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Margaret McNeely

Story…  61-year-old gentleman with oropharyngeal cancer, treated with surgery and radiation therapy.

“The surgery and radiation therapy were very important…it was important for them to remove the cancer.  However, I thought I was never going recover, ever be the same again… treating the cancer is only half the battle; the recovery is where it is all about.

It has been this rehab program that has made all the difference for me. I am really back to the way I was…my physical being, my shoulders, arms and neck.  I feel great and it is strictly because of this rigorous (rehabilitation) program that has been so well thought out… through the stages of treatment and recovery.”


Who is affected by cancer?

Two in five Canadians will develop cancer in their lifetime.1

The risk of cancer increases dramatically with age, and the population is aging. Thus, we are seeing growing numbers of Canadians being diagnosed with cancer, while at the same time overall survival rates are improving.1

While cancer more commonly occurs in older adults, it can occur at any age. Recent attention has been paid to the need for surveillance of late effects in survivors of childhood cancers2, as well as the distinct survivorship issues of adolescents and young adults with cancer, a group that typically is not well served by either pediatric or adult oncology practices.3


What is the problem?

The Canadian Partnership Against Cancer published a document titled “Living with Cancer: A Report on the Patient Experience”.4 In the report, cancer survivors shared their experiences dealing with the physical and emotional effects of cancer and its treatment, and highlighted the lack of support and services to address their needs.

The consequences of cancer and cancer treatment include physical impairments such as cancer-related fatigue, peripheral neuropathy, lymphedema, dyspnea and incontinence; and the needs of survivors are often complex.5 This can be reflected in survivors changing or having to give up their employment and recreational activities.


How can physical therapy help?

Cancer rehabilitation extends beyond exercise and physical activity promotion. Interventions span the full spectrum of physical therapy fields including musculoskeletal, neurological, cardiopulmonary and chronic pain. Research evidence supports the benefit of physical therapy specialist care to prevent, minimize, and remediate many of the physical impairments experienced by survivors.6 To date, a lot of this evidence has been generated in Canada. Thus, the findings are relevant to our healthcare system and practice settings.


How can we meet this emerging need?

We have the opportunity, as physical therapists to promote the value of our profession in cancer rehabilitation and survivorship. Importantly, we have the skills to help survivors recover from cancer treatments, and to optimize their function and independence, and can play a major role in the care of survivors from diagnosis, through treatment, to end of life.

Before we can advocate for increased services, however, we need to ensure we are prepared to meet the needs of the growing number of cancer survivors.


Steps in preparation…

Increase our capacity to serve cancer survivors: More physical therapists with oncology knowledge and skills are needed within both public and private systems; physical therapists who are able to deliver quality, evidence-based care to survivors.

To this end, the Oncology Division is placing “education” as a priority over the next few years. Our plans are to:   

  1. Examine the content of oncology in the professional programs across the country, with the goal to advocate for enhanced content within the physical therapy curriculum. 
  2. Work with the CPA to inform core competencies in oncology physical therapy.
  3. Offer courses that aim to strategically develop core competencies in oncology physical therapy.

Partner with Survivor organizations such as the Canadian Cancer Survivorship Network, Brain Tumour Foundation of Canada, Breast Cancer Support Services, Canadian Lymphedema Framework, and Prostate Cancer Canada – organizations that can help promote physiotherapy as a means to provide quality care, support and follow-up to optimize outcomes of survivors with cancer.

Work with Researchers to support the generation of new knowledge, especially to further evaluate rehabilitation models of care, self-management strategies and methods to build capacity for cancer rehabilitation service delivery in the community. Moreover, knowledge translation efforts are needed to disseminate research findings to key stakeholders, survivor organizations, and clinicians.

Identify and recruit champions who can help us to educate others, advocate for our involvement in cancer care, and build relationships with decision-makers. To make change happen, we need to be at the decision table, be intentional about our involvement with site and provincial tumour teams, the creation of clinical practice guidelines, care pathways and teams, and survivor and family education.

By providing excellent care and improving health outcomes, survivors themselves will be our greatest advocates. 



1. Canadian Cancer Society. Canadian Cancer Statistics Toronto, Canada.2018.

2. Langer T, Grabow D, Steinmann D, et al. Late Effects and Long-Term Follow-Up after Cancer in Childhood. Oncol Res Treat 2017;40:746-750.

3. Shay LA, Parsons HM, Vernon SW. Survivorship Care Planning and Unmet Information and Service Needs Among Adolescent and Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2017;6:327-332.

4. Canadian Partnership Against Cancer. Living with Cancer: A Report on the Patient Experience, 2018.

5. Silver JK, Baima J, Mayer RS. Impairment-driven cancer rehabilitation: an essential component of quality care and survivorship. CA Cancer J Clin 2013;63:295-317.

6. Silver JK, Baima J, Newman R, et al. Cancer rehabilitation may improve function in survivors and decrease the economic burden of cancer to individuals and society. Work 2013;46:455-72.


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It seems that the program curriculum in Canadian universities faces significant, mounting pressure by a variety stakeholders to evolve to address current challenges in health care delivery.  Pain management, whether in the cancer or non-cancer population, requires a pain education component in the PT program that better addresses this and must become a primary focus of reformation in the physiotherapy profession.  Program leaders recently provided some consensus in pain education delivery, the results indicating disparate approaches and time allotment across the country.  Using pain education as an example of how information leads to change in practice, perhaps it is worth considering this as a prelude and prerquisite to training students and clinicians in working with cancer patients since pain is a common symptom across many individuals seeking resolution or temporary respite.  The psychological and sociological perspectives of pain and disability must become part of the way physios handle health care routinely.



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