{"entity":{"id":"rejuv-rehab-cancer-rehabilitation","kind":"technology","name":"Cancer rehabilitation: the discipline that puts function back","aka":[],"tldr":"Cancer rehabilitation is the medical speciality that treats what treatment leaves behind: weakness, a stiff shoulder, a swallow that no longer works, a bladder that leaks, a limb that swells. It is delivered by a named set of professions, it has randomised evidence behind several of its parts, and in the largest study to measure it only three in ten of the impairments that needed it were treated.","summary":"Cancer rehabilitation is not a synonym for exercise and it is not physiotherapy alone. It is a model of care in which a person's function is treated as a clinical problem with a diagnosis, a measurement and a treatment plan, the same way a blood count or a scan is.\n\nWho does it. A cancer rehabilitation team is built from six professions, and in most countries each is a separate referral. Rehabilitation medicine, called physiatry in the United States and rehabilitation medicine in the United Kingdom, is the medical speciality that diagnoses the impairment and prescribes the programme. Physiotherapy treats strength, range of movement, balance, breathing and the pelvic floor. Occupational therapy treats the activities themselves: dressing, washing, cooking, working, driving, and the fatigue management that makes those possible. Speech and language therapy treats swallowing and voice, which after head and neck treatment are the same therapist's problem. Dietetics treats the weight, the protein intake and the feeding tube. Clinical psychology treats the fear, the low mood and the body image that determine whether any of the rest is attempted. Lymphoedema services, prosthetics and orthotics services and vocational rehabilitation sit alongside them.\n\nWhat it is for. Silver and colleagues set out the organising idea in 2013: screen for impairment all the way along the care pathway and treat what is found, rather than waiting for disability to arrive. Their review states the case plainly: \"Research has also demonstrated that the majority of cancer survivors will have significant impairments and that these often go undetected and/or untreated, and consequently may result in disability.\" They also note that \"more cancer survivors have a reduced health-related quality of life as a result of physical impairments than due to psychological ones\", which is the finding that most changes where attention should go.\n\nWhat it achieves, and what it does not. The parts of the discipline have been tested separately rather than together, and this page grades each of them in its own record: prehabilitation before surgery, swallowing therapy during head and neck radiotherapy, pulmonary rehabilitation after lung resection, pelvic floor training after prostate surgery, vestibular rehabilitation after skull base surgery. Some of those are strong, one of them is a well-conducted negative trial, and several rest on single small studies. No randomised trial has tested the whole multidisciplinary model against usual care with survival or disability as its endpoint, and it is unlikely one ever will, because the parts are not withheld in the same way a drug is. Occupational therapy is the clearest example of the evidence problem: a 2021 systematic review of occupational therapy after discharge found nine studies covering 531 people with cancer, and concluded that \"Small sample sizes and methodological quality precluded any formal analysis\".\n\nWhat comes back, and when: that depends entirely on which impairment, and each record here states it. The general shape is that function treated early recovers further than function treated late, and that the single biggest determinant of outcome in the published data is not the therapy but whether the referral was made at all.","status":"established","asOf":"2026-10-02","wikipedia":"https://en.wikipedia.org/wiki/Physical_medicine_and_rehabilitation","links":[{"label":"Impairment-driven cancer rehabilitation: an essential component of quality care and survivorship (CA Cancer J Clin 2013)","url":"https://doi.org/10.3322/caac.21186"},{"label":"Prevalence and treatment patterns of physical impairments in patients with metastatic breast cancer (JCO 2008)","url":"https://doi.org/10.1200/JCO.2007.12.3075"},{"label":"A prospective surveillance model for rehabilitation for women with breast cancer (Cancer 2012)","url":"https://doi.org/10.1002/cncr.27476"},{"label":"Occupational therapy intervention for cancer patients following hospital discharge: a systematic review (Aust Occup Ther J 2021)","url":"https://doi.org/10.1111/1440-1630.12750"}],"tags":["rejuvenation","survivorship","rehabilitation","evidence:moderate"],"related":["idea-acc-return-to-work-rehabilitation","idea-acc-cognitive-rehabilitation-after-chemotherapy"],"cancers":["breast-hr-positive","head-and-neck","colorectal","nsclc","prostate","sarcoma"],"sections":["rejuvenation","supportive-care"],"technologies":["survivorship-care-plan","exercise-prescription-after-cancer","rejuv-rehab-prospective-surveillance","rejuv-rehab-provision-gap","rejuv-rehab-prehabilitation-evidence","rejuv-rehab-commissioning-inequity","oncology-nutrition","geriatric-assessment","psycho-oncology","oncology-nursing"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["late-effects","quality-of-life"],"trials":[],"people":[],"bottlenecks":["b-survivorship","b-toxicity-qol"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"An impairment is a diagnosable, measurable problem with a treatment. Rehabilitation medicine works by naming it (shoulder abduction to sixty degrees, six-minute walk distance of 280 metres, a swallow that penetrates the larynx), prescribing a graded programme against that measure, and reassessing. The measurement is what distinguishes it