Cancer Rehab and Return to Work

More People Surviving Cancer Due to Improved Treatments

Although returning to work after cancer can be challenging, rehab can play a valuable role

Returning to work following a cancer diagnosis is more viable than it ever has been before. More people are surviving cancer due to improved treatments, better diagnostics and the fact that many are being diagnosed at a younger age. Although returning to work can sometimes be a challenge, rehabilitation can play a valuable role in achieving this important step in the transition from illness to wellness. The success and durability of their return to work depends on many factors which we are only now beginning to recognize.

Multidisciplinary Rehabilitation is Effective in the Return to Work Process

Research shows that the majority of people who are diagnosed with cancer want to return to work however many struggle to do so and end up having to leave or change jobs, if they manage to return at all. So how are we best able to support and encourage this return to work process?  A Cochrane review article, including 18 research studies and 1652 participants studied the effectiveness of interventions aimed at enhancing return to work in cancer patients. They concluded that there is moderate quality evidence to suggest that multidisciplinary interventions involving physical, psychological and vocational components led to higher return to work rates. Multidisciplinary rehab should always be considered over the “wait and see” approach.
(de Boer A, Taskila T., Frings-Dresen M, Feurstein M., Verbeek, J: Interventions to enhance return-to-work for cancer patients: A Cochrane Review. Proceeding of the First Scientific Conference on Work Disability Prevention and Integration.  2010)

Rehabilitation Not Routinely Offered

The current research recommends rehabilitation to address and treat the cancer related and cancer treatment related “side effects” for improved functional outcomes. However it is clear that although rehabilitation services are needed they are not usually received by cancer survivors. Only 19% of breast cancer patients reported having received any physical, psychological or educational rehabilitation service. The medical profession continues to be disease centered and there continues to be a lack of consideration of the possible rehabilitation services, which in turn negatively impacts successful return to work. In many cases the health disability insurance companies are left to encourage and fund this important step in the recovery process.
(Silver Jk, Gilchrist LS: Cancer Rehabilitation with a focus on evidence-based outpatient Physical and Occupational Therapy Interventions. Am.J. Phys.Med. Rehabil. Vol 90, No 5 (Suppl), May 2011)

Cancer Rehabilitation is Cost Effective

A recent large government funded review in the UK found that structured vocational interventions can be both beneficial to individuals and cost effective. They claim that if a cancer patient is supported back into work the cost of the intervention pays for itself within the first 12 weeks that they otherwise would not have worked. This study demonstrates “that personalised and timely vocational rehabilitation interventions do result in better work and health outcomes for people with cancer and can be cost effective.” Assisting people with cancer back to work has a positive economic impact for everyone involved.
(Macmillan (2013) Making the Shift: Providing specialist work support to people with cancer. London. Macmillan Cancer Support)

Early Results from Rehab Professionals Working With Cancer Patients Are Positive

In 2013 LifeMark/Centric Health embarked upon a strategy to train our clinicians, to improve our Cancer Rehab services and to begin to meet the rehabilitation needs of the almost one million cancer survivors living in Canada today. We wanted to ensure that our rehabilitation professionals were prepared with the latest evidence based information on Cancer Rehabilitation.

Moving beyond the research and into clinical care in our clinics, we are beginning to see the evidence borne out in our own clinical results.  The early results from our Cancer Rehabilitation services are beginning to show the positive impact on our patient’s lives.

• 100% of patients attained their return to activities of daily living goals;
• 90% of patients attained their symptom improvements goals; and
• 74% of patients attained their return to work goals

To find out more about Cancer Rehab Canada please see our website.

Please contact one of our 62 Cancer Rehab locations across Canada. Links will direct to a Cancer Rehab provider in your area.

British Columbia

Alberta
Saskatchewan & Manitoba
Ontario
Nova Scotia

5 Tips to Keep Cancer Patients Active

Motivation to exercise is important when you can't exercise or feel too tired to exercise

Can't Exercise? Too Tired to Exercise?

