Survivors of cancers involving neurological and musculoskeletal systems may be left with very significant physical and functional daily living problems at the conclusion of their cancer treatment.
Individual professionals working in rehabilitation teams can bring their skills to bear, to improve these cancer survivors’ ability to return to living as independently as possible in ordinary daily life. The outcomes of rehabilitation can be measured with standard assessment tools, including Barthel and Functional Independence Measures (FIMTM), which are being built into standard subacute casemix funding algorithms in Australia.
There are no randomised control studies of rehabilitation and restorative care provided to survivors of neurological and musculoskeletal cancers. Observational studies however provide level III evidence for the efficacy of rehabilitation programs in improving residual functional disability left in people after acute treatment of brain, spinal and bony tumours. Indeed, survivors with disability arising from these tumours can expect a response to multidisciplinary rehabilitation therapy that is entirely comparable with that seen in individuals with “benign” lesions in similar anatomical locations, as in strokes, fractures or brain or spinal trauma, for example.
One problem requiring particular attention is in restoring social mobility and participation, for return to safe driving of a motor vehicle after treatment of a brain tumour. As we all know, learning independent and safe driving is an important social rite of passage into adult life for most people, especially here in Australia, and restoration of this ability is a central concern for most brain tumour survivors. The multi-disciplinary program usually involves medical, visual and psychological review as well as occupational therapy assessment of the survivor’s skills and abilities in off-road and on-road settings.
In summary, there is absolutely no place for therapeutic nihilism in the presence of physical disability in survivors of neurological and bony tumours, any more than there is in the presence of similar disability due to “benign” illnesses.