Cancer rehabilitation in Germany
Cancer rehabilitation is an integral part of the treatment pathway for patients who have completed therapy for a malignant disease. It comprises a whole range of measures aimed at restoring the patient's well-being and ability to work (restorative rehabilitation), improving quality of life, supporting social reintegration and extending life as far as possible while relieving pain (palliative rehabilitation). Mud therapy, manual lymphatic drainage, massage, therapeutic exercise and physiotherapy can be of invaluable help in the rehabilitation of patients.
Rehabilitation for patients who have faced cancer has its own particular features. These arise from the need to address complications caused both by the effect of the tumour on the patient's health and by the side effects of the treatment given (surgery, radiotherapy, chemotherapy). The programme is drawn up individually — taking into account the patient's condition, functional capacity and motivation. Physiotherapy, acupuncture, therapeutic exercise and similar methods help bring about a marked recovery of physical mobility. Psychological support for patients and their families also plays an important role. Occupational therapy is a key aspect of preventing disability: it is therapy aimed at helping patients adapt to independent living and return to work.
Restorative rehabilitation after the completion of cancer treatment differs from every other form of rehabilitation in that it is essentially psychosocial support for a person in a very difficult period of life, and this inevitably has a most beneficial effect on their physical health as well.
After long treatment – surgery, systemic therapy, radiotherapy – it is vital for a person not only to recover physically and overcome the consequences of aggressive, demanding treatment that can lead to disability, but also to adapt psychologically to living in this new condition. This involves a whole range of measures aimed at restoring the patient's well-being and ability to work, improving quality of life, supporting social reintegration and extending life as far as possible.
Modern restorative cancer rehabilitation is strictly individual in nature. During the initial consultations and conversations with the patient, rehabilitation physicians and psycho-oncologists study not only the medical history but also the patient's psychological make-up, taking into account both the «subtle» pathophysiology of that particular patient's disease and all of their personality traits. Cancer rehabilitation is therefore medicine with a special attitude towards the patient, or «client-oriented» medicine, in which the entire rehabilitation process is «tailored» to the patient's needs.
When drawing up an individual rehabilitation programme, doctors take into account above all such aspects as:
- the patient's age;
- the underlying disease;
- concomitant conditions;
- complications caused by the tumour and side effects of the treatment given;
- the patient's general condition, functional capacity and motivation.
This is precisely why the cost of rehabilitation treatment is difficult to calculate exactly in advance. The therapy plan is drawn up only after a consultation with rehabilitation specialists, an examination and a review of current test results. In addition, the programme itself and its duration may be adjusted during the course of rehabilitation, based on the medical history and the patient's condition on admission. Rehabilitation clinics in Germany set a standard deposit; once treatment is complete, the patient receives a final invoice covering the cost of the services actually provided.
- manual lymphatic drainage
- exercise therapy;
- massage;
- therapeutic exercise and walks in the fresh air;
- psychological counselling;
- training in relaxation techniques;
- carbon dioxide baths;
- mud therapy.
After just the first week in a rehabilitation clinic, patients report a surge of energy, improved mood, a marked recovery of physical mobility and a reduction in the most common unwanted consequences of cancer treatment, for example in the severity of the clinical symptoms of lymphoedema, irritable bladder and inflammation of the mucous membranes at various sites.
Occupational therapy is an indispensable element of cancer rehabilitation. It is understood as a set of measures aimed at helping the patient adapt to independent living and return to work. To the physical discomfort, pain, hair loss, brittle nails, surgical scars and damage to the skin and internal organs after radiotherapy is added a sense of helplessness and of being unwanted. Occupational therapy begins with an assessment of the degree of functional impairment: for this purpose special equipment is often used, or even rooms fitted out to reproduce a standard domestic setting. These help to identify the «gaps in independence», which are then compensated for with individually selected exercises or with special aids that the person may need after finishing the rehabilitation programme.
Features of recovery after different types of cancer
Each cancer has its own pathophysiological features, which determine the treatment strategy and the consequences for the patient's health. This is why restorative therapy for cancer patients varies depending on the disease involved.
Breast cancer
The distinctive feature of this type of rehabilitation is the emphasis on restoring function in the upper limbs, taking into account the side on which the tumour was removed. Exercises and measures are prescribed to mobilise the affected arm and reduce lymph stasis, for example therapeutic massage and manual lymphatic drainage, which help restore micro- and macrocirculation and thereby significantly reduce or completely eliminate tissue swelling of the upper limb on the operated side. If aggressive cytostatics with side effects involving weakening of the heart muscle were used during systemic polychemotherapy, exercises are prescribed to increase exercise tolerance and to train the cardiovascular and respiratory systems. In addition, psychotherapy plays a key role for women who have survived breast cancer, allowing them to regain a sense of femininity and to overcome the insecurities left by the treatment they have been through. The most lasting therapeutic effect in lymphoedema after surgery for breast cancer is achieved with comprehensive rehabilitation:
- massage;
- elastic bandaging of the upper limb;
- exercise therapy sessions;
- hydrokinesitherapy in a swimming pool;
- pneumatic compression, electrical stimulation of the shoulder girdle muscles;
- magnetotherapy.
Stomach cancer
Patients with this diagnosis need specialised rehabilitation programmes aimed at restoring appetite, relieving pain and strengthening the body in general, since impaired nutrition often leads to cachexia (pathological wasting).
Prostate cancer
A common complication in patients with prostate cancer is loss of control over pelvic organ function — this may mean urinary incontinence or erectile dysfunction. It is essential to relieve the patient's condition as far as possible, restoring access to their usual way of life without any loss of dignity. This is why rehabilitation requires the involvement of specialists in pelvic floor muscle training and in exercises to strengthen the bladder sphincter muscles.