Neobook — clinical reference

Physical therapies

Physiotherapy and occupational therapy are essential components of cancer rehabilitation. The main aims are to improve or maintain function; foster independence and autonomy; restore participation in occupational and social activities; improve vitality, mobility and quality of life; and to help relieve pain (where that is possible).

In order to prevent chronicity, anticipate future problems and facilitate early discharge from hospital, it is important that patients are referred for physical therapy as early as possible after diagnosis or when beginning cancer treatment. Physical activity interventions are useful to reduce the severity and impact of cancer-associated symptoms, including pain, nausea and fatigue, and may also be effective in rehabilitation and restoring function to parts of the body affected by deconditioning or surgery. Furthermore, there is some evidence that exercise may help to reduce the rate of tumour recurrence.^68-73

Types of physical interventions and goals of therapy are listed in Table 1. These interventions require commitment from the patient and cooperation from the family, so therapy needs to be patient-centred and well planned with clearly defined, achievable goals.⁶⁷

Table 1: Physical Interventions for Patients with Cancer
Intervention	Goals of Therapy
Graded exercise therapy	- Improve physical function and reduce deconditioning problems associated with inactivity and immobility: muscle wasting and weakness, joint stiffness, reduced motor control and cardiovascular deconditioning - Reduce severity and impact of symptoms of pain, nausea and fatigue - Relieve pain-related fear of movement or repeated injury - Improve self-efficacy - Improve quality of life
Transcutaneous electrical nerve stimulation (TENS)	- Pain relief
Graded and purposeful activity; e.g., scheduling of daily activities, recreation and participation, including work	- Increase activity tolerance, autonomy, social integration, self-esteem and competency - Restore function and independence for participation in daily activities and work
Teach activity pacing skills	- Minimise painful episodes - Increase self-efficacy and pain coping skills
Educate patients in neurophysiology of pain	- Reduce fear of movement and improve coping self-efficacy
Physical treatment modalities, including massage and soft tissue mobilisation, heat and cold where appropriate (heat should not be applied directly to an active tumour), posture re-education^74,75	- Relieve pain where possible - Restore range of motion and function of the affected regions of the musculoskeletal system
Environmental adaptation Orthotics	- Restore function and independence for participation in daily activities and tasks - Minimise painful episodes

Complementary therapies for cancer pain

Although there is little or no evidence for effectiveness of complementary therapies in improving cancer pain, they are commonly used by patients who have faith in them or who are disillusioned with the efficacy of conventional medicine. In these terms they have the potential to improve well-being and may be useful in conjunction with conventional treatments and palliative care. Examples include aromatherapy, music therapy, homeopathy, hypnotherapy, massage, reflexology, reiki and relaxation.

Although there is no evidence of a direct effect on cancer pain, acupuncture may assist in alleviating chemotherapy-associated nausea and vomiting.