Cancer rehabilitation.

Cancer-related functional impairments and the associated economic burden are likely to increase in coming decades. A variety of factors contribute to the current availability of comprehensive rehabilitation services in only a few cancer centers. In general, cancer patients are highly distressed by the loss of independent mobility and self-care. The majority of patients are amenable to receiving rehabilitation services. Reports describing the integration of rehabilitation specialists into the delivery of cancer care strongly suggest that patients independence can be optimized through established techniques. The provision of humane and effective rehabilitation requires the formulation of dynamic and clinically appropriate goals. Many goals are common to most malignancies, eg, reducing the functional impact of aerobic deconditioning and chemotherapeutic neuropathy. Others are highly disease-specific, such as scapular stabilization following cranial nerve IX sacrifice. The expectations of patients and clinicians must evolve in response to the progression of disease. Restorative, supportive, preventative, and palliative goals should be re-evaluated at critical points along the disease course. A rubric for the development and implementation of rehabilitation goals at different cancer stages is described and illustrated with examples from breast and head and neck cancers.