Cancer and Fear- The Role of the Rehab Provider

Psychological distress and cognitive impact are common sequelae of a cancer diagnosis, even once a patient is considered disease-free. Fear of cancer recurrence or progression is a significant issue for many patients, and can have severe impacts on a patient's well-being and function. Research published in August of last year describes predictors of this fear of recurrence, or FOR, in almost 1300 patients who completed a range of validated measures. The study reports that patients within a lower social class, this with skin cancer, colon or blood cancer, palliative treatment intention, pain, an increased number of physical symptoms, depression, and decreased social support were at higher risk of having fear of cancer.

Fear and psychological distress could potentially impact a patient's life in many ways, and also may have an effect on a patient's ability to maximally participate in recommended rehabilitation. If a patient is experiencing anxiety and/or depression, getting out of the house, making it to appointments on time, and participating in health programs may be very difficult. Cognitive impact from treatment or from psychological stress can also make remembering a home program or other instruction from you very challenging. What are things we can do to support a patient who has been impacted by a diagnosis of prior cancer? We can ask some simple questions…

What if we, as rehabilitation experts, acknowledged this research and simply asked the patient if fear of cancer recurrence or progression was creating any struggles for him or her? We already inquire about pain and physical symptoms, so can we link a reduction in physical symptoms to reduced psychological distress? Reducing pain and improving function is a logical way for us to have a positive impact. We can also screen a patient for the FOR risk factors mentioned in the literature, and ask if the patient has noticed some changes in the way information is processed or retained since having treatment for cancer. Knowledge that the patient experiences quick mental fatigue is valuable when designing home programs or when teaching important concepts; a therapist could use brief, repeated instruction rather than one long explanation. If a patient describes significant distress, discussing referral options is another way in which rehabilitation providers can serve our patients.

A Cochrane summary that was updated last in 2012 confirmed that a regular physical examination and annual mammogram are as effective as "more intense methods" of exam in detecting a cancer recurrence. If fear of recurrence prevents a patient from wanting to schedule a medical follow-up, we can encourage a patient to make any recommended medical appointments so that changes in health status are caught as early as possible. For further discussions in caring for patients who have experienced cancer, the Pelvic Rehab Institute offers Rehabilitation for the Breast Oncology Patient as well as Oncology and the Pelvic Floor, Parts A and B. The breast oncology course is taking place next month in San Diego, and the pelvic floor oncology (female) course is scheduled for June in Orlando!