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David J. Conti, DPT, NCS, CSCS is the owner of Revive, Boost, Rebuild, Physical Therapy, LLC (RBR PT), and an adjunct professor at St. Augustine’s University. He has practiced physical therapy for 10 years, with a clinical focus on orthopedic and neurologic patient cases. He is a certified strength and conditioning specialist, and one of only 57 PTs in NC who is board-certified in neurology.

RBR PT treats patients from infants to geriatrics. RBR PT is known as an inclusive clinic and a strong community resource.

Life After Cancer: The Challenge of Recovery

By David Conti, DPT, NCS, CSCS

Malignant cancer has long been recognized as one of the leading causes of death in the United States and worldwide. In fact, a 2014 study found that in the US, cancer was second only to heart disease, by a margin of less than 1 percent. The number of new cases has consistently risen—a trend expected to continue well into the foreseeable future. Despite these sobering facts, however, there is great promise. Thanks in large part to advancements in medical technology, legislative changes affecting multiple risk factors, and growing general awareness based health and wellness initiatives, the number of cancer related deaths has been steadily decreasing over the past two decades.

David Conti

According to the September 2016 SEER Cancer Statistics Review, cancer-related deaths in the US decreased by 1.8 percent for men and 1.4 percent for women between 2004-13. It also reported a 1.4 percent decline among children from 2009-13.

What have we to learn from these statistics? Consider this: a rise in both incidence and survival rates, means that the number of people navigating the period of life beyond cure will continue to increase dramatically. And while becoming “cancer-free” is the goal for all of those in the battle, when the smoke clears, there is frequently still much work to be done.

The truth is that aggressive cancer treatment can wreak havoc on the body. Chemotherapy, radiation, and surgical excision frequently and traumatically alter musculoskeletal, neuromuscular, and cardiopulmonary systems. Imagine being granted a new lease on life, only to realize that you lack the prerequisite mobility, strength, and endurance to fully enjoy it.

The Role of Physical Therapy

Following cancer treatment, body systems must be mended, impairments addressed, and functional limitations corrected. This is why the role of the physical therapist is instrumental in the growing field of cancer rehabilitation. Coordinating the management of common symptoms—such as pain, fatigue, muscle weakness, lymphedema, incontinence, and balance issues related to neural degeneration—is paramount. The establishment of a thorough, patient-specific plan of care is often the path to achieving the desired functional outcomes.

Pain: Physical therapists use a variety of manual and modality based techniques for pain management. Pain is frequently secondary to poor posture and positioning during functional activity. Identifying the root cause and mechanically correcting it is the most successful way to long-term relief.

Cancer Related Fatigue (CRF): CRF is one of the most common side effects of cancer medication. The difficulty in its management is that it is not generally caused by over-exertion. Physical therapy can emphasize components of stress management, energy conservation, activity pacing, adaptive equipment, and structured exercise to combat CRF.

Weakness: General deconditioning is also a frequent side effect associated with cancer and its treatment. Physical therapists can target specific muscle groups and construct functional programs to help restore muscle strength.

Lymphedema: Insufficient lymphatic drainage carries with it a variety of complex issues. Physical therapy can promote proper drainage via manual and vasopneumatic techniques, as well as minimize infection risk by educating patients on self-management.

Incontinence: Urinary incontinence is a common complication associated with cancer and its treatments. Appropriate intervention may include biofeedback, electrical stimulation, and various forms of motor control efficiency techniques. Physical therapy can help strengthen pelvic floor musculature to improve bladder function and overall quality of life.

Balance: One of the many side effects of chemotherapy is peripheral neuropathy—damage to the nerves that takes a heavy toll on functional balance. Physical therapy can help remediate proprioceptive and kinesthetic awareness when possible or develop compensatory strategies to spare function.