If Julie Silver, M.D. had suffered a stroke or was injured in a car accident, her doctor would have sent her for rehabilitation. This would likely involve months of physical therapy as well as other medical treatments to help her regain her strength and flexibility and decrease her pain and fatigue. If she had survived nearly any serious illness, or even a relatively minor injury such as an ankle sprain, she would have been referred to a rehab program in order to expedite her recovery.
Instead, when Dr. Silver was a 38-year-old physician and a mother of three, she had breast cancer. After surgery and chemotherapy, she was discharged from treatment with no follow up care plan. When she looked to our healthcare system for support, there were no rehab programs in place to help her with her recovery.
Faced with post-treatment symptoms that left her too sick to care for her family or return to work, Dr. Silver, a specialist in physical medicine and rehabilitation, began to wonder why the same principles of rehab that are widely recognized as beneficial in fields such as cardiac and orthopedic medicine were not being applied to oncology. Why weren’t cancer patients offered rehab services similar to those that had become the standard of care for survivors of other serious illnesses and injuries?
Encouraged by their oncologists to get back to the busy lives they led before the cancer diagnosis, many survivors--there are currently more than 11 million in the U.S. alone--–find the going tough, if not impossible. Cancer treatments are extremely toxic. Chemotherapy, immunotherapy, radiation, and surgery cause debilitating physical problems that impede daily activities. Troubling symptoms include pain, fatigue, loss of strength, cognitive impairment, sleep difficulties, sexual dysfunction, depression and anxiety. If left unresolved, they can plague individuals for a lifetime. Here is a typical story:
In 2003 I started chemo and simultaneous radiation--a horrid combination. The chemo made me bald, nauseous, no appetite, dry mouth, neuropathy, and incredibly fatigued. No one told me that without eyelashes, dust and dirt fly into your eyes, and that my nose would constantly run and run and frequently bleed. The radiation was even worse. For 3 days I was living in a star-wars movie with beams of light shooting across the room--the cold room where I was half naked, forced into a uncomfortable position and told not to move while strangers drew lines on my chest with markers and placed little bb's--and this was just the pre-work! Then the physiologists started taking measurements. They had a tough job to aim at a malignant node under the chest bone while avoiding my heart and working around my implants. The radiation itself was okay for a while, but then my skin started to burn. I stopped going, and was told to go to the burn unit for "burn baths" till I healed enough to continue the treatments. That was my entry into the world of cancer treatment—Ellen.
This year, more than 1.5 million Americans will be diagnosed with cancer and undergo treatments not unlike those just described. Desperate to keep pace with the growth of this disease, medical technology is rapidly improving cancer treatment: five-year survival rates have increased to approximately 70%. But cancer patients like Ellen and Dr. Silver pay a high price for these lifesaving treatments. Quality survivorship programs that include cancer rehab services could enable survivors to recover their health and resume happy, fulfilling lives. However, in the absence of knowledge of such programs many cancer patients may be left to suffer longer, and needlessly. In this regard the results of a 2011 survey co-sponsored by the AARP and the National Center for Complementary and Alternative Medicine are instructive. That survey found that while roughly half of adults age 50m and older use some form of complementary treatment (acupuncture, physical therapy, massage, meditation, etc.), less than half reported ever talking with their primary health provider about it. And of those who did have such a conversation, twice as many said it was they, not their health care provider, who initiated that conversation. In other words, the much needed rehabilitation of cancer patients is still in many ways an untold story. Moreover, that rehabilitation may actually enhance patients’ survivability.
Stress, Rehabilitation, and Survivability
According to a study conducted by David Spiegel, M.D., of Stanford University School of Medicine, women with breast cancer who are also clinically depressed are at higher risk for a recurrence of cancer than are women who have only the cancer but not the depression. The reason, he concludes, may well have to do with the way depression affects the immune system. This was a study of women with metastatic breast cancer and there is little doubt that these women were under chronic stress. In fact, the more symptoms of depression these women had, the less their immune systems were able to respond to a variety of bacteria, fungi, and yeasts. Meanwhile, researchers at the Health Sciences Center at the State University of Londrina in Brazil, in a review published in The Lancet of many studies on the immune system concluded that “chronic stress impairs the immune response and contributes to the development and progression of some types of cancer.”
If the above is the bad news, then here is the good news: According to a growing body of research complementary treatments can significantly reduce stress. And if we can effectively reduce stress in cancer patients, can’t we reasonably expect that to improve their prognosis at the same time it can facilitate their rehabilitation.
Those interested in learning more about complementary treatments can visit the National Center for Complementary and Alternative Medicine (http://nccam.nih.gov). For information on Dr. Silver’s groundbreaking work on extending rehabilitation services to cancer patients visit www.oncrehab.com. For information on helping families cope with terminal illness visit www.newgrief.com
@ Dr. Joe Nowinski 2012