from advice to keep active.","strengths":["Treats the problems that patients rank highest after treatment: strength, mobility, swallowing, continence","Several components have randomised evidence of their own","Measurable: the same instruments used in trials can be used in clinic"],"limitations":["No randomised trial of the whole multidisciplinary model against usual care","The occupational therapy evidence base is too small to pool","Referral, not therapy, is where most people are lost"]},"route":"/technologies/rejuv-rehab-cancer-rehabilitation/","neighbours":{"idea":[{"id":"idea-acc-cognitive-rehabilitation-after-chemotherapy","kind":"idea","name":"Trials of structured cognitive rehabilitation for cancer-related cognitive impairment","route":"/ideas/idea-acc-cognitive-rehabilitation-after-chemotherapy/"},{"id":"idea-acc-return-to-work-rehabilitation","kind":"idea","name":"Vocational rehabilitation integrated into cancer care so survivors can return to work","route":"/ideas/idea-acc-return-to-work-rehabilitation/"}],"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"head-and-neck","kind":"cancer","name":"Head and neck squamous cell carcinoma","route":"/cancers/head-and-neck/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"},{"id":"sarcoma","kind":"cancer","name":"Sarcomas (soft tissue, bone, GIST)","route":"/cancers/sarcoma/"}],"section":[{"id":"rejuvenation","kind":"section","name":"Recovery & Rejuvenation","route":"/fronts/rejuvenation/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"rejuv-rehab-balance-vestibular","kind":"technology","name":"Balance, dizziness and falls after cancer treatment","route":"/technologies/rejuv-rehab-balance-vestibular/"},{"id":"rejuv-recon-breast","kind":"technology","name":"Breast reconstruction: implant and autologous, immediate and delayed, and what women report afterwards","route":"/technologies/rejuv-recon-breast/"},{"id":"rejuv-rehab-respiratory","kind":"technology","name":"Breathing and exercise capacity after lung resection","route":"/technologies/rejuv-rehab-respiratory/"},{"id":"rejuv-recon-facial-prosthetics","kind":"technology","name":"Facial reconstruction and facial prostheses: ears, orbits and noses","route":"/technologies/rejuv-recon-facial-prosthetics/"},{"id":"geriatric-assessment","kind":"technology","name":"Geriatric assessment","route":"/technologies/geriatric-assessment/"},{"id":"rejuv-rehab-driving-and-exercise-return","kind":"technology","name":"Going back to driving, lifting and exercise","route":"/technologies/rejuv-rehab-driving-and-exercise-return/"},{"id":"rejuv-recon-head-neck","kind":"technology","name":"Head and neck reconstruction: the free flap, and what it gives back","route":"/technologies/rejuv-recon-head-neck/"},{"id":"rejuv-recon-limb","kind":"technology","name":"Limb salvage, amputation, and the rehabilitation that follows either","route":"/technologies/rejuv-recon-limb/"},{"id":"oncology-nutrition","kind":"technology","name":"Nutrition support and cachexia management","route":"/technologies/oncology-nutrition/"},{"id":"oncology-nursing","kind":"technology","name":"Oncology nursing and nurse-led care","route":"/technologies/oncology-nursing/"},{"id":"rejuv-rehab-pelvic-floor","kind":"technology","name":"Pelvic floor rehabilitation after prostate and rectal surgery and after pelvic radiotherapy","route":"/technologies/rejuv-rehab-pelvic-floor/"},{"id":"rejuv-rehab-prospective-surveillance","kind":"technology","name":"Prospective surveillance: looking for the problem before it becomes a disability","route":"/technologies/rejuv-rehab-prospective-surveillance/"},{"id":"psycho-oncology","kind":"technology","name":"Psycho-oncology and distress screening","route":"/technologies/psycho-oncology/"},{"id":"rejuv-recon-pelvic-exenteration","kind":"technology","name":"Recovery after pelvic exenteration","route":"/technologies/rejuv-recon-pelvic-exenteration/"},{"id":"rejuv-rehab-scar-contracture","kind":"technology","name":"Scars, stiffness and contracture: shoulders, necks and jaws","route":"/technologies/rejuv-rehab-scar-contracture/"},{"id":"rejuv-recon-stoma-reversal","kind":"technology","name":"Stoma reversal after rectal cancer surgery: who gets the bowel joined up again","route":"/technologies/rejuv-recon-stoma-reversal/"},{"id":"survivorship-care-plan","kind":"technology","name":"Survivorship care and late-effects surveillance","route":"/technologies/survivorship-care-plan/"},{"id":"rejuv-rehab-swallowing","kind":"technology","name":"Swallowing therapy around head and neck radiotherapy","route":"/technologies/rejuv-rehab-swallowing/"},{"id":"exercise-prescription-after-cancer","kind":"technology","name":"The exercise prescription after cancer: the dose the guidelines state","route":"/technologies/exercise-prescription-after-cancer/"},{"id":"rejuv-rehab-provision-gap","kind":"technology","name":"The gap between the rehabilitation people need and the rehabilitation they are offered","route":"/technologies/rejuv-rehab-provision-gap/"},{"id":"rejuv-recon-voice-after-laryngectomy","kind":"technology","name":"Voice after the larynx is removed","route":"/technologies/rejuv-recon-voice-after-laryngectomy/"},{"id":"rejuv-rehab-prehabilitation-evidence","kind":"technology","name":"What the randomised trials of prehabilitation found, operation by operation","route":"/technologies/rejuv-rehab-prehabilitation-evidence/"},{"id":"rejuv-rehab-commissioning-inequity","kind":"technology","name":"Where rehabilitation is commissioned, and who misses out","route":"/technologies/rejuv-rehab-commissioning-inequity/"}],"term":[{"id":"late-effects","kind":"term","name":"Late effects and survivorship toxicity","route":"/terms/late-effects/"},{"id":"quality-of-life","kind":"term","name":"Quality of life","route":"/terms/quality-of-life/"}],"bottleneck":[{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}]}}