As the incidence of cancer rises, medical advancements have made it possible to have increased survival rates among cancer patients. However, many experience persistent treatment-related side effects that negatively affect their quality of life. At the first international Oncology Physiotherapy Conference in 2018, it was agreed that undergraduate physiotherapy training provides a strong foundation for oncology rehabilitation. However, management of specific side effects such as cancer-related fatigue (CRF), chemotherapy-induced peripheral neuropathy (CIPN) and lymphoedema, necessitates additional oncology-specific knowledge and skills. Cancer-related fatigue is one of the most common and distressing symptoms during cancer treatment. Evidence supports the effectiveness of non-pharmacological interventions, such as exercise, to manage CRF, while pharmacological options remain limited. Referral to physiotherapy should thus be considered as a primary approach. Research also supports the use of physiotherapeutic interventions such as exercise and sensorimotor integration in the treatment of CIPN. Physiotherapists upskilled as lymphoedema therapists can deliver Complex Decongestive Therapy (CDT), the gold standard in treating lymphoedema. The Lymphoedema Association of South Africa (LAOSA) promotes standardised care through a 135-h certification process. Exercise for cancer patients should be promoted by all members of the multidisciplinary team, and referral to professionals such as physiotherapists should occur early in the treatment journey. This article aims to sensitise primary healthcare providers to the integral role physiotherapists play in the management of patients with cancer who experience CRF, CIPN and lymphoedema.
Globally, cancer is considered a leading cause of disease burden
The National Cancer Policy Forum in the United States called for better integration of rehabilitation services into cancer care, including physiotherapy. They believe that by integrating these rehabilitation services, ideally from the start of the cancer diagnosis, long-term treatment-related disability and side effects may be reduced.
Similarly, the Clinical Oncology Society of Australia (COSA) issued a guideline on exercise in cancer care. They recommended that exercise should be viewed as an adjunct therapy to mitigate the side effects of cancer and its treatments, and that it should be embedded as standard practice in cancer care. The promotion of physical activity and adherence to exercise guidelines should be encouraged by all members of the multidisciplinary team. They also suggest that best practice involves referring patients to professionals such as physiotherapists with experience in cancer care.
Across the literature, CRF is noted to be one of the most common symptoms experienced by patients with cancer.
An evidence-based resource tool from the Oncology Nursing Society states that, to date, there are no evidence-based pharmacological agents or nutritional supplements for the treatment of CRF, apart from dexamethasone and erythropoietin, both of which could have detrimental side effects.
Another study investigated the impact of a multimodal exercise and functional rehabilitation programme for managing CRF in patients with cancer. The multidisciplinary team, which included physiotherapists, achieved improvements in fatigue, functional ability, pain and quality of life among oncology patients.
A practical recommendation for clinicians encountering a patient with CRF would be to follow the American College of Sports Medicine (ACSM) guidelines. The guideline recommends that cancer survivors should avoid inactivity and participate in moderate aerobic exercise (talk but not sing) for up to 30 min, 3 times a week, and 2 sessions a week of resistance training for 20 to 30 min.
The use of chemotherapy as an anti-cancer treatment is contributing to the increasing number of cancer survivors. This powerful medicine acts by targeting rapidly dividing cancer cells; however, healthy cells and tissues are not selectively spared. This often results in undesirable and negative side effects, which may impair the patient’s ability to complete their oncology treatment regimen, potentially reducing patient survival.
Chemotherapy-induced peripheral neuropathy is more likely to develop after intravenous infusion of epothilones, taxanes (especially paclitaxel and docetaxel), platinum-based agents (especially oxaliplatin or cisplatin) or vinca alkaloids.
A South African study investigated the correlation between exercise prescription, motor function and health-related quality of life in patients with CIPN. Exercise was associated with lowering the symptoms of CIPN and improvements in quality of life and physical well-being.
Addressing CIPN is therefore imperative as it may prevent chemotherapy dosage alterations or discontinuation, which could lead to better survival outcomes. It may also support greater participation in exercise, thereby enhancing patient quality of life, and aligns with global initiatives to integrate exercise into cancer care.
Lymphoedema is a chronic and progressive condition where an abnormal collection of protein-rich fluid in the tissues below the skin occurs because of dysfunction in the lymphatic system, which could lead to severe swelling of the affected limb or body part. Primary lymphoedema is because of a developmental deficiency, and secondary lymphoedema is acquired because of the disruption of normal lymphatic channels.
Physiotherapists are among the healthcare practitioners eligible for lymphoedema certification training. Complex Decongestive Therapy (CDT) is regarded as the gold standard for the treatment of lymphoedema. This includes a collection of treatments such as manual lymph drainage, compression therapy (including multilayered lymphoedema bandaging and compression garments), exercise, skin care and home care. Techniques aimed at reducing the volume fall under the initial (intensive) phase. The use of garments is commonly used in the long-term management of lymphoedema, known as the maintenance phase.
Medical advances have increased cancer survival rates, meaning patients are living longer with their cancer diagnoses. Dealing with the long-term sequelae of treatment-related adverse effects poses a challenging reality and may negatively affect an individual’s ability to thrive, even long after cancer treatments have ceased. Physiotherapists can, and should, play a vital role within the multidisciplinary team by helping to reduce these symptoms. Entry-level physiotherapists can effectively manage common problems like pain, limited range of motion and decreased physical fitness. More complex symptoms such as CRF, CIPN and lymphoedema require advanced physiotherapy skills and knowledge of oncology treatments. Physiotherapy is ideally suited to improve functional ability and enhance the quality of life for individuals with cancer, including those currently undergoing cancer treatments, those in remission and those receiving palliative care. Implementation of the proposed physiotherapy roles must be considered within the realities of the South African public health system, where allied health capacity is often limited. Approaches such as early integration of oncology training within physiotherapy undergraduate programmes, clinician upskilling, promoting awareness among medical clinicians, structured referral pathways and remote support may help extend the reach of physiotherapy in oncology care and warrant further investigation.
The author would like to thank Mareike Rabe, Assistant Editor of the
The author declares that no financial or personal relationships inappropriately influenced the writing of this article.
Lomé Prinsloo: Conceptualisation, Data curation, Formal analysis, Methodology, Writing – original draft. The author confirms that this work is entirely their own, has reviewed the article, approved the final version for submission and publication, and takes full responsibility for the integrity of its findings.
This article followed all ethical standards for research without direct contact with human or animal subjects.
The data that support the findings of this study are not openly available because of sensitivity and are available from the corresponding author, Lomé Prinsloo, upon reasonable request.
The views and opinions expressed in this article are those of the author and are the product of professional research. They do not necessarily reflect the official policy or position of any affiliated institution, funder, agency or that of the publisher. The author is responsible for this article’s results, findings and content.