METHODS
Total of 176 patients with various cancer diagnoses who were treated at Hacettepe University Oncology
Hospital and were consulted to physiotherapy and rehabilitation were included in this retrospective
study. Patient data regarding diagnosis, metastasis condition, and treatment types, as well as rehabilitation
needs such as performance of daily life activities, physical function deficiencies, and sensoryperception
problems were evaluated and recorded by physiotherapists.
RESULTS
Average age of the 87 male and 89 female patients included in this study was 56.25±14.53 years. According
to evaluations of performance of daily life activities, 137 (77.8%) of the participants had difficulty
with mobility, 132 (75%) had difficulty with transfer activities, and 106 (60.2%) had difficulty using
the bathroom. It was observed that 162 (92%) of the patients experienced deconditioning, 150 (85.2%)
had fatigue, and 149 (84.7%) had balance problems. In addition, 42 (24.4%) of the patients had sensory
problems.
CONCLUSION
It is important to point out that cancer patients have various forms of rehabilitation needs, including
functional deficiency, dependency in daily life activities, and sensory-perception-cognitive problems.
Keywords: Cancer; physiotherapy; rehabilitation
After being diagnosed with cancer, patients, families
and caregivers make great efforts to cope up with
the problems that emerge due to the disease and treatments.
Patients' performance in their daily life, their
ability to continue their profession or education, and
their participation in family and social activities are
adversely affected due to the progressive nature of the disease, as well as the side effects of applications such
as chemotherapy and radiotherapy.[
In 1978, for the first time, Lehman et al. investigated
the rehabilitation needs of 800 cancer patients
and reported that their most prominent problems
were the ones related to psychological stress, pain,
muscle weakness, daily living activities, ambulance
and family support.[
Emotional support, pain, difficulties in daily living
activities, and mobility problems were reported
by DePompolo in 1994; standing up from a chair,
using the toilet, showering, walking and climbing
the stairs were amongst the problems reported by
Sabers in 1999; and sleeping disorders, pain, fatigue
and anxiety were the problems stated by Whelan in
1997.[
In 1998, however, Van Harten pointed out that
rehabilitation problems included not only physical
function adversities but also psychosocial and cognitive
function difficulties, and that several of these
problems can be seen together.[
In fact, oncologic rehabilitation differs from rehabilitation
programs for other diseases in some
aspects. Here, physiotherapists treat their cancer patients
with more flexible and differentiated treatment
programs that take into account changes in their
conditions resulting from both the disease and treatments.
For example, daily exercise program varies
depending on the level of fatigue and factors affecting
it (blood table, chemotherapy session, etc.). Hence, it
is important that the cancer patients are evaluated in
detail, their needs are identified and any changes in
their conditions are detected immediately.
Taking these into account, the purpose of our
study was to determine physiotherapy and rehabilitation
needs of cancer patients who are hospitalized
due to complications or some treatment procedures,
and to help physiotherapists to establish an appropriate
physiotherapy and rehabilitation program that
meets all the needs of their cancer patients.
Minimum one week of hospitalization, ability to communicate, being in the II-IV stage of the illness, and being in the age range of 18–65 years were the inclusion criteria. Patients who did not want to participate in the physiotherapy and rehabilitation program were excluded from the study.
Medical records of the participants were precisely
checked and their physiotherapy-rehabilitation
needs were evaluated in accordance with their diagnosis,
anamnesis and major complaints. Along with
recording the patients' diagnoses, demographic data,
metastatic status, and their treatment, the participants'
daily life activities (such as transfer, mobility,
self-care and dressing), physical functional deficits
(such as pain, fatigue, deconditioning, and balance
problems) and their sensory-perceptual problems
(such as sensory loss, polyneuropathy, cognitive and
communication problems) were also evaluated and
recorded by physiotherapists. The evaluation of physical
functions is shown in Table
Statistical Analysis
SPSS 10.0 package program was used for the analysis.
