Pain and Cancer
Cancer rehabilitation can help reduce pain
Pain is a common symptom from cancer and its treatment. Among individuals with cancer, approximately 55 percent during cancer treatment, 40 percent after curative treatment and 60 percent with advanced cancer will experience pain of at least moderate intensity.1 Often pain can persist for years after diagnosis and become chronic.2 Pain frequently occurs along with depressive symptoms, decreased functional activity and poor-quality of life. Adults with cancer, who also have increased anxiety and depressive symptoms, have lower adherence to cancer treatment3 and poor treatment outcomes.4 Unfortunately, pain, functional limitation and depressive symptoms are often underdiagnosed and undertreated.5-7
Burden on oncology care providers and primary care physicians

A 2010 study in the Journal of Pain and Symptom Management found pain and depression to cause substantial disability in terms of functional activity limitation. Individuals reported they spent an average of 60 percent of days within the last month in bed or had activity levels reduced by at least 50 percent.7

TA study examining the Medical Expenditure Panel Survey (MEPS) found adults with cancer to be more likely to go to the emergency room and have higher yearly health expenditures compared to those without depressive symptoms.8

Exercise shown to help reduce pain

Recent studies demonstrate that exercise helps decrease pain resulting from cancer and cancer treatments. Here is an overview of some of the research:
  1. De Groef and colleagues9 found that outpatient physical therapy can improve physical health and decrease pain.  
  2. A recent randomized control trial examined 52 adults with head and neck cancer who engaged in a 12-week exercise program.  After 12 weeks, adults with head and neck cancer demonstrated significant improvements in shoulder pain and disability, endurance and muscular strength.10 Outpatient physical therapy has also been reported to decrease lymphedema and pain (from 7.8 ± 2.2 to 3.6 ± 1.6; p < .001) in adults affected by head and neck cancer.11 
Individuals with cancer respond to oncologists’  recommendations to exercise

Recent research has shown that people with cancer respond positively when oncology providers initiate discussions about exercise.12 However, communication between oncology care providers and patients about exercise remains limited.13

Researchers suggest that given the benefits of exercise, discussions about exercise and appropriate referrals to a qualified rehabilitation clinician or exercise physiologist could significantly improve prognosis, recovery, symptom burden and overall quality of life for individuals affected by cancer.14 

Guidelines for pain and cancer

The American Society of Clinical Oncology and National Comprehensive Cancer Network’s clinical practice guidelines both refer to physical rehabilitation professionals as appropriate adjunct team members to assist in the screening and treatment of cancer pain.2,15 In particular, ASCO’s guidelines state the following, which are applicable to the utilization of other health care professionals in the management of adult cancer pain:

  • Ask patients about their pain at every visit using a quantitative screener.
  • Engage with patients in pain self-management and aim to decrease symptom burden while improving function.
  • Evaluate the need for other supportive services that can be provided by members of the cancer care team.
  • Physicians and advanced care clinicians may prescribe or refer patients to other professionals to provide the supportive interventions focused on mitigating chronic pain or improving functional outcomes. 
ReVital is a Leader in Cancer Rehabilitation

We have a common goal: to improve quality of life for individuals affected by cancer. As oncology care providers, your focus is on lifesaving medical interventions. With the growing numbers of individuals affected by cancer, the shift to value-based care and a shortage of oncology care providers, we know you are busy.

As cancer rehabilitation therapists, and members of the cancer care team, our focus is to support you and your patients. Together we can reduce pain and optimize function and quality of life through education and various rehabilitation interventions. Given the current opioid crisis in the U.S., rehabilitation professionals are well positioned to help reduce the impact of pain and help improve functional impairments. ReVital’s cancer rehabilitation therapists have been extensively trained in the unique needs of both patients and oncologists. This allows them to serve as key partners to improve patients’ quality of life, while also reducing the burden on oncology practices.
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Resources

  1. van den Beuken-van Everdingen MHJ, Hochstenbach LMJ, Joosten EAJ, Tjan-Heijnen VCG, Janssen DJA. Update on Prevalence of Pain in Patients With Cancer: Systematic Review and Meta-Analysis. Journal of Pain and Symptom Management. 2016;51(6):1070-1090.e1079.
  2. Denlinger CS, Ligibel JA, Are M, et al. Survivorship: Pain Version 1.2014. 2014;12(4):488.
  3. DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000;160(14):2101-2107.
  4. Roth AJ, Modi R. Psychiatric issues in older cancer patients. Crit Rev Oncol Hematol. 2003;48(2):185-197.
  5. Syrjala KL, Jensen MP, Mendoza ME, Yi JC, Fisher HM, Keefe FJ. Psychological and behavioral approaches to cancer pain management. Journal of Clinical Oncology. 2014;32(16):1703.
  6. Zaza C, Baine N. Cancer pain and psychosocial factors: a critical review of the literature. Journal of pain and symptom management. 2002;24(5):526-542.
  7. Kroenke K, Theobald D, Wu J, Loza JK, Carpenter JS, Tu W. The association of depression and pain with health-related quality of life, disability, and health care use in cancer patients. Journal of pain and symptom management. 2010;40(3):327-341.
  8. Pan X, Sambamoorthi U. Health care expenditures associated with depression in adults with cancer. The Journal of community and supportive oncology. 2015;13(7):240-247.
  9. De Groef A, Van Kampen M, Dieltjens E, et al. Effectiveness of postoperative physical therapy for upper-limb impairments after breast cancer treatment: a systematic review. Arch Phys Med Rehabil. 2015;96(6):1140-1153.
  10. McNeely ML, Parliament MB, Seikaly H, et al. Effect of exercise on upper extremity pain and dysfunction in head and neck cancer survivors. Cancer. 2008;113(1):214-222.
  11. Tacani PM, Franceschini JP, Tacani RE, et al. Retrospective study of the physical therapy modalities applied in head and neck l ymphedema treatment. Head & Neck. 2016;38(2):301-308.
  12. Jones LW, Courneya KS, Fairey AS, Mackey JR. Effects of an oncologist’s recommendation to exercise on self-reported exercise behavior in newly diagnosed breast cancer survivors: a single-blind, randomized controlled trial. Annals of Behavioral Medicine. 2004;28(2):105-113.
  13. Nyrop KA, Deal AM, Williams GR, Guerard EJ, Pergolotti M, Muss HB. Physical activity communication between oncology providers and patients with early‐stage breast, colon, or prostate cancer. Cancer. 2016;122(3):470-476.
  14. Mustian KM, Cole CL, Lin PJ, et al. Exercise Recommendations for the Management of Symptoms Clusters Resulting From Cancer and Cancer Treatments. Seminars in oncology nursing. 2016;32(4):383-393.