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.

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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

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 physician, oncologist, or physiatrist (physical 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 pain, fatigue, and muscle weakness. These may then interfere with life in a variety of ways including 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 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.

Some of the signs that you might benefit from help with your rehabilitation include:

• Feeling weaker now than when you were initially diagnosed
• Having difficulty talking or swallowing
• Experiencing pain that is not caused by cancer
• Feeling more tired than you were before you were diagnosed
• Having muscular or orthopedic problems
• Recovering from treatment and doing the things you used to do
• Uncertainty about how much to exercise or how to best exercise

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 physician 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 concerns, 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 doctor to develop your plan for rehabilitation.

Each member of the rehabilitation team is likely to also work with you to develop a plan for their specific area of expertise. For example, a physical therapist will develop a plan to help you recover physical strength and abilities. A vocational specialist may work with you to develop a vocational rehabilitation plan if you need help returning to work.

Who provides rehabilitation services?

Rehabilitation services may be prescribed by any medical or osteopathic doctor including an oncologist, primary care physician, 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.

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 also work on prevention. Some have expertise in oncology rehabilitation and work with cancer 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 therapists.

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

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 doctor at that time. If your doctor 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 concern you such as difficulty getting in and out of the car, weight issues, and problems performing job duties.
  • 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 doctor, develop your plan for physical 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 doctor 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?
  • 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 impacting 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 impacting 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 usually need a physician's order. You can get this from your oncologist, primary care physician, 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 resources listed below provide more detailed information and support services to help you with rehabilitation services.  Please read the Detailed Information and Suggestions document for more information and questions to ask.

LIVESTRONG SurvivorCare Program
www.livestrong.org/survivorcare

Email: Send email through the LIVESTRONG website.
Phone: 1-866-673-7205
1-866-927-7205 (Spanish)
Intake Coordinator is available for calls Monday through Friday, 9:00 a.m. to 5:00 p.m. (Central Time). Voicemail is available after hours.

LIVESTRONG SurvivorCare offers assistance to anyone affected by cancer, including the person diagnosed, loved ones, caregivers and friends. The program provides information about treatment options and matching to clinical trials or treatments in development. Counseling services and assistance with financial, employment and insurance issues are also available. To provide these services, LIVESTRONG SurvivorCare has partnered with several organizations including CancerCare, Patient Advocate Foundation and EmergingMed.

American Occupational Therapy Association
www.aota.org

Email: Send email through the website.
Phone: 1-301-652-2682

The American Occupational Therapy Association is a professional organization of that provides information for consumers. The website helps you to learn what an occupational therapist does and how you may be helped with therapy. Tip sheets on managing physical limitations are included, as well as links to other consumer organizations. The site also provides contact information for state occupational therapy associations, which may provide you with help in finding providers or resources in your area.

American Physical Therapy Association
www.apta.org

Email: Send email through the website.
Phone: 1-800-999-2782 or 703-684-2782

The American Physical Therapy Association is a professional organization for physical therapists, physical therapist assistants and students. The consumer section of their website has information for patients that explains what physical therapy is and how it can help. Information about insurance coverage for physical therapy is included. You can also use their search tool to find a physical therapist in your area.

American Speech-Language-Hearing Association
www.asha.org

Email: actioncenter@asha.org
Phone: 1-800-638-8255
Calls are answered 8:30 a.m. to 5:00 p.m. (EST).

The American Speech-Language-Hearing Association is the professional, credentialing association for more than 123,000 audiologists, speech-language pathologists, and speech, language, and hearing scientists in the United States and internationally. The ASHA website includes information about problems and treatments related to speech, hearing, language, swallowing and balance. Links to related groups are provided, as well as lists of questions to ask a treatment provider. The website also has a search tool to find speech, language and hearing professionals in your area.

