Restore
January 1, 2013

To gauge recovery, Sam Mayer may ask a breast cancer patient if she still has trouble brushing her hair or if she’s been able to resume her regular walks.

“When you’ve had major breast surgery and reconstruction, you can have a rough time just trying to do your normal activities,” says Mayer, medical director of cancer rehabilitation at The Johns Hopkins Hospital. “We pay attention to a lot of quality-of-life issues.”

Now that 80 percent of breast cancer patients are reaching the five-year survival mark, Mayer says, they want solutions for many of the disabilities resulting from their treatment. Along with fatigue and reduced range of motion, problems can include pain, difficulties with balance, swelling in arms and legs, and body image and psychological issues.

“With the increase of survivors with many forms of cancer, we now need to focus more on returning people back to their normal lives,” notes Michael Friedman, director of rehabilitation therapy at Hopkins Hospital. “That’s why we’ve integrated rehabilitation as part of a survivorship model.”

Hopkins’ cancer rehabilitation team consists of a physiatrist, physical therapist and occupational therapist with additional experts available in speech pathology and rehabilitation psychology. These specialists work with the primary care physician, medical oncologist, nurse navigator and family caregivers to help patients regain as much function as possible.

Friedman says cancer survivors should strive to regain mobility, strength and stamina just like patients who have their hips or knees replaced.

“It’s intuitive to send patients with neurological, orthopedic or cardiac diagnoses to rehab to regain strength and endurance,” he points out. “However, cancer patients with similar issues who could benefit from similar rehabilitation are not receiving it. Our first question to a patient is, ‘What kind of work did you do before you were diagnosed, and what were your leisure activities?’ Our goal, regardless of your diagnosis, is to get you back to the level at which you were functioning.”

In addition to offering cancer patients “the basics,” such as rehabilitation for range of motion and strength, how to manage swelling and increase endurance, the team also works with providers in the Johns Hopkins Kimmel Cancer Center who help patients with sexual dysfunction, nutrition and palliative care.

It can be challenging to work with cancer patients, Friedman says, because they can present complex medical problems as well as difficult psychological adjustment. The members of Hopkins’ interdisciplinary rehab team, however, are well versed in collaboration and also understand how to plan treatment schedules that may include radiation and chemotherapy.

One area of focus is helping patients to manage cancer-related fatigue. Hopkins providers visit patients’ homes to suggest strategies for conserving energy, such as preparing food while sitting down rather than standing.

 “We don’t do rehab to people, we do it with them,” Mayer says. “We figure out what our patients’ goals are and work on what is meaningful to them.”