Rehabilitation, Palliative Care, and Integrative Medicine Interventions in Cancer

For patients with a broad range of serious life-threatening illness, loss of function and independence is a common struggle and a significant contributor to diminished quality of life. Among the factors that can contribute to loss of function are prolonged hospitalization, deconditioning, pain, fatigue, depression, malnutrition, organ failure, neurologic injury, and musculoskeletal problems. Patients with cancer can additionally experience sarcopenia from direct tumor effects and fatigue from cancer treatment.1 Rehabilitation, even in the advanced phase of an illness, can help to maintain or restore function, permit patients to retain mobility and independence, and improve symptoms, all of which can contribute to a reduced burden on families and caregivers and improved quality of life. The main rehabilitation modalities are physical therapy, occupational therapy, and speechswallowing rehabilitation. Regular and open communication with patients and their families regarding the goals of rehabilitation is critical in designing a rehabilitation plan so that realistic goals can be identified. The rehabilitation plan must also consider the patient’s environment, existing functionality, and available resources. The measure of success of a palliative care rehabilitation program should not focus on length of survival but rather on enhancing quality of life, function/independence, and psychosocial well being. Patient condition and goals of care can shift dramatically while under palliative care, and therapists must maintain some flexibility, respecting patient choices and allowing for frequent interruptions in the rehabilitation treatment plan.