Section Sponsored by:

After cancer treatment, people are often elated that the worst is over and then quickly sobered by the fact that they don't feel well.

There's no doubt that cancer takes a tremendous physical toll on the body. Marilyn French, who was diagnosed with esophageal cancer, wrote this about physicians in her memoir, A Season in Hell : "Simply to treat cancer means they must violate the primary tenet of their code: First, do no harm." ¹

The current treatments for cancer remain highly toxic. In fact, for someone diagnosed with a malignancy, the illness typically is causing few, if any, problems at the time of discovery. This means patients often feel much better physically at the beginning of cancer treatment than they do at the end.

A report from the Institute of Medicine and the National Research Council of the National Academies documented what almost every cancer survivor already knows: Not enough is being done for cancer survivors as they transition out of acute cancer treatment. ²

An important recommendation from this report is to make survivorship a distinct phase of cancer treatment with a dedicated plan for this phase. Ellen Stovall, a 34-year survivor of two bouts with cancer and president of the National Coalition for Cancer Survivorship, says the reason cancer patients become lost in transition is that "there is no coordinated system of care. People who are post-treatment don't have any systematic way of being followed for short-term or long-term problems. They are lost to follow-up."

A survivorship care plan should include surveillance for recurrence, of course. But there is much more to survivorship, and post-treatment intervention should help survivors restore their functional abilities.

Physical Healing
Many treatment-based decisions affect pain, function and quality of life post-therapy. These decisions need to take into account the acute problem of cancer, the treatment toxicity and long-term deficits.

For example, a recent study evaluated radical neck dissection versus "functional" neck dissection. The functional neck dissection aims to spare the function of the sternocleidomastoid muscle (SCM) and the spinal accessory nerve (SAN). With a radical neck dissection, significant disability occurs because the patient loses function of the spinal accessory nerve that innervated the SCM. ³

Immediate pre-operative and postoperative care also can be important. Another recent study looked at the effects of an enhanced recovery program on clinical outcomes, costs and quality of life after colorectal cancer surgery. It found that patients who had pre-operative counseling, epidural analgesia, early feeding and mobilization, fared significantly better and stayed in the hospital half as long as those who didn't receive this care. ⁴

We're becoming more aware of the importance of carefully weighing the benefits and long-term risks of cancer therapy, including loss of function and pain. Cancer survivors face disability. We need to combat fatigue, pain and disability in this patient population. By doing so, we can enhance quality of life.

Get Moving
For anyone who has had a serious injury or illness, a major part of healing involves recovering from immobility and bed rest. One of the most striking effects of bed rest happens at the muscular level. Research shows that people on bed rest lose 1 percent to 3 percent of their strength per day for the first two weeks. The total loss of strength can be as high as 50 percent in those who are inactive for 3 weeks or more.⁵

While the effects of complete inactivity or reduced activity are profound at the muscular level, many other detrimental changes occur in the body, such as:

• significant loss of muscle strength 

• reduced heart efficiency, which decreases endurance

• bone loss, which can result in osteoporosis

• skin changes that may result in poor wound healing, rashes and pressure ulcers

• loss of lean body mass and increased body fat

• loss of important minerals, including nitrogen, calcium, phosphorus, sulfur and potassium

• impaired glucose tolerance

• altered circadian rhythm

• reduced breathing capacity

• impaired kidney function

• decreased bowel motility

• problems with balance and coordination

• poor sleep quality.

Early exercise and focusing on cardiovascular reconditioning and strength training helps mitigate these effects. Encourage cancer survivors to buy a pedometer and begin to track how many steps they take daily. The goal for active, healthy adults is 10,000 steps per day. Exercise improves strength and endurance, lessens fatigue and pain, and has important implications for mood. Studies suggest that exercise may help reduce the incidence of recurrence in breast and colon cancer.^6,7