Clinical characteristics of patients with cancer referred for outpatient physical therapy.

BACKGROUND: Cancer rehabilitation is a developing area, with an increasing number of survivors of cancer in the United States. The increase in survivorship occurs alongside impairments arising directly from cancer or from treatment-related side effects. OBJECTIVE: This study described clinical characteristics of patients with cancer referred for outpatient physical therapy and explored patterns in frequency of impairments between type of cancer and mode of cancer treatment. DESIGN: This was a retrospective chart review of patients with cancer referred to a tertiary care physical therapy clinic over a 2-year period. METHODS: Characteristics such as age, sex, cancer type, mode of treatment, and neuromusculoskeletal impairments were identified. Impairment frequencies were computed based on cancer type and mode of treatment. RESULTS: Data from 418 patients (mean age=57.9 years, SD=14.3; 41.1% female) were examined. Genitourinary cancer (n=169) and breast cancer (n=90) were the most prevalent types of cancer reported in this sample. Impairments in strength (83.6%) and soft tissue (71.3%) were the most common examination findings. Lymphedema was most common in patients with breast cancer, and incontinence was most common in patients with genitourinary cancer. LIMITATIONS: The types of cancer identified in this study may be reflective of this tertiary center and may not generalize to other facilities. Impairment identification during the initial physical therapist evaluation was not performed systematically. CONCLUSION: These data reinforce that physical therapists should screen for lymphedema in patients with breast cancer and incontinence in urogenital cancers. Strength and soft tissue integrity should be evaluated in most patients with cancer. Assessing pain and fatigue levels is recommended for patients who have had radiation therapy.

Pelvic radiotherapy and sexual function in men and women.

INTRODUCTION: Despite the decrease in overall cancer incidence and mortality rates in developed countries since the early 1990 s, cancer remains a major public health problem. Sexual dysfunction is one of the more common consequences of cancer treatment. AIM: To shortly review the literature and level of evidence on sexual dysfunction in men and women following pelvic radiotherapy. MAIN OUTCOME MEASURES: Male and female sexual dysfunction. METHODS: Literature review. RESULTS: Sexual dysfunction in cancer patients is multidimensional and may result from biological, psychological, and social factors. Anatomic changes caused by surgery and/or radiotherapy, physiological changes following hormonal manipulation, and the secondary effect of medical intervention may impede or preclude sexual functioning, even when sexual desire is intact. Pelvic irradiation constitutes the primary or adjuvant treatment for a large number of both female and male cancers. No randomized controlled trials could be identified regarding the effect of radiotherapy on sexual dysfunction. However, prospective and clinical controlled trials all demonstrated a severe negative effect on sexual functioning in men and women following radiotherapy for a pelvic cancer. Following pelvic radiotherapy for prostate cancer, a positive effect of phosphodiesterase type 5 inhibitors on erectile dysfunction has been demonstrated, whereas no significant effect on female sexuality was found. Few studies evaluated treatment of female sexual dysfunction following radiotherapy; hormone replacement therapy and the use of vaginal dilator in combination with psycho-educational support is recommended. CONCLUSION: Pelvic radiotherapy plays a significant negative role in the complex scenario of male and female sexual dysfunction. The literature has focused on sexual dysfunction and intervention in prostate and cervical cancer patients. Sexual dysfunction following pelvic radiotherapy for cancer in other pelvic organs, e.g., bladder, rectum, and anus, requires more attention in future studies. Health care providers should pay attention to and provide psychological and medical support regarding sexual dysfunction to all patients who have received pelvic radiotherapy.

[The significance of psychooncology for rehabilitation in urological oncology]. / Die Bedeutung der Psychoonkologie in der Rehabilitation in der urologischen Onkologie.

This article describes the necessities, possibilities and limits of psycho-oncological treatment during the rehabilitation of patients with uro-oncologic malignancies. Studies verify the efficacy of educational and behavioral-medicine orientated interventions: improved coping, reduced burden affects, increased quality of life and a better compliance with the medical treatment.

[Structure and process quality of inpatient urologic rehabilitation]. / Struktur- und Prozessqualität der stationären urologischen Rehabilitation.

Inpatient rehabilitation and "Anschlussheilbehandlung" (rehabilitation soon after operation or acute intervention) are effective and economic for long-term improvement of urologic patients. Only therapy guided by urologic specialists during rehabilitation and afterwards guarantees the possibility of excellent results. Especially QOL and functional deficits are improved markedly by urologic rehabilitation. Therefore, inpatient urologic rehabilitation should be initiated more often in the future.

[The status of medical-occupational rehabilitation exemplified by urologic tumor patients]. / Stellenwert der medizinisch-beruflichen Rehabilitation am Beispiel urologischer Tumorpatienten.

