessary for people who have some weakness or paralysis.
Prosthetist	This is a rehabilitation professional who is an expert at making and fitting artificial limbs—usually after an amputation.
Case Manager	This person acts as a liaison between the rehabilitation team, the insurance company, the patient and the family. Case managers are helpful in answering your questions related to insurance and assisting you with getting the best possible care. Case managers may be found in both inpatient and outpatient settings.

How long will survivors require rehabilitation services?

A progressive and ongoing physical rehabilitation plan may enhance the quality of life at any time during the cancer journey. Some of the physical side effects that survivors may experience are only temporary and occur during or right after cancer treatment is completed. In this case, a survivor might participate in rehabilitation services only while the temporary changes affect his or her daily life.

For other survivors, physical aftereffects (late effects) may not happen for years after treatment ends. If these changes bring pain or require adjustments in daily life, rehabilitation services may be needed and prescribed by the health care provider at that time. If your health care provider is not certain how to address your rehabilitation needs, he or she can refer you to a physiatrist who can prescribe an appropriate treatment plan.

The length of time that rehabilitation treatment and services are needed can vary depending on specific issues. Some insurance plans cover only a limited number of visits to physical, occupational, and speech therapists. Contact your insurance company or case manager about the specific coverage provided by your plan. If the coverage ends, there may be other options available in your community to allow you to receive ongoing services. Talk with the health care team, especially an oncology social worker, about other services that may exist in your area.

This document was produced in collaboration with:

Julie Silver, MD
Assistant professor at Harvard Medical School in the Department of Physical Medicine and Rehabilitation
Sue L. Frymark R.N., B.S.
Executive Director, Cancer Care Resources

Works Cited:

Frymark, S. "Cancer Rehabilitation Services-The Road to Survivorship." Oncology Issues 14 (6)1999: 16-19

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Rehabilitation Services: Suggestions

The suggestions that follow are based on the information presented in the Detailed Information document. They are meant to help you take what you learn and apply the information to your own needs. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Additional Resources document for links to more resources.

• Address concerns as you and your health care team work together to create a rehabilitation plan.
  
  • Make a list of physical issues that affect your ability to function (such as difficulty concentrating at work or exercising, or even something as simple as getting in and out of the car).
  • Discuss your specific concerns with your health care team.
  • Ask the rehabilitation professionals you work with to evaluate your needs and report their suggestions to other members of your health care team.
  • Together with your health care provider, develop your plan for physical and emotional recovery.
  • Ask for referrals to health care providers who specialize in the type of rehabilitation you need.
  • Talk to a registered dietician about what diet would be best for your recovery needs.
  • Share your plan with your support system such as family, friends, or support groups.


• Be sure that your health care provider is knowledgeable about and able to guide your rehabilitation care. When you are working with rehabilitation professionals, ask them if they have experience in treating cancer survivors. You may want to ask:
  
  • Have you treated many cancer survivors?
  • Have you helped anyone with a similar issue?
  • What do you think will help me improve my health and ability to function?
  • Would you be willing to discuss your suggestions with other members of my health care team?
  
  You can also ask questions about your particular concerns such as:
  
  • What can I do to improve my balance?
  • Can I improve the strength of my hands?
  • What can be done to improve my swallowing?
  • How can I manage my job and home life with this fatigue?
  • What can I do about my poor memory?
  • What kind of exercise program should I follow at home?
  
  In order to develop a plan for rehabilitation, your health care team will likely want to know answers to questions such as:
  
  • What are you unable to do now that you could do before your cancer diagnosis?
  • How has your diet and appetite changed?
  • How has your activity level or exercise regimen changed?
  • How has your cancer and treatment affected your ability to work?
  • What daily tasks or recreational activities are you not able to do now that you could do before?
  • How is pain affecting your ability to function, including being able to get a good night's sleep?
  • Do you think that you need to build up your strength and stamina?
  • Are you tired? If so, how is that affecting your ability to function day to day?
  • Are you sad, worried, anxious or depressed and how is this affecting your ability to function?


• Check to see if your insurance plan covers the rehabilitation services you need.
  • To receive rehabilitation services, you will often need a health care provider’s order. You can get this from your oncologist, primary care provider, or physiatrist.
  • Check your insurance coverage to see how many physical, occupational or speech therapy visits you are allowed each year by each type of therapist. Each insurance company may cover rehabilitation services differently. Call your insurance company's helpline or talk to your case manager and ask specifically what your plan does and does not cover for rehabilitation services.
  • If medical devices or aids are needed, ask the rehabilitation professional who is recommending this or prescribing it about the cost. Many items are covered by insurance and Medicare, but some are not covered. There may be other ways to get the medical devices or aids if you cannot afford them.
  • If you need rehabilitation services or special equipment but do not have insurance ask to talk with a social worker. An oncology social worker may be able to direct you to resources in your community where you can get these needed services or items for a discounted rate or for free.


• The American Academy of Physical Medicine and Rehabilitation (www.aapmr.org) can help you find a physiatrist in your area.

  Physiatrists help people to physically recover after a diagnosis with a serious illness or injury.

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Rehabilitation Services: Additional Resources

The previous sections of this document provide detailed information, suggestions, and questions to ask related to this topic. This section offers a listing of additional resources that are known to provide support and quality services that may be helpful to survivors during the cancer journey.

LIVESTRONG Cancer Navigation Center
www.LIVESTRONG.org/GetHelp

Email:	Cancer.Navigation@LIVESTRONG.org
Phone:	1.855.220.7777 (English and Spanish)
	Navigators are available for calls Monday through Friday, 9 a.m. to 5 p.m. (Central Time). Voicemail is available after hours.

The Navigation Center provides free, confidential one-on-one support to anyone affected by cancer. This is not a medical facility, but rather a center that provides the following support services:

• Emotional Support—assistance coping with a cancer diagnosis, help accessing support groups, as well as peer-to-peer connections
• Fertility Risks and Preservation Options—information on fertility risks and help accessing discounted rates for fertility preservation options
• Insurance, Employment and Financial Concerns—information on employment rights and benefits, financial assistance and debt management, including insurance and billing issues as well as medication co-pay assistance

In addition to professional cancer navigators on staff, LIVESTRONG partners with specialty organizations such as Patient Advocate Foundation, Imerman Angels, Navigate Cancer Foundation and EmergingMed to provide support services.

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