Why rehabilitation should begin during cancer treatment, not only after problems develop
Cancer Rehabilitation Is More Than Lymphoedema: Why Rehabilitation Should Start During Cancer Treatment
When people hear the words cancer rehabilitation, one of the first things that often comes to mind is lymphoedema. Lymphoedema surveillance, assessment and management are important parts of cancer rehabilitation for people at risk, but they are only one part of a much broader picture.
Cancer and its treatment can affect movement, strength, endurance, tissue health, pain, fatigue, scarring, swallowing, shoulder function, confidence and a person’s ability to participate in everyday life. For CRLS Founder Kate Perkins, this is an important message: cancer rehabilitation should not simply begin after treatment or once a problem has become established. Where appropriate, it should be considered at diagnosis and early in the cancer treatment pathway.
In short: Cancer rehabilitation is specialised care that helps people maintain or restore movement, strength, function and quality of life during and after cancer treatment. It can include individualised exercise, scar and tissue management, lymphoedema surveillance and treatment, education, functional rehabilitation and, where clinically appropriate, photobiomodulation therapy (PBMT).
Cancer Rehabilitation Looks at the Whole Person
Cancer rehabilitation focuses on how cancer and its treatment are affecting the person’s day-to-day function, not simply the diagnosis itself. The needs of someone undergoing breast cancer treatment may be very different from those of someone receiving treatment for head and neck cancer, melanoma or another cancer.
Depending on the individual, rehabilitation may address:
- Reduced strength and physical conditioning
- Shoulder, neck or upper limb restriction
- Pain, stiffness or altered movement
- Surgical scars and tissue tightness
- Radiation-related tissue changes
- Cancer-related fatigue
- Swelling and lymphatic dysfunction
- Reduced jaw movement or swallowing-related functional issues in some head and neck cancer presentations
- Difficulty returning to exercise, work or everyday activities
- Confidence in moving and using the body following treatment
At CRLS, breast cancer rehabilitation can include individualised exercise prescription, manual therapy, scar management and support to regain upper limb function and range of movement. Lymphoedema care is important, but it sits within this broader rehabilitation picture.
When Should Supportive Cancer Care Start?
Ideally, supportive cancer care should be considered at diagnosis or as early as clinically appropriate. Depending on a person’s diagnosis, treatment, and individual needs, that may include assessment before surgery, support during chemotherapy or radiation therapy, and ongoing rehabilitation after treatment.
Starting earlier creates an opportunity to establish a baseline, understand a person’s pre-treatment function, and identify emerging issues sooner. It also allows for early education and for rehabilitation strategies to be adjusted as treatment progresses rather than waiting until the end of treatment to address problems that may already be affecting daily life.
A more proactive approach
For patients at risk of cancer-related lymphoedema, CRLS has been an early adopter of SOZO® bioimpedance spectroscopy, which can be used as part of prospective surveillance to monitor subtle changes in fluid levels over time. The broader principle is the same across cancer rehabilitation: monitor early, educate early, and intervene appropriately rather than assuming rehabilitation only starts when treatment ends.
What Is Photobiomodulation Therapy (PBMT) and How Is It Used in Cancer Rehabilitation?
Photobiomodulation Therapy (PBMT) uses specific wavelengths of therapeutic light to influence biological processes within tissue. It is a non-invasive supportive therapy and is not an alternative to cancer treatment.
PBMT is increasingly used in supportive oncology in selected clinical settings. International MASCC/ISOO mucositis guidelines include recommendations for PBMT for the prevention of oral mucositis in specific cancer treatment settings. This is an important distinction: evidence for PBMT varies by indication, so it should be used for appropriate treatment-related concerns and in coordination with the treating healthcare team.
At CRLS, Kate Perkins co-founded the OncoLaser™ with Dr Catherine Norton, and developed the treatment model integrating PBMT using MLS® Laser Therapy with hands-on cancer rehabilitation techniques. Where clinically appropriate, this can form one part of a broader rehabilitation plan rather than being viewed as a stand-alone treatment.
Why Early Support During Radiation Therapy Can Matter
Radiation therapy can cause acute and longer-term side effects that vary depending on the area treated, dose, individual response, and other aspects of care. Rehabilitation during treatment can provide an opportunity to monitor function, maintain movement, educate patients, and address selected treatment-related issues as they arise.
For example, people receiving treatment for head and neck cancer may experience challenges such as:
- Oral mucositis
- Dry mouth and changes in oral comfort
- Skin reactions
- Pain
- Neck and shoulder tightness
- Reduced jaw movement or trismus
- Tissue fibrosis
- Swelling and lymphoedema
- Reduced strength and mobility
Depending on the presentation, rehabilitation may incorporate exercise, hands-on treatment, lymphatic management, education and PBMT where clinically indicated. This is one reason cancer rehabilitation should not be reduced to simply treating lymphoedema after treatment is complete.
Radiation Fibrosis: Another Example of Why Cancer Rehab Is Broader Than Swelling
Radiation-related tissue changes can develop over time and may contribute to pain, stiffness, restricted movement, altered tissue function, and lymphoedema. Radiation fibrosis is one of Kate Perkins’ areas of clinical interest and professional education. She has presented internationally on the use of MLS® Laser Therapy in cancer rehabilitation and continues to contribute to education around PBMT, lymphatic care and treatment-related tissue changes.
