An Evolving Role for Cancer Rehabilitation in the Era of Low‐Dose Lung Computed Tomography Screening

Abstract

Lung cancer is the number one cause of cancer-related death worldwide, and is often detected in the later stages. Use of low-dose chest computed tomography in at-risk patients provides earlier detection and is being adopted as the standard screening tool, replacing less precise methods of radiography and sputum cytology. In the past, late detection of disease meant that rehabilitation interventions attempted to salvage function and to improve aerobic capacity to the point where patients could tolerate the sometimes-extensive oncologic treatment, including lobectomy or pneumonectomy. Earlier detection may shift this toward more often addressing specific neuromusculoskeletal impairments, such as postthoracotomy pain or peripheral neuropathy, as patients with early-stage disease may not be as debilitated by chronic disease or metastases as those with late-stage lung cancer. Patients with advanced disease, however, will still require rehabilitation interventions, and this fragile population creates unique challenges. Rehabilitation professionals should look for ways to expand care to lung cancer patients, as both the number of those treated and the 5-year survival rate are expected to increase.

Prehabilitation for adults diagnosed with cancer: A systematic review of long‐term physical function, nutrition and patient‐reported outcomes

“…If we are tackling obesity in cancer and its risks, then a greater focus on adiposity, fat distribution and sarcopenia should be included in prehabilitation studies. With emerging therapies and earlier diagnosis techniques, for example of low dose computerised imaging in lung cancer (Smith, Khanna, & Wisotzky, 2017), the opportunity for prehabilitation becomes more feasible as patients are less likely to be burdened by advanced disease or chronic illness.…”

Integrating Rehabilitation Into the Cancer Care Continuum

“…In 2015, a group of subject matter experts in surgical cancer prehabilitation convened in Canada to reach consensus regarding recommendations for future research [40]. Prehabilitation is a fascinating and evolving field that, in the future, may prove to help with physical and functional outcomes, adherence to adjuvant treatment, value‐based care, and even survival [41,42].…”

Training and Practice Patterns in Cancer Rehabilitation: A Survey of Physiatrists Specializing in Oncology Care

“…As oncology‐directed treatment modalities advance, overall survivorship is expected to continue to increase, with number of survivors expected to exceed 20 million by 2026 . As these survival rates continue to increase, it is important for all clinicians to not only be aware of potential impairments that may arise as a direct result of a tumor or its oncologic management, but to understand how to apply rehabilitation principles to this population . This topic is of great interest to physiatrists in general, as the majority of them are regularly caring for cancer survivors who often have problems related to oncology‐directed treatment (eg, shoulder adhesive capsulitis in patients with a history of breast, lung, or head and neck cancer) .…”