Many patients with urological carcinomas feel able, and indeed are able, to return to work after medical treatment. From a medical, psychological and socioeconomic point of view, routine pensioning must nowadays be rejected. Vocational reintegration is prepared in an individual and comprehensive manner in facilities for medical-vocational rehabilitation (phase II). The indication for vocational rehabilitation measures depends on the prognosis, on age and motivation, as well as on treatment aftereffects. The implications of operative, radiation and chemotherapy for the timing and course of the rehabilitation measures are set out, tumour- and treatment-related restrictions in future working life are discussed from an occupational medical view. Special emphasis is placed on carcinomas that should give rise to very early initiation of vocational rehabilitation services.

Future directions in cancer rehabilitation.

Many of the current and future directions in cancer rehabilitation have been briefly discussed; and some of the important areas for development are outlined in Table 1. Implementation of rehabilitation measures may be facilitated by organized and creative multidisciplinary rehabilitation programs. Advances are also dependent on health care policy, particularly in reimbursement for rehabilitation services and in the funding of rehabilitation research. Much progress can be expected in the years ahead.

Rehabilitation needs of the patient with cancer.

As the success rate of earlier diagnosis and more effective cancer therapy increases, more individuals are finding that they are living with a cancer diagnosis. Cancer, as a chronic illness, requires that all health care professionals view the patient from a perspective of functional abilities rather than from a disease process. Rehabilitation is a dynamic process and is generally goal-directed. The goal of rehabilitation is to help the individual to function at his maximum level within the limitations and constraints of the disease and treatment protocols (Dudas, 1984). The physical, mental, emotional, social, sexual, and economic potential of the individual are the broad areas involved in the assessment, plan, implementation, and evaluation of rehabilitation programs. The rehabilitation team consists of the oncologist, surgeon, nurse, social worker, physical therapist, occupational therapist, nutritionist, and others depending on the special needs of the individual. The most important members of the team are the patient and family. The patient involved on the team can help to identify specific needs throughout the trajectory of the cancer diagnosis and treatment. The spouse and friends of the patient with cancer are important support systems and assist the patient in exploring feelings and needs (Frank-Stomborg and Wright, 1984). Dietz (1980) described four rehabilitation stages for cancer programs: preventive, restorative, supportive, and palliative. During each phase of rehabilitation the physical, mental, emotional, social, sexual, and economic needs of the patient must be considered. This report identifies specific areas of concern for the patient and family during the four stages of rehabilitation and to identify potential action plans for individual patients.

Sexual rehabilitation of urologic cancer patients: a practical approach.

Sexual rehabilitation is an important aspect of preserving a patient's quality of life after treatment for urogenital cancer. Sexual rehabilitation does not usually require a specialized program, but can be an integral part of cancer treatment. Members of the health care team can provide sexual information for the patient and partner, as well as assess the need for more intensive marital or sex therapy. This paper presents specific sexual issues related to prostate, bladder, testicular, and penile cancers.

[Problems of assessment and occupational rehabilitation of patients with malignant urogenital neoplasm]. / Probleme bei der Begurachtung und beruflichen Rehabilitation von Patienten mit malignen Urogenitaltumoren.

The expert opinion and the rehabilitation of patients with urogenital tumours often render great problems and tasks for the urologist. A schematic invalidisation of these patients is to be refused. The leading idea of an expert opinion should be the rehabilitation. This demands from the expert a judgment of the function with evaluation of the oncological prognosis quoad vitam and a judgment of the remaining functions of the treated organism as well as a recommendation for the further professional activity based on this judgment. A close cooperation with industrial institutions, the factory public health, the medical advisory commissions and the rehabilitation commissions is necessary for rehabilitation. The notion of rehabilitation--professional as well as social--is to be extended to the not unconsiderable number of patients at pensioner's age. The resumption of a suitable work effects in a patient sith successfully treated tumour disease the improvement of the general physico-psychic resistance, increases the will to recovery and activity and furthers the acclimatization and adaptation to remaining disturbances. Thus expert opinion in the sense of rehabilitation is also a therapy. The results of modern tumour therapy should not be measured only at the survival rates, but also at the degree of the social and professional rehabilitation of the patients.

[Medical evaluation and rehabilitation following intensive therapy of malignomas in the female genitalia and breast]. / Arzliche Begutachtung und Rehabilitation nach Intensivtherapie der Malignome des weiblichen Genitale und der Brustdrüse

The selective therapy of malignant tumours of the female genital tract has led to the abandonment of radical procedures in the treatment of early stages of carcinomas. The histological diagnosis, including tumour localisation, tumour grading, applied therapy, early and late complications are criterion to be taken into consideration in laying down the degree of infirmity. In the light of functional gynaecology, principles for such patients care are laid down, taking into account the time of disablement as well as problems of rehabilitation, not only for patients with malignant tumours of the female genitals but for those with mammary tumours as well.