Our Oncological Rehabilitation programs aim to increase the quality of life of cancer patients by increasing their physical strength, reducing their pain and gaining their functional independence during and after their illness. Within the scope of the treatment, personalized exercises, massage, physiotherapy applications and rehabilitation programs are carried out according to the patient’s condition. These problems can be seen in all tumor types, but the need for rehabilitation is more especially in central nervous system, breast, lung and head and neck tumors.
What are the Effects of Cancer on Body Systems?
Effects due to long-standing systemic disease are usually seen in the early phase of treatment. Immobility (immobility), malnutrition, decrease in immune functions (immune system) and psychological factors affect the general condition of the patient. Many cancer treatments affect cell division in general and this effect in the intestinal tract causes nausea, vomiting and diarrhea. Disability in cancer patients is usually due to tissue spread and pain. Pain is one of the most important problems.
Immobility and related problems
Bed rest causes various metabolic and physiological changes in cancer patients. Bone loss is frequent and causes hypercalcemia. Changes occur in muscle fiber type and joint physiology. All these factors cause pressure sores, mononeuropathy (nerve involvement) and contractures (joint stiffness), increasing the risk of deep vein thrombosis and pulmonary embolism. Patients on bed rest can perform exercises against gravity or against light resistance using an elastic band. In bedridden patients, normal joint movements of the lower and upper extremities prevent contractures in the shoulders, elbows, hips, knees and ankles, and maintain strength and endurance. In order to prevent pressure ulcers, it is appropriate to change the patient’s bed position frequently, to support him with pillows, to use an air mattress, to follow up skin lesions closely, and to use moisturizing creams. When it is not used for a long time, tendon, ligament and muscle shortening and joint movements are restricted. Radiation fibrosis facilitates the development of contractures. In particular, if a radiotherapy program is applied to include the joint area, the patient should definitely be included in a protective stretching exercise program. Active or passive joint movement exercises should be started early in bedridden patients.
central nervous system involvement
CNS involvement may be primary system involvement or metastatic. The most common types of cancer with brain metastases are lung, breast, gastrointestinal carcinomas (intestinal system) and melanomas. Early symptoms are headache, seizures and impaired cognitive (mental) functions. The location and depth of the lesion determine the severity and form of the deficit. Rehabilitation attempts should be directed towards the identified deficit. Similarly, primary or metastatic tumor may be seen in the spinal cord (spinal cord). Radiation myelitis is directly related to radiation dose. Rehabilitation in spinal cord involvement is the same as in traumatic spinal cord lesion. Low back pain and neurological deficit (weakness in the muscles, inability to walk, weakness in the arms) that occur in the late period during the follow-up of the cancer patient constitute a diagnostic problem. Although mechanical low back pain may be seen in cancer patients, it should be kept in mind that spinal column involvement may occur.
Peripheral nervous system involvement
Chemotherapy-induced neuropathy is usually distal (on the extremities of the arms and legs) and symmetrical. Although rare, brachial plexopathies may occur in patients receiving radiotherapy. There may also be direct tumor spread. Lymphedema usually accompanies the picture in radiation plexitis. The association of lumbosacral plexopathy with radiation, intra-arterial chemotherapy, metastatic involvement, and primary tumors in the pelvis has been reported. Neuropathic pain treatment is required in these cases. In addition, it is appropriate to support the patient with adaptive devices, orthoses and walking aids.
Myopathies (muscle involvement)
Carcinomatous myopathy is mostly seen with metastatic disease and supportive treatment is applied. Steroid-induced muscle weakness is mostly due to atrophy of type II fibers in the proximal muscles. Isometric exercises accelerate recovery by increasing muscle metabolism.
Bone metastases are encountered during cancer treatment. It is mostly seen in breast, lung, kidney, colon, prostate, bladder, ovarian and uterine carcinomas. The spine and proximal extremities are more frequently involved. Primary bone tumors such as osteogenic and Ewing sarcoma may also be seen. The most important symptom in bone involvement is pain; It is localized, blunt in type and prominent at night. Pain in the extremity with weight bearing suggests a pathological fracture.
Cachexia is “a condition that cannot be completely reversed with conventional nutritional support and results in protein breakdown and consequent loss of muscle mass.