Measurable data is expressed as arithmetic mean, ±
standard deviation.
Distribution of diagnosis of the individuals, which
is shown in Table
Reasons for admission to the hospital are shown
in Table
When individuals' physiotherapy and rehabilitation
needs were assessed, it was determined that
deconditioning, fatigue, balance problems, transfer
and mobility difficulties were the most common and
primary ones. In DLA, it was observed that patients
had the most problems with mobility and transfers.
Physiotherapy and rehabilitation needs of patients
are categorized and their distributions are shown in
Table
According to the results of the study in Switzerland
by Ture et al. out of all cancer patients who were
rehabilitated, the ones with digestive system tumors
were the first, the patients with thoracic tumors were
the second, and the ones with breast cancer were the
third group who had benefitted from the rehabilitation
program the most.[
In the present study, diagnosis distribution of 176
cancer patients who required physiotherapy and rehabilitation
consultation was reported in the following order:
lymphoma, breast cancer, multiple myeloma, lung
cancer, leukemia, and brain tumors. In our study, the
need for rehabilitation was found to be equally important
for both male and female patients. Metastasis was
recorded in 58.5% of the patients participating in the
study. This indicates that the diagnosis distributions of
patients who require physiotherapy and rehabilitation
consultation vary significantly and their illness is in an
advanced stage.
Mavsas et al. investigated functional disorders and
rehabilitation needs of 55 patients in the medical oncology
unit and highlighted many previously unknown
rehabilitation requirements of the patients; the most
primary one of which was deconditioning.[
Aras et al. investigated rehabilitation needs of 300
in-patients of the oncology hospital who did not apparently
require any physiotherapy and rehabilitation.
[
In their study examining functional impairments
and rehabilitation needs of non-operated lung cancer
patients, Bayly et al. reported that fatigue, respiratory
distress and pain are the most important issues to be
considered in the rehabilitation program.[
In our study, evaluation of the patients' daily living
activities showed the loss of independency in 77.8%
of the patients in terms of mobility, in 75% in terms
of transfer activities, and in 60% in terms of using the
bathroom. In our patient group, for which physiotherapy
and rehabilitation needs were identified by the oncologist,
it was noticed that difficulties in mobility and
transfer activities were very common, and that elevated
levels of dependency during daily living activities was
the reason for requesting physiotherapy and rehabilitation
consultation.
Rehabilitation needs of the patients in accordance
with their physical problems were determined as: 92%
deconditioning, 85.2% fatigue, 84.7% balance disorders,
and 64.2% pain. Similar to the literature, we also
concluded that deconditioning and fatigue were the
most prominent problems of the patients within the
physiotherapy and rehabilitation program. Moreover,
edema/lymphedema, joint motion limitations, respiratory
problems and swallowing problems were also determined
depending on the diagnosis and involvement
zone. Hence, deconditioning and fatigue leading to
deficits in balance, mobility and transfers were among
the first clues that would cause physicians to consult
physiotherapy and rehabilitation unit. Patients suffering
excessive fatigue and ambulatory loss are seen to be
the primary candidates for physiotherapy and rehabilitation
consultation.
Gültekin et al. examined health care expectations of
40 lung patients.[
The rehabilitation needs we have shown in our work
show that physiotherapists, as an important member of
the multidisciplinary team, are needed for the treatment
and follow-up of cancer patients.
The researchers also concluded that functional
malfunctions of cancer patients are not adequately and
precisely identified, appropriate and timely physiotherapy
and rehabilitation consultations are generally underestimated,
and family members are not trained and
informed about rehabilitation needs of the patients. In
addition, in the study investigating and comparing the
needs of cancer patients in admission to and discharge
from the hospital; it was emphasized that the rehabilitation
needs of the patients were continued at discharge
and that they should be followed up with home
programs.[
Disclosure Statement
The authors declare no conflicts of interest.