The evidence supporting exercise for cancer patients is undeniable. However, sometimes we feel we can't exercise or are too tired to exercise. Although we know we need to be physically active, it is often very difficult to stick to it.

How to Stay Motivated to Exercise

As a physiotherapist and cancer survivor myself, I can certainly appreciate both sides. On those days when my "get up and go" has "got up and left", I put on my physiotherapy hat and recall some of the tips I have learned over the years that help me stay motivated and physically active. Here are a few things to consider:

• Exercise with a friend. If I have someone waiting to meet me at the gym I am far more likely to go, and my friend usually appreciates me encouraging them to be there too.
• Vary your exercise routine to avoid boredom. I like to try something different each day of the week, but also change it up with the seasons.
• Exercise outdoors whenever you can. It just feels healthier to me to be breathing fresh air and enjoying the scenery, regardless of whether it is 20 below or 20 above.
• Record your exercise achievements, so that you can track your progress. There are some cool apps for tracking walking and running progress now, that make this easy and fun.
• Identify barriers to exercise and work to overcome them. One example of this is using urban walking poles to give you confidence to walk further or on uneven terrain when your balance might be slightly impaired.

How Physiotherapists Can Help

Physiotherapists are trained to help individuals with a variety of disabilities overcome their barriers to being physically active. Physiotherapists have heard every excuse in the book as to why someone cannot exercise. In most cases, modifications can be made to create a safe and effective exercise program for just about anyone. It may definitely be worthwhile to consult a physiotherapist during or after your cancer treatment to develop a physical activity plan with achievable goals.

To find out more about Cancer Rehab Canada please see our website.

Please contact one of our 62 Cancer Rehab locations across Canada. Links will direct to a Cancer Rehab provider in your area.

British Columbia

Alberta

Saskatchewan & Manitoba

Ontario

Nova Scotia

Benefits of Exercise for Cancer Management

Incorporating Exercise into Your Cancer Management Plan

Exercise is one of the most beneficial things that cancer patients can incorporate into their cancer management plan

Physical activity is important in all stages of cancer. Many cancer patients are reluctant to exercise for fear of ‘making things worse” when in fact it is one of the most beneficial things that they can do. The scientific evidence to support this is growing and every effort should be made to incorporate exercise as part of the accepted cancer management plan.

How Exercise Benefits Cancer Patients

During cancer treatment 

• Reduces pain and fatigue
• Prevents decline of physical function
• Manages stress and improves mental outlook

After cancer treatment

• Increase energy levels
• Assists in the recovery of physical function
• Improves quality of life

During and after cancer treatment

• Reduces the risk of cancer reoccurrence
• Reduces the risk of developing other long term complications

Advanced cancer

• Helps maintain independence and well being

How a Physiotherapist Trained in Cancer Rehabilitation Can Help

People living with cancer should be advised to gradually build up their physical activity to meet the recommended guidelines. A physiotherapist trained in cancer rehabilitation can assist them in preparing an exercise program that meets the energy expenditure amounts recommended in the research, in addition to making sure that they are safely adapting to meet any medical restrictions or physical impairments.

It is important that we continue to encourage, support and assist cancer survivors to initiate and maintain a lifestyle that regularly includes physical activity at all stages of their journey with cancer.

To find out more about Cancer Rehab Canada please see our website.

Please contact one of our 62 Cancer Rehab locations across Canada. Links will direct to a Cancer Rehab provider in your area.

British Columbia

Alberta
Saskatchewan & Manitoba
Ontario
Nova Scotia

Integrating Exercise on the Cancer Care Pathway

Growing Evidence Supports the Role of Physical Activity During and After Cancer Treatment

Research indicates that with tailored programs, exercise is likely to have a positive effect on cancer patients

In a Macmillan Cancer Support Review of the evidence for integrating the promotion of physical activity within the cancer care pathway, a team of medical researchers* found that if exercise prescriptions are individually tailored to each individual and the potential for side effects taken into account, exercise is likely to have a positive effect on cancer patients.

