Ringing the bell at the conclusion of cancer treatment is a moment of triumph and jubilation for patients and their families. But the journey does not necessarily end there as patients transition to an active life beyond cancer.
Making sure patients have the best possible experience before, during and after their cancer treatment is the top concern of physiatrist Adrian Cristian, MD, chief of cancer rehabilitation at Miami Cancer Institute.
dr Cristian is part of a growing specialty called oncology rehabilitation. He works with Romer Bismonte Orada, DO, as part of Miami Cancer Institute’s Cancer Patient Support Center, which provides a broad range of services including comprehensive survivorship care, physical rehabilitation and pain management, nutrition counseling, mental health support, and integrative medicine such as acupuncture, massage therapy, exercise and wellness classes.
“Early identification, intervention and surveillance of any challenges in survivorship can maximize the patients’ function,” Dr. Cristian says. “This is really rising to the top of what people want – not just longevity, but quality of life.”
Here, Dr. Cristian shares insights about oncology rehabilitation and guiding cancer patients live their best life.
Are impairments after cancer treatment simply a fact of life?
“A lot of patients are just grateful to be alive after cancer treatment, so they accept a new norm of how they move and how they are functioning. However, there can be a significant impact on their ability to care for their physical needs, on their work, on their life-care roles as spouses or caregivers. Some people learn to accept it, but that is not necessarily how it should be. We need to educate the patients, their families and their providers about the role of rehabilitation and various other interventions.”
Can you share some statistics that would help give perspective?
“It has been projected that by 2030 there will be approximately 22 million cancer survivors in the United States. That is a striking number. It represents the success of today’s early detection and cancer treatment programs. At the same time, it is very common for cancer survivors to experience limitations in their ability to perform one or more self-care activities.
“The limitations vary depending on type of cancer, cancer treatment and stage of cancer. It’s not uncommon for us to see patients months or years after their cancer diagnosis, after they have been living with various physical limitations for a while. The goal is to prevent these limitations in the first place — however, if that is not possible, to identify and treat them as early as possible.”
Why do so many cancer patients accept these limitations?
“Sometimes the last place patients want to be after they finish their treatment is a cancer center. They went through a very challenging time and they want to resume their lives. But what happens is that as they reenter that life, they start coming up against physical limitations associated with their cancer and cancer treatment. Maybe they are unable to function at work because they are fatigued from radiation treatments, or they may have a job that requires them to do a lot of lifting overhead and they find they can’t move their shoulder very effectively. Maybe they have problems with short-term memory or multi-tasking.
“The limitations were not apparent when they were undergoing treatment, but now they are back in their life and they are facing daily challenges. Many times, these physical impairments are slow to develop and can be subtle initially, until something happens that brings them to medical attention — for example, a fall in a person with weakened legs.”
Any examples of things you see commonly?
“There are some common threads — for example fatigue and neuropathy, or nerve pain, among cancer patients who are treated with certain chemotherapeutic agents. There are also very specific physical limitations for certain types of cancer. In head and neck cancers, for example, patients can develop problems with swallowing, difficulty opening the mouth, shoulder and neck pain, and restricted movement. In the breast cancer population, it is very common to see shoulder pain, swelling of the arms, and hand weakness and pain. In prostate cancer patients, certain treatments can result in balance problems and swelling of the legs.”
How do you address those problems?
“At Miami Cancer Institute, the treatment involves a holistic, multidisciplinary approach. Our survivorship experts understand that side effects can last beyond cancer treatment. We consult with the medical, surgical and radiation oncologists and collaborate with physical therapists, occupational therapists, speech pathologists, nutritionists, social workers and psychiatrists — just to name a few disciplines. We have exercise physiologists who specialize in cancer, massage therapists who specialize in cancer patients, wonderful medical assistants, an acupuncturist. It’s very much a team approach.”
Is taking such a wide approach typical?
“It’s an approach and a philosophy of how to think about the patient. Oncologists are focused on the medical, surgical and radiation therapy needs of the patient to save the person’s life. Where I hope to be of assistance is in evaluating the patient’s physical ability to tolerate those treatments. How do we prepare the patient? How do we keep that patient going during and after their treatment, so that they can get the benefit of cancer care? Once they’ve finished this battle, how can we help them get back to their life?”
How do you ensure patients get the support they need?
“During the active treatment period, we track the patients. We see how they are doing functionally – we treat them with pain management techniques, rehabilitative interventions, counseling, education. We track them through post-treatment to survivorship, especially those that may be at risk of unique physical impairments, such as head and neck cancer patients. We want to proactively make sure they don’t develop the kinds of physical limitations that can affect their quality of life.”
Do all cancer centers have rehabilitation oncologists?
“There are not that many cancer rehabilitation physicians across the country, and they are typically housed in larger institutions or academic centers. At Miami Cancer Institute, we have two – me, and Dr. Roman Orada. We are fortunate to have a very supportive team in the Cancer Patient Support Center led by Dr. Beatrice Currier. She and the leadership at Miami Cancer Institute have created an environment where this holistic approach to patient care can thrive.”
What is the message you want to share with the public?
“The message is that while cancer and its treatment can cause physical limitations, many of these conditions can be treated – ideally, even prevented. Patients can proactively seek rehabilitative interventions for limitations they may encounter — not to just accept that this is their new normal.”