The focus of rehabilitation is on promoting functional independence and facilitating self-management.
Rehabilitation will be required by different people at different time points throughout their lives depending on their individual needs. Rehabilitation is relevant to those having different modalities of treatment.
Shared decision making is key and the person with cancer is encouraged to lead their own SMART (Specific, Measurable, Achievable, Realistic, Timed) goal setting.
Successful rehabilitation relies on comprehensive and accurate subjective, objective and holistic assessment to establish the nature and cause of the person’s symptoms and develop a personalised plan based on the person’s individual strengths and needs.
Many of the symptoms and consequences of cancer and its treatment set out in the sections below do not exist in isolation and frequently are co-dependent.
A cancer rehabilitation assessment is likely to include many of the following elements depending on the type of cancer, the stage of the pathway the person is at (diagnosis, having treatment, living with and beyond cancer, palliative care, end-of-life care), the needs of the individual and the aims of the professional undertaking the assessment.
Generic elements included in a rehabilitation assessment:
- Undertake baseline holistic needs assessment
- General functional assessment:
- independent functional status
- quality of life and daily living
- fatigue
- anxiety and depression
- mood and coping strategies
- lifestyle, including diet and nutrition, smoking and alcohol use, physical activity
Other elements of assessment could include:
- Cognitive and perceptual ability: level of understanding and ability to make decisions. This will affect the person’s capacity to give informed consent and to follow a rehabilitation treatment plan
- Communication and impact treatment or cognitive changes may have/have had on this
- Swallowing and impact treatment may have/has had
- Nutritional assessment including monitor and record weight, height and waist as a benchmark to enable any weight gain or loss to be monitored
- Functional and neurological assessment to improve quality of life including mobility, exercise tolerance, functional task, balance, vestibular and upper limb function
- Respiratory function, mobility, muscle strength, symptom/side effects
- Assess and assist in management of incontinence
- For cancers involving, or in the location of lymph nodes, undertake limb volume measurements and screen for lymphoedema
- Risk assesses the possibility of pathological fracture and spinal cord compression especially in cancers of the breast, lung, skin, prostate, renal, ovarian, teenage and young adult sarcoma and myeloma