The Challenges Faced By Cancer Survivors

Feeling On Your Own After Cancer

Some cancer survivors describe feeling a sense of abandonment, and feel "left hung out to dry"

Although there is a lot of cancer information out there, it is sometimes difficult for cancer patients after treatment to feel supported with the tailored information and care that they need. The way some cancer survivors have described it to us is that they feel a sense of abandonment, or feel "left hung out to dry". But with regular care from a cancer rehabilitation professional, these feelings can gradually be overcome and survivors can get back to their regular routines.

Dis-Ease Means Unease With a Disruption to Self

Some cancer patients indicate feeling a lack of ease with themselves and their physical fragility that no-one is addressing or helping them get through. This unease really speaks to a need for integrated cancer rehabilitation services to help patients:

• recover their identity
• learn how to manage and adapt to any permanent impairments
• have a regular exercise schedule that has been tailored for them and will help to overcome the sense of constant fatigue
• receive specialized physiotherapy to address movement restrictions, swelling and cancer related pain
• when necessary, have counseling to overcome the sense of being deflated, dejected and even jaded after surgery

Acquiring a New Meaning for Physical Activity

When exercise means lowering the chances of cancer ever coming back, it takes on a new meaning. As one patient puts it, "keeping her blood oxygenated" through everyday exercise is the best way to keep the cancer away. For her, exercise has become a tool for a second chance and the gateway for her to get back to living her life. Building up muscle mass that has deteriorated is another often challenging aspect of post-cancer physical activity, but the benefits of exercise for cancer management are numerous and encouraging!

Cancer Rehabilitation is Available In Canada at 62 Different Locations

We offer a means for cancer patients to overcome many of the challenges and impairments that have resulted from cancer and its treatment. These side effects are most effectively overcome with an individualized treatment plan designed by a Cancer Rehabilitation professional.

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

British Columbia

Alberta

Saskatchewan & Manitoba

Ontario

Nova Scotia

Other Helpful Links for Cancer Rehabilitation

Willow Breast Cancer Support Canada

Canadian Cancer Society

Livestrong Foundation

ELLICSR Kitchen - UHN Princess Margaret Cancer Centre

Childhood Cancer Canada Foundation

Canadian Partnership Against Cancer

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

Increased Physical Activity Improves Cancer Survival Rates

Are You a Cancer Survivor With N.E.D.?

Cancer survivors can improve their chances of remaining NED through regular exercise

We live in a world of acronyms that are only meaningful to people "in the know". I have worked my whole life with PTs, OTs and RMTs who do things like measure ROM, use the IFC and put people through FCEs. What may seem strange to those outside my physiotherapy world is all very clear to me.

The Importance of the Acronym N.E.D.

One acronym that really sticks in my mind these days though, is N.E.D.! This has a special meaning to me, along with thousands of other cancer survivors. It means No Evidence of Disease. These are the best three letters you can hope to see written at the bottom of your doctor's chart. Nothing makes me happier than hearing that the follow-up test results have shown N.E.D.!

Increased Physical Activity Improves Survival Rates

But the question remains how cancer survivors can improve their chances of remaining N.E.D. One of the best ways is engaging in regular exercise.

A systemic review completed in 2010 by Barbaric et al, looked at the Effects of Physical Activity on Cancer Survival. They concluded after reviewing hundreds of scientific research articles that there is growing evidence demonstrating that increased physical activity improves survival rates in patients with breast or colorectal cancers. The recommended amount required to make a difference is a mere 3 hours of moderately paced walking per week. More recently, there is evidence supporting exercise with other types of cancers including lung and prostate. Surely regular daily exercise is possible for most cancer survivors and should be strongly encouraged by the medical community.

I believe it is time to challenge the meaning of N.E.D.! From now on... let us all remember that it really should mean NEED EXERCISE DAILY!

How to Get Cancer Rehabilitation

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

Ontario
British Columbia

Alberta

Saskatchewan & Manitoba

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.

Physician Information When Referring Patients to Cancer Rehab

How can I convince my cancer patients of the therapeutic value of exercise?

How Can I Convince My Cancer Patients of the Therapeutic Value of Exercise?

Although exercise for cancer patients is strongly supported in studies, surprisingly few patients realize that physical activity can actually improve their survival outcomes and reduce their odds of reoccurrence, especially for colorectal and breast cancer patients. This is documented by Barbaric et al in Effects of Physical Activity of Cancer Survival: A Systematic Review. Physiotherapy Canada. 2012: 62:25-34.

When Should Patients be Referred for Cancer Rehabilitation?

The Cancer Rehab Canada program is appropriate for those who have completed their cancer treatments and are medically stable. Early referral to rehabilitation allows us to recognize and treat cancer-related physical impairments before they negatively impact daily function and increase emotional distress. Candidates must be willing to actively participate in their rehabilitation process.

Why Cancer Rehabilitation?

The goal of Cancer Rehab Canada is to optimize your patient’s functional abilities, enabling them to gradually return to work in a safe and timely manner in a capacity suitable to their abilities.

Cancer rehabilitation is strongly supported in the research for all types of cancer diagnosis and at all stages of survivorship. As stated in Advances in Survivorship Care: Resources, Lessons Learned and Promising Practices. Canadian Partnership Against Cancer, good survivorship care includes a plan to help patients achieve their optimal level of function.

What Types of Cancer Impairment Can Rehab Help?

Functional impairments that benefit from rehabilitation include:

• Cancer Related Fatigue
• Pain
• Chemo Brain
• Radiation Fibrosis Syndrome
• Scar Tissue Management
• Lymphedema
• Frozen Shoulder & other movement restrictions
• Axillary Web Syndrome
• Chemo Induced Peripheral Neuropathy

What Safety Measures Are Followed by Cancer Rehab Canada?

We monitor for potential problems such as bony metastasis, cardiac autonomic insufficiency, balance issues, fever, and fluctuating blood lab values indicating problems such as anemia or neutropenia. We will be reporting any medical red flags to you immediately and asking for your assistance in directing the appropriate medical follow up.  Cancer patients should be carefully screened for impairments prior to participating in community or group exercise, in order to address their individual needs, as outlined in Patient Safety in Cancer Rehabilitation. Physical medicine and rehabilitation clinics of North America. 2012:23(2): 441-56 by Cristian et al.

Principles of the Cancer Rehabilitation Program

 Client-centered, active rehabilitation and empowerment are the principles of the program that is now offered at over 60 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

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

Ontario
British Columbia

Alberta

Saskatchewan & Manitoba

Nova Scotia