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Physical Rehabilitation: 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. What is physical rehabilitation? Physical rehabilitation is the process of physically recovering from your cancer and adjusting to any physical changes you may experience. Cancer and its treatment affect some survivors’ bodies more than others. You may have been able to physically recover from cancer on your own. Or, you may have a hard time physically adjusting to life after cancer and want to seek help from a medical professional. Medical professionals who can help you with physical rehabilitation focus on: Restoring your independence Preventing other physical problems you may get from being inactive for so long Assisting you with adjustments from physical changes and disabilities Helping you physically handle day-to-day activities For some survivors, life after cancer means learning how to live with major physical changes. You may have to find new ways to do things or change the things you do on a daily basis. This may affect you emotionally. It’s perfectly understandable if adjusting to physical changes upsets you. The information in this document can help you identify whether you would benefit from getting help with your physical rehabilitation. If you want to learn more about how physical changes can affect you emotionally, you should talk to a mental health professional. A physical rehabilitation plan is something you can develop with the help of your health care team. A part of your physical rehabilitation plan may be working with therapists who specialize in helping your body recover after cancer. These therapists can help you with physical changes throughout your survivorship. Who can benefit from physical rehabilitation? Recovering from cancer and its treatment is difficult for many survivors. Getting back to work, regaining your independence and feeling like you have enough energy to get through the day may take time. Physical rehabilitation is important for all survivors who feel that cancer or its treatment affected them physically. It’s important to give your body some time to recover, but if you are struggling with your physical recovery at any time during your survivorship, you can talk to your health care team about physical rehabilitation. Working with a therapist on physical rehabilitation is usually recommended for survivors who have a leg or arm amputated, receive a prosthetic, or experience any other serious physical change that interferes with their mobility or ability to physically function. It can also be helpful for survivors who experience minor physical changes but still have a hard time physically adjusting to life after cancer. If you feel like the physical effects of cancer and its treatment are seriously interfering with your life after your treatment ends, you can ask a member of your health care team if you would benefit from help. What are some signs that a survivor might benefit from help with their physical rehabilitation? You feel weak all the time You often lose your balance You have difficulty moving your arms and legs You don’t have enough energy to get through the day You have muscular or orthopedic problems You have difficulty walking and going up stairs You have difficulty swallowing You have difficulty talking You are recovering from a major surgery You're having a hard time adjusting to major physical changes Who can help a survivor with physical rehabilitation? The type of physical rehabilitation therapist you should see will depend on your individual needs. You may need to learn how to use your muscles again. You may need to learn how to move around your home or conserve your energy so you can return to work. You may have trouble communicating with people because of physical changes to your face, mouth or throat. There are therapists who specialize in each of these areas. A physical therapist can help you adjust to the physical changes in your body by teaching you exercises and physical activities that can help condition your muscles and restore strength and movement. Examples of things a physical therapist may do: Evaluate your muscle strength, mobility and how well you can move your joints Teach you exercises that increase or maintain your range of motion, strength, flexibility, endurance, coordination, posture and balance Help you manage aftereffects from treatment Assist you in chronic pain management Design a self-care exercise program that fits your recovery needs An occupational therapist will help you learn to manage your daily activities and incorporate any physical changes caused by cancer into your home and work life. Examples of things an occupational therapist may do: Help you learn to use assistive devices like walkers, if needed Discuss with you possible changes in your home or workplace to accommodate your physical changes Show you ways to conserve your energy and plan your days Examine your hand/eye coordination Evaluate any cognitive changes cancer or treatment may have caused A speech therapist will help you if you have difficulty talking or swallowing after your treatment for cancer. Examples of things a speech-language pathologist (therapist) may do: Evaluate and train you in areas where you may have difficulty communicating Help you with difficulty swallowing Teach you about voice preservation and treatment in voice restoration Treat symptoms of memory loss and attention How long should survivors work with therapists on their physical rehabilitation? Some of the physical side effects that survivors experience are only temporary. You may want to participate in some kind of physical rehabilitation plan only while the temporary change affects your daily life. There are also physical side effects that may not happen until years after treatment ends. If these changes require adjustments in your daily life, you might benefit from physical rehabilitation. A progressive and ongoing physical rehabilitation plan may enhance the quality of your life at any time during your survivorship. Depending on your specific issues, the length of the physical rehabilitation process can vary. Some insurance plans only cover a limited number of visits. You should ask your insurance company about the number of visits allowed in your plan if getting financial assistance to pay for your physical rehabilitation is important to you. What are some suggestions for survivors who need help with physical rehabilitation? Below is a brief list. For more information, see Suggestions. Create a strong physical rehabilitation plan with your health care team. Find a good physical rehabilitation therapist. Check to see if your insurance plan covers physical rehabilitation services. This document was produced in collaboration with: Sue L. Frymark R.N., B.S. Executive Director, CancerCare Resources Works Cited Frymark, S. “Cancer Rehabilitation Services-The Road to Survivorship.” Oncology Issues 14(6) (1999): 16-19. Print this Topic  Email this story