Impairment-driven cancer rehabilitation: An essential component of quality care and survivorship 2013

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 "Adult cancer survivors suffer an extremely diverse and complex set of impairments, affecting virtually every organ system. Both physical and psychological impairments may contribute to a decreased health-related quality of life and should be identified throughout the care continuum. Recent evidence suggests that more cancer survivors have a reduced health-related quality of life as a result of physical impairments than due to psychological ones......

Table 3: Identifying Physical Impairments in Patients With Cancer (includes ovarian cancer)

Table 3 lists the myriad impairments that may occur in patients with cancer, impacting virtually every organ system, and Table 1 lists some examples of validated tools that may be used to identify physical impairments in this population. These impairments can be due to tumor compression, treatment side effects, or paraneoplastic phenomena. While they can be sudden, catastrophic events such as spinal cord compression, Cheville et al noted that in patients with metastatic breast cancer, disablement is more frequently “driven by the accrual of multiple physical impairments, adverse symptoms, and their interactions rather than by discrete and functionally catastrophic impairments.”[29] In order to limit the scope of this review, several common impairments will be presented as examples. This article focuses on rehabilitation interventions; the reader should refer to specific treatment guidelines for the medical and surgical management of these conditions.

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"A leading cause or perhaps even the leading cause of emotional distress in cancer survivors is physical disability. Banks et al investigated distress in cancer survivors and found that the major cause was disability.[14] They concluded, “The risk of psychological distress in individuals with cancer relates much more strongly to their level of disability than it does to the cancer diagnosis itself.”[14] Ponto et al observed that, in women living with ovarian cancer, a predictor of distress was poor performance status.[15] A study of 112 Jordanian patients receiving chemotherapy found that lower scores in emotional and physical functioning were associated with higher reports of distress.[16] In fact, the link between physical and psychological function is becoming so important that, in a recent study of screening in an inpatient setting, researchers advised, “…routinely screening for psychological and physical distress should become a first step in the assessment of the biopsychosocial needs of people receiving inpatient treatment for cancer.”[17]

16.

Ponto JA, Ellington L, Mellon S, Beck SL. Predictors of adjustment and growth in women with recurrent ovarian cancer. Oncol Nurs Forum. 2010;37:357-364.

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