Physiotherapy treatment of Cancer

Role of physiotherapy in cancer 

Definition

Caner is defined as a group of disorder characterized by uncontrolled growth and spread of abnormal cells resulting in imbalance in the tissue growth control mechanism and increase in the total number of cells

Physiotherapy Aims of Treatment

·        Promote relaxation

·        To provide moral and psychological support

·        To promote social interaction (group therapy)

·        To maintain and improve mobility

·        To relive pain

·        To improve cardiovascular endurance

·        To improve strength and flexibility of muscles

·        To improve skin care

·        To improve posture and gait patter

·        To make the patient ambulatory and functionally independent

Means of Physiotherapy Management

 1. Relaxation

·        Use of pillow support

·        Various relaxation techniques are taught

·        Yoga (savasana)

·        Breathing exercises

·        Moral and psychological support

·        Proper positioning of the patient

2. Improve pulmonary function

·        Breathing exercises

Ø Deep breathing

Ø Diaphragmatic breathing

Ø Pursed-lip breathing

Ø Segmental breathing

·        Chest mobility

·        Clear airway secretions

Ø Cuffing and huffing

Ø ACBT

Ø Incentive spirometry

Ø Postural drainage

Ø Suctioning

·        Bronchial hygiene techniques

3. To improve techniques

·        To prevent lymphedema

Ø Elevation of limb on a pillow by 300

Ø Pneumatic pressure pump

Ø Elastic stockings and bandages

Ø Massage techniques

Ø Active movements of distal joints

Ø Avoid dependent positioning

·        Protective skin care

Ø Avoid use of allergens, detergents or chemicals

Ø Avoid carcinogenic substances

Ø Cleaning of wound with antiseptics and antibiotics

 4. Pain management

a. Bone pain is not treated by physiotherapist. Therefore for management pharmacology is indicated

b. Pain from other organs are reduced by physical and electrical modalities

c. During chemotherapy, the application of physical modalities improves blood flow and increases delivery of drugs to the tumor site. Physical modalities and heat therapy are contraindicated directly over the tumor

d. Acute pain is treated by heat and cold therapy and TENS

e. TENS (Transcutaneous electrical nerve stimulation)

High TENS

·        For acute pain

·        Frequency: 100-150 Hz

·        Intensity: less than 30 mA

·        Pulse width: 100 us

·        Mechanism: It causes stimulation of impulses which are carried by large afferent (A delta and C) nerve fibers leading to pre-synaptic inhibition of pain transmission at substantia gelatinosa cells of Rolando in the pain gait.

Low TENS

·        Frequency: 2-5 Hz

·        Intensity: more than 30 mA

·        Pulse width: 100 us

·        Mechanism: Nociceptive pain impulses are carried to the cerebrum by spinothalamic tract. Low TENS application causes interaction between preaqueductal grey matter (PAG) and Raphe nucleus to release endorphin and encephalin which blocks the forward transmission of pain impulses.

f. Massage

·        Manual massage techniques produces relaxation, reduces pain and relieves anxiety

·        Petrissage and efflurage are used

g. Relaxation techniques and positioning

5. Exercises in cancer patient

i. Aim: The main aim of exercises in cancer patients is to improve and maintain CVS endurance and joint mobility

ii. Diet management

·        The patient usually complains of weakness, malaise, fatigue due to loss of appetite

·        Nutritious diet is given

·        Small amount of frequent meals are given

·        Heavy diet is not allowed

·        Fluid and nutrition balance

iii. Exercises to improve CVS endurance

·        Aerobic training is started by keeping the rate, mode, frequency, intensity, duration into consideration

·        Interval training is beneficial for debilitated patients

·        Breathing techniques are taught to relieve dyspnea and improve exercise tolerance (pursed-lip breathing, diaphragmatic breathing)

·        The exercise program consists of:

Ø Warm-up phase

Ø Aerobic training (low intensity exercises like walking, cycling, jogging, swimming)

Ø Cool down phase

- Circuit interval training can also be given.

- Enough “rest intervals” should be given to prevent fatigue and tiredness.

iv. Exercises to improve strength

·        It should be given only when the vital signs are normal

·        Start with assisted-resisted exercises followed by progressive resisted training

·        Initially, start with 10 RM exercises using weights, pulleys, springs, dumbbells

·        Application of oxford techniques, DeLorme techniques or McQueen techniques are used

·        Moderate intensity exercises are done with a duration of 45 mins 1hr to prevent fatigue 

v. Exercises to improve flexibility and ROM

·        Active and free exercises to upper and lower limb

·        Reaching out activities

·        Trunk mobility and chest mobility exercises

·        Stretching activities and splints to prevent contractures

·        Shoulder wheels exercises, overhead pulley exercises, upper arm ergometry, quadriceps table can be given

vi. Mental and psychological support

·        Approach the patient in a calm and caring way

·        Relaxation techniques

·        Breathing exercise and yoga

·        Gain the patient confidence

·        Meditation techniques

·        Parental counseling and education is also important

·        Encourage group and social activities

vii. Effects of exercises of body

a. On CVS

·        Improve cardiac output

·        Maintain heart rate and BP regulation

·        Improves blood circulation to all the parts of body

·        Reduces the risk of thromboembolism 

b. On respiratory system

·        Increases lung volume and lung capacities

·        Maintains respiratory rate

·        Relieves dyspnea and fatigue

·        Improves thoracic expansion

·        Improves strength of respiratory muscles

·        Prevent collapse and atelectasis

c. On nervous system

·        Relieves pain

·        Induces relaxation

·        Relieves insomnia

·        Decreases anxiety and concentration

d. On digestive system

·        Increases appetite

·        Prevents constipation and other gastric problems

·        Promotes intestinal movement and faster removal of bowels

e. Self confidence and esteem