The important message for patients is that supportive cancer care may involve much more than measuring swelling. It can also address mobility, scar and tissue restriction, pain, functional limitations and the practical impact treatment is having on everyday life.
Exercise Is a Core Part of Cancer Rehabilitation
Technology is only one part of cancer rehabilitation. Individualised movement and exercise remain central to helping people preserve or rebuild physical capacity.
A rehabilitation program may aim to help a person:
- Maintain movement during treatment
- Rebuild strength and endurance
- Restore shoulder, neck or limb function
- Manage fatigue through appropriate pacing and activity
- Gradually return to work, exercise and normal activities
- Build confidence in using their body after treatment
The right program depends on the person’s cancer diagnosis, surgery, treatment, medical history, current symptoms and individual goals. There is no one-size-fits-all cancer rehabilitation program.
Where Does Lymphoedema Care Fit?
Lymphoedema remains an important part of specialised cancer rehabilitation. Cancer treatment involving lymph nodes can increase lymphoedema risk, and early education, surveillance and specialist management can be valuable.
But an accredited lymphoedema therapist working within a specialised cancer rehabilitation service may be assessing and treating far more than swelling. The bigger aim is to support overall function, recovery and participation in everyday life.
Moving From Reactive to Proactive Cancer Rehabilitation
Kate Perkins’ approach at CRLS has always focused on early intervention, innovation and integrated care. Through CRLS, Coastal Rehab Hub and the development of OncoLaser™, she has championed the use of technologies such as SOZO monitoring and PBMT alongside exercise, manual therapy, education and multidisciplinary collaboration.
A proactive cancer rehabilitation approach asks questions such as:
- How is this treatment likely to affect this person’s function?
- Can we establish useful baseline measures before treatment begins?
- Can we maintain movement and strength during treatment?
- Are there supportive interventions that may help prevent, reduce, or manage selected treatment-related side effects?
- Are lymphatic, scar, or tissue changes emerging that should be addressed early?
- What will this person need to return to the life they want to live?
That is very different from waiting until treatment is complete and then addressing problems only after they have become established.
Cancer Treatment and Cancer Rehabilitation Should Not Be Separate Conversations
Cancer rehabilitation is not simply lymphoedema treatment, and it is not something that automatically needs to wait until cancer treatment has finished. For some people, the most useful rehabilitation pathway begins during the treatment journey and works alongside oncologists, surgeons, radiation teams and other healthcare professionals.
At Cancer Rehabilitation & Lymphatic Solutions, the aim is to combine specialised rehabilitation, early monitoring, appropriate technology and individualised care to support people through treatment and beyond.
Because cancer care is not only about treating the disease. It is also about helping people maintain function, manage treatment effects and recover as well as possible afterwards.
Frequently Asked Questions
What is cancer rehabilitation?
Cancer rehabilitation is specialised care designed to help people maintain or restore physical function, movement, strength, independence and quality of life during and after cancer treatment. It may include exercise, scar and tissue management, lymphoedema surveillance and treatment, functional rehabilitation, education and selected supportive therapies.
When should cancer rehabilitation begin?
Cancer rehabilitation can be considered before, during or after cancer treatment depending on the individual. Early assessment may help establish baseline function, identify risks and support issues as treatment progresses rather than waiting until treatment has finished.
Is cancer rehabilitation only for people with lymphoedema?
No. Lymphoedema care is one part of cancer rehabilitation. Cancer rehabilitation can also address fatigue, weakness, reduced movement, scar and tissue restriction, pain, radiation-related changes and difficulty returning to exercise, work or everyday activities.
Can I have cancer rehabilitation while I am still having cancer treatment?
In most cases, yes, provided it is appropriate for your individual situation and coordinated with your treating healthcare team. Rehabilitation may be adapted around surgery, chemotherapy, radiation therapy, and other treatments.
What is PBMT in cancer rehabilitation?
Photobiomodulation Therapy (PBMT) is a non-invasive treatment delivered via a therapeutic medical laser. It has evidence and guideline support for selected oncology-related indications, including minimisation of oral mucositis, radiation dermatitis, and chemotherapy-induced peripheral neuropathy in specific treatment settings. Its use should be individually assessed because evidence varies depending on the condition being treated. The treatment also supports lymphatic function, increasing the effectiveness of adjuvant therapies.
Do I need a referral to see CRLS?
Private patients do not generally require a referral. Some patients may attend under a GP Chronic Disease Management plan or be referred by a specialist or other health professional. Contact CRLS if you are unsure which pathway applies to you.
Considering cancer rehabilitation?
If you are preparing for, undergoing or recovering from cancer treatment and would like to understand whether specialised rehabilitation may be appropriate for you, contact Cancer Rehabilitation & Lymphatic Solutions in Erina on (02) 4312 7033 or visit www.crls.au.
Clinical note: Cancer rehabilitation and PBMT should be individually assessed and coordinated with a person’s treating healthcare team. Suitability, timing and expected outcomes vary according to diagnosis, treatment and individual circumstances.