The review reports that exercise during treatment prevents a decline in functional outcomes without increasing fatigue. One study within the review highlighted the fact that the loss of physical function experienced by cancer survivors apply to longer-term survivors, not just patients who have just completed treatment:

“Limitations in physical functioning were reported by a significantly higher proportion of both short-term (54%) and long-term (53%) cancer survivors… The commonest problems experienced (crouching, kneeling, standing for long periods, walking short distances and lifting/carrying a load) are all vital for carrying out basic daily activities…”

 General Exercise Safety Precautions During and After Cancer Treatment

It is important to see a rehab professional with special training in cancer-related physiotherapy techniques for help in deciding what and how much exercise is recommended both during and after treatment. Below are some potentially adverse events associated with physical activity and cancer, with precautions you can take to avoid them:*

To prevent the exacerbation of symptoms (eg pain, fatigue, nausea, dyspnea) - Avoid high-intensity exercise; monitor symptoms; modify exercise type based on site of treatment (eg avoid exercise bike after prostate/rectal surgery).

To prevent immunosuppression – If patient has low white blood cell counts, avoid high intensity/volume of exercise (keep to light – moderate intensity).

To prevent falls – If patient has dizziness, frailty, peripheral sensory neuropathy: incorporate balance and coordination exercises (eg tai chi) and avoid activities needing considerable balance/coordination (eg treadmill).

To prevent bone fracture – If patient has bone metastases/osteoporosis risk avoid high impact or contact activities.

To prevent lymphedema – Progress resistance exercises in small and gradual increments. To avoid exacerbation of lymphedema, avoid strenuous repetitive exercise with affected limb;  wear compression garment.

* Written by Dr. Anna Campbell, University of Dundee; Jo Foster, Macmillan Cancer Support; Dr. Clare Stevinson, Loughborough University; and Dr. Nick Cavill (Cavill Associates Ltd).


A current Canadian study hopes to inspire health-care professionals to incorporate exercise into standard cancer care programs.

To find a Cancer Rehab Canada location near you, please see our list of British Columbia, Saskatchewan, Ontario, and Nova Scotia locations.

Cancer Patients Need a Plan to Help Them Get Back to Work

Cancer patients need a plan to help them get back to work

If you have completed cancer treatment and want to improve your abilities so you can return to work and leisure activities, you are a candidate for the Cancer Rehab Canada program. Here are a few things that you can expect on your first visit:

An Assessment Allows Your Rehab Team to Make a Treatment Plan

You will be assessed by a physiotherapist and/or occupational therapist on your first visit. Your functional status may also be assessed by a kinesiologist, testing for your ability to do things such as lifting, walking, squatting etc. From this information, together with your input, the rehab team will make recommendations and prepare an individualized treatment plan based on your needs.

What a Typical Treatment Program Can Involve

Your treatment sessions will likely vary in length, and your therapist will advise you of this after the first visit. Often sessions become longer as you are able to tolerate more exercise/work conditioning. Although treatment varies for each individual based on their goals, some of the more common type of treatment for cancer rehab may include:

• Exercise
• Work Conditioning
• Manual Therapy
• Cognitive Behavioural Therapy
• Lymphedema Management
• Acupuncture
• Education & Coping Strategies
• Techniques to Reduce Dizziness or Vertigo
• Pelvic Floor Treatment

What You Should Bring to Your First Appointment

We recommend that you dress in comfortable clothing that you can easily move around in, and bring running shoes and a water bottle if possible. Since some clients feel more comfortable using their own mats, so you can also bring your own “yoga” mat if desired.

Principles of the Cancer Rehabilitation Program

Client-centered, active rehabilitation and empowerment are the guiding principles of the program that is now offered at 24 LifeMark/Centric Health clinics.

Client Centered – individualized, evidence based care provided in your community

Active – increasing your physical activity will have the biggest impact on your recovery

Rehabilitation – includes a multi-disciplinary team of rehab professionals

Empowerment – providing you with the tools you need to regain control of your life

Contact us for more information at judy.boivin@lifemark.cajudy.boivin@lifemark.ca.