CANCER REHABILITATION: PHYSIOTHERAPY IN CLINICAL PRACTICE REHABILITATION FOR HEMATOPOIETIC STEM CELL TRANSPLANTATION PATIENTS AND ESOPHAGEAL CANCER PATIENTS

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Abstract

In cancer rehabilitation, it is necessary to consider the types, regions, stages, and treatments of cancer because not only cancer itself causes deconditioning and dysfunctions but also the treatments of cancer appropriate for the types, regions, and stages, such as operation, chemotherapy, and radiation therapy do in association with various complications. Moreover, the rehabilitation in the pre-treatment phase is considered to be effective to prevent the complications and dysfunctions which would appear in the post-treatment. Furthermore, it is indispensable to approach to the exacerbation of dysfunctions and the secondary disorders following the progression of cancer. That is, the rehabilitation should be carried out according to each phase in Dietz's classification; preventive, restorative, supportive, and palliative phases.

We introduce two examples of preventive cancer rehabilitation positively carried out in Kobe University Hospital, the clinical practices to prevent deconditioning in patients undergoing hematopoietic stem cell transplantation (HSCT) and the intensive respiratory rehabilitation to prevent the postoperative pulmonary complications (PPCs) in patients undergoing esophagectomy.

For HSCT patients, the exercise, such as strength training, walking, and ergometer is carried out to increase the physical activity level and to prevent deconditioning in the bioclean room. The physical activity level is monitored with a pedometer from the preventive phase of pre-transplant to the restorative phase of post-transplant. In our previous studies, the HSCT patients who kept the higher degree of physical activity through positive rehabilitation might favorably shorten the length of hospital stay after HSCT and maintain the higher level of quality of life.

For esophageal cancer patients, the comprehensive respiratory rehabilitation is carried out from the preoperative to the perioperative and postoperative phases to reduce PPCs and to shorten the postoperative length of hospital stay. In the preoperative phase, the intensive respiratory rehabilitation such as abdominal respiration, incentive spirometer, strength training, and ergometer is carried out. In perioperative and postoperative phases, the respiratory rehabilitation, early mobilization, and fitness training is carried out. In our study, the intensive preoperative respiratory rehabilitation could reduce the incidence of PPCs in esophageal cancer patients who underwent esophagectomy.

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