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INTRODUCTION

The american cancer society estimates that there will be more than 15.5 million cancer survivors, 1.7 million new cancer patients, and 601,000 cancer deaths in the United States in 2017.1 The number of cancer survivors is expected to grow to more than 20 million by the year 20262 (Fig. 98–1). It has been demonstrated that 40% to 60% of these survivors report one or more long-term functional deficits, with even higher rates for those with metastatic disease. This represents a massive population of patients with functional and quality of life limiting impairments. Unfortunately, many survivors accept their limitations as the “new normal.” Education of the rehabilitation professional is essential if we are to meet the needs of this critically underserved population.3,4

Figure 98–1

Decline in cancer deaths: The decline in death rates from cancer is shown for different age ranges by sex and race for the 20-year period between 1991 and 2010 expressed as a percentage of the 1991 rate. (Reprinted with permission from Siegel R., et al. Cancer Statisitic 2014. CA Cancer J Clin, 2014;64:9.)

Although there are numerous complications of cancer and cancer treatments, the focus of the chapter will be to provide an overview of key topics. Many cancer survivors will likely have multiple impairments that can be complex and interrelated. The complexity of such patients can be daunting for many rehabilitation professionals. While it may seem intimidating at times, it is important to remember that the physiatrist already has much of the knowledge and skills needed to care for the rehabilitation needs of this population. The approach to these patients is always to apply what one has learned through their training in the various domains of rehabilitation medicine, such as brain injury, stroke, musculoskeletal medicine, and spinal cord injury, and apply those to best improve the function and quality of life of the cancer patient.

Additionally, it is important to understand that in oncology every decision must be made using a careful cost/benefit analysis. Poor outcomes are common in cancer patients, despite one's skill and intentions. The challenge for the physiatrist is to maximize function and quality of life while minimizing, to the best of their ability and knowledge, any potential adverse outcomes. Toward that goal, many of the most common and important concepts seen in cancer rehabilitation will be described here.

COMPLICATIONS OF CANCER AND ITS TREATMENT

Direct Effects of Cancer

The direct effects of cancer itself are often secondary to the mass effect of the primary tumor or metastatic lesion. The clinical impact in this case would be dependent on the location and size of the disease often with clinically obvious effects. Examples would include a large lung tumor resulting in pulmonary dysfunction, metastasis to lymph ...

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