Cancer rehabilitation is a one block (4 week) mandatory rotation in the Core of Discipline stage of PM&R Residency Training. The block is typically undertaken in early PGY-4.

Goals & Objectives

1. Understand the clinical approach to various cancer physiatry issues

2. Know the principles of various functional impairments that are cancer-related including cancer-related fatigue, chemotherapy-induced peripheral neuropathy, chemotherapy-related cognitive dysfunction, and common impairments in head & neck and breast cancer

3. Recognize potential areas of physiatry interventional treatments in other oncology

Interventional procedures with Dr. Ghuman during cancer rehabilitation clinic

Appreciate the role of cancer rehabilitation therapies in PT, OT and SLP as well as psychosocial oncology

Shadow allied health and related disciplines during independent study time and after DCNS rounds on Fridays

RESOURCES & TEACHING TOPICS

1. General overview of cancer rehabilitation:

-       Cheville AL. Cancer Rehabilitation. Seminars in Oncology, 2005.

-       Silver JK et al. Impairment-Driven Cancer Rehabilitation: An Essential Component of Quality Care and Survivorship. 

2. Lymphedema

-       Kerchner K, Fleischer A, Yosipovitch G. Lower extremity lymphedema update: pathophysiology, diagnosis, and treatment guidelines. J Am Acad Dermatol. 2008 Aug;59(2):324-31.

3. Chemotherapy-related cognitive impairment (CRCI)

-       Joly F, et al. Impact of Cancer and Its Treatments on Cognitive Function: Advances in Research From the Paris International Cognition and Cancer Task Force Symposium and Update Since 2012. J Pain & Symptom Mgmt, 2015.

-       Lange M et al. Cancer-related cognitive impairment: an update on state of the art, detection, and management strategies in cancer survivors. Annals of Oncology, 2019.

4. Breast cancer rehabilitation:

-      Wisotzky et al. Deconstructing Postmastectomy Syndrome Implications for Physiatric Management. Phys Med Rehabil Clin N Am, 2017.

-       Roberts K et al. Management of aromatase inhibitor induced musculoskeletal symptoms in postmenopausal early Breast cancer: A systematic review and meta-analysis. Critical Reviews in Oncology/Hematology, 2017.

5. Cancer related fatigue (CRF) and asthenia/deconditioning

-       Berger AM et al. Cancer-related fatigue. J Natl Compr Canc Netw. 2015

6. Radiation fibrosis syndrome: 

-       Stubblefield MD. Clinical Evaluation and Management of Radiation Fibrosis Syndrome. Phys Med Rehabil Clin N Am, 2017.

-       DiFrancesco T et al. Clinical Evaluation and Management of Cancer Survivors with Radiation Fibrosis Syndrome. Seminars in Oncology Nursing, 2020 (this article is more neuromuscular focused than the first one).

7. CNS Tumours and rehabilitation 

-       Gillis TA, Yadav R, Guo Y. Rehabilitation of Patients with Neurologic Tumors and Cancer-Related Central Nervous System Disabilities. Society of NeuroOncology. Link: https://soc-neuro-onc.org/UploadedFiles/Levin/Levin_ch22_p470-492.pdf

8. Hematologic Tumours and rehabilitation issues

●      Morishita S, Nakano J, Fu JB, Tsuji T.  Physical exercise is safe and feasible in thrombocytopenic patients with hematologic malignancies: a narrative review.  Hematology. 2020 Dec;25(1):95-100.

-       Mohananey D, Sarau A, Kumar R, Lewandowski D, Abreu-Sosa SM, Nathan S, Okwuosa TM.  Role of physical activity and cardiac rehabilitation in patients undergoing hematopoietic stem cell transplantation. JACC CardioOncol.2021 Mar 16;3(1).

9. Bone Tumours/Metastases and Precautions

●      Morishita S, Nakano J, Fu JB, Tsuji T.  Physical exercise is safe and feasible in thrombocytopenic patients with hematologic malignancies: a narrative review.  Hematology. 2020 Dec;25(1):95-100.

-       Mohananey D, Sarau A, Kumar R, Lewandowski D, Abreu-Sosa SM, Nathan S, Okwuosa TM.  Role of physical activity and cardiac rehabilitation in patients undergoing hematopoietic stem cell transplantation. JACC CardioOncol.2021 Mar 16;3(1).

10. The role of exercise in Cancer 

●      Dimeo FC. Effects of exercise on cancer-related fatigue. Cancer. 2001;92(6 Suppl): 1689-1693.

-       Stout NL, Santa Mina D, Lyons KD, Robb K, Silver JK. A systematic review of rehabilitation and exercise recommendations in oncology guidelines. CA Cancer J Clin.2021 Mar;71(2):149-175.

11. Chemotherapy-related cognitive impairment (CRCI)

-       Joly F, et al. Impact of Cancer and Its Treatments on Cognitive Function: Advances in Research From the Paris International Cognition and Cancer Task Force Symposium and Update Since 2012. J Pain & Symptom Mgmt, 2015.

-       Lange M et al. Cancer-related cognitive impairment: an update on state of the art, detection, and management strategies in cancer survivors. Annals of Oncology, 2019.

12. Palliative Rehabilitation

●      Javier NS, Montagnini ML. Rehabilitation of the hospice and palliative care patient. J Palliat Med. 2011;14:638–48.

●      Santiago-Palma J, Payne R. Palliative care and rehabilitation. Cancer. 2001;92:1049–52.

●      Padgett LS et al. The Intersection of Rehabilitation and Palliative Care: Patients With Advanced Cancer in the Inpatient Rehabilitation Setting.