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 involvement

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.


Swelling in the extremity may be due to lymphatic or venous drainage being affected, deep vein thrombosis (clot formation in the veins) or lymphedema. Lymphedema can occur in different ways. There may be acute, mild, temporary edema that starts within a week after surgical interventions such as mastectomy (post-breast surgery) and primary lymph node dissection and usually resolves in a short time. The second type is lymphangitis or phlebitis, which occurs 4-6 weeks after surgery, is painful, responds to anti-inflammatory drugs. The most common form is chronic, slowly progressive, painless lymphedema and occurs 18-24 months after surgery. In the late period, edema due to fibrous tissue can be seen as a result of radiation therapy. Lymphedema in the legs can be seen especially after gynecological cancer treatment. The first step in edema control is elevation (raising the arm or leg), and a shoulder strap may be recommended. Isometric exercises can reduce lymphedema by increasing muscle tone. Compressive dressings and stockings can be applied in long-term edema. The individual can be included in the lymphedema treatment program.


psychosocial problems

Psychosocial problems can be seen in cancer patients and may continue even after treatment or after physical symptoms have improved. The resulting stress affects the family as well as the patient, so for a successful psychosocial rehabilitation, the family should also be included in the program. Cancer patients are faced with the possibility of death, undergo treatments with serious side effects, and experience the fear of recurrence of the disease. During treatment, they stay away from school, work and family life for a long time and become physically, emotionally and economically dependent. Studies have shown that 20-38% of patients have problems in work and family relationships after the diagnosis of cancer. It was observed that depression was associated with energy loss and working hours in these patients. Depression, sense of social isolation, hopelessness and decrease in social functions are seen in the early stages of the disease and treatment. Investigating the presence of depression at different stages of the disease and treatment will help to solve the problems. Often, individual or group therapies will minimize this natural response.


Sexual Issues

Sexual problems vary according to the localization of the disease and treatment in cancer patients. Although these problems intensify in patients diagnosed with genital cancer and undergoing pelvic radiotherapy, they can be seen in all types of cancer and may be related to the disease or treatment. Especially in the protective phase of rehabilitation, sexual history should be taken and a treatment plan should be made. After surgery, chemotherapy and radiotherapy, sexual functions are affected with pain, anxiety, depression and fear in female patients. Sexual rehabilitation should start in the preoperative (pre-surgery) phase and the spouses should be present together.

Group treatments are also established for cancer patients. The aim of these treatments is to give patients the chance to freely talk about their feelings such as fear, depression, anxiety, anger, uncertainty, guilt, to share their experiences by meeting with people with similar problems, to reach local institutions serving such patients, to have more information about the medical aspect of the disease. .


Soft Tissue Tumors

Soft tissue malignant tumors can affect connective tissue, vessels, lymphatic system, muscle, adipose tissue, fascia and synovial tissue. Treatment varies according to the size, depth and anatomical location of the lesion and can range from simple excision (removal of that tissue) to amputation (loss of limbs). Chemotherapy and radiotherapy have a role as well as surgery in determining the rehabilitation program. It should be noted that when an excision is made in the lower extremity, the ankle should be kept in 90° dorsiflexion to prevent shortening of the Achilles tendon. After a surgery on the arm, it is necessary to keep the shoulder and elbow in the proper position, after an excision on the forearm, the wrist and fingers should be kept in a neutral position, and exercises should be given in the normal range of motion. With these measures, the patient’s daily life activities and ambulation (walking) will be easier. When a muscle is transferred, this muscle is reeducated.


Bone Tumors

Treatment depends on the localization, type and extent of the lesion. Cancer patients have a higher rate of amputation. Especially in young patients, it is recommended to wear a temporary prosthesis when the patient leaves the operation. Cosmetic prosthesis can be recommended for those who cannot use functional prostheses. Prosthesis compliance and training is more complicated in cancer patients because chemotherapy and radiotherapy accompany treatment.


Breast Cancer

Breast carcinoma is the most common malignancy in women and is estimated to affect one in 10 women. Lumpectomy (removal of the breast lobe) or modified rad, depending on the type and size of the tumor

Radiotherapy is applied with ical mastectomy (removal of the breast completely). Lymph node dissection and radiotherapy can often lead to lymphedema and shoulder joint limitation. In order to prevent lymphedema in the late stage, the patient should be warned to protect the operated side arm from cuts, needle sticks, insect bites, burns and excessive sunlight. Although rarer, brachial plexopathies (nerve involvement) may occur. Mobilization in mastectomy patients should begin on the 1st or 2nd day after surgery. A one-week delay may cause limitation in shoulder movement. In this program, the patient is allowed to eat, comb his hair and brush his teeth on the 2nd day after surgery. Exercises are started on the 3rd post-operative day.


Head and Neck Tumors

Functional and cosmetic disorders often occur in the treatment of head and neck tumors. This causes psychological trauma in the patient and should be corrected as much as possible with reconstructive surgery or prostheses. During the treatment of head and neck tumors, facial nerve, accessory nerve, mandible (jaw bone), eye and ear are at risk. The postoperative rehabilitation program should include exercises that work the facial muscles, chewing and swallowing exercises, strengthening exercises for the neck, shoulder and trapezius muscles, and speech therapy. Speech therapist has a great role, especially in laryngectomy (removal of the larynx) or other head and neck surgeries. Mechanical devices and esophageal speech training can be applied to configure voice functions.