4 stages of cancer treatment and what they mean

Published 8:28 pm Friday, March 3, 2017

My father recently was diagnosed with cancer. Again. He had a meningioma 10 years ago and had a recurrence two years ago. When having a routine follow-up scan for the meningioma, the doctor found lymphoma. So cancer care has been in the forefront of my mind, especially for the past year as he went through treatment and now is on maintenance therapy for lymphoma. I have done quite a bit of research in the past year and have decided that it is no coincidence that I am a physical therapist … and that I am a certified lymphedema therapist. I have learned so much about the treatment of cancer, and I am convinced more than ever that there is even more hope at each stage of cancer and the treatment of cancer.

There are basically four stages of cancer treatment. These stages were identified in the literature in the late 1980s, and they are the preventative phase, the restorative phase, the supportive phase and the palliative phase. Prior to my lymphedema certification, I believed (as so many do) that there was not much we could do as physical, occupational and speech therapists until after treatment has completed. We were so wrong.

In the preventative phase, we can focus on general wellness and healthy habits. We focus on maintaining a healthy weight, eating the right foods and exercising regularly. We recommend that people stop behaviors considered to place them at a higher risk, including smoking. These are great recommendations for all of us. Unfortunately, for many, the cancer diagnosis is the point at which we come to the realization that we have to make a significant lifestyle change as our focus changes from prevention to restoration.

In the restorative phase, we are focused on restoring loss of function. Before surgery, before treatment, it is a great time to begin to build strength and endurance to better tolerate the process of cancer treatment. There is an excellent program in our community called Exercise is Medicine. It is offered through Vidant Wellness Center and is a great “bridge” from inactive to active. It’s led by an exercise physiologist and gives a person the opportunity to change his at-risk behaviors and make lifestyle changes even after the cancer diagnosis. It is truly never too late. Physical therapy and wellness partner in this effort. Some people may need more individualized assessment and treatment that is more appropriate to be performed by a physical therapist. Some patients need speech therapy to evaluate for swallowing issues that arise with some head and neck cancers. Some people may be at a higher level of function and need only the guidance of an exercise physiologist. We all work together to determine the appropriate need and level of the patients, so that they get what they need. We work to restore function, whatever that is. It may be managing fatigue, or it may be improving strength and endurance to return to work. It really is what the patient needs.

In the supportive phase, the patient has many times completed treatment and is ready to resume a normal life again! There is not a clear line between restorative and supportive. I feel like we move back and forth from restorative to supportive as a patient moves through treatment and begins to move through survivorship. There is some controversy over when survivorship begins. Regardless of whether it is at diagnosis or at cure, the patient has needs for support after active treatment ends. Some patients may struggle with “what now?” once they get through their treatments. Life continues on. And there is hope for so many!

In the palliative phase, the therapist is working to identify what is needed for the patient to participate and to allow an optimal level of activity. This phase can be continued through the end of life, if that is the direction of care. This level of care for a therapist can focus on the patient’s ability, but also on the family’s ability to manage the patient. I have taught family members proper body mechanics to reduce injury and massage techniques for comfort.

There is a need for rehabilitation services at all levels of cancer care. If you are wanting to work on prevention, or if you are in the active stages of treatment, physical therapy and speech therapy have something to offer. We are here to help improve the lives of the people in our community. I want to provide the highest level of care and to make a difference in the lives of the people I live with, work with and care for.

Maria Stalls, PT, CLT, MBA, is manager of the physical therapy and of rehab services at Vidant Beaufort Hospital of Washington and can be reached at 252-975-4292.