Rehabilitation Strategy Points of Management in Thoracic Malignancy
Nury Nusdwinuringtyas
Pulmonary Rehabilitation Division, Department of Physical Medicine & Rehabilitation, Cipto Mangunkusumo Hospital, Jakarta
ABSTRACT
Rehabilitation has been described as the restoration of a patient to a person. The aim of rehabilitation with its holistic approach according to the World Health Organization is not only to train disabled and handicapped person to adopt environment and society as a whole, but also to facilitate the social integration where to live and they should be in the mainstream of community level.
Types of cancer rehabilitation, includes preventive, supportive, and palliative aspects. The goal of preventive rehabilitation therapy is to achieve maximal function considered to be cured or in remission. The goals of supportive rehabilitation therapy include providing adaptive self-care equipment in an attempt to offset what can be a steady decline in the patient’s functional skills. Palliative rehabilitation therapy goals are to improve or maintain comfort and function during the terminal stage of the disease. Palliative care rehabilitation at its best is the transformation of the dying into the living.
Patients with thoracic malignancies mostly suffer from respiratory symptoms (i.e. dyspnea) and pain. The World Health Organization estimates that 25% of all cancer patients die with unrelieved pain. Up to 60% of patients at all stages of the disease process experience significant pain. Most of this pain can be adequately relieved by analgesics. Cancer pain is managed by using opioid agonists and adjuvant drugs (i.e. antidepressants, anticonvulsants, benzodiazepines, neuroleptics, psychostimulants, antihistamines, corticosteroids, and calcitonin) which are chosen to supplement analgesics for their specific secondary effects or to treat side effects.
In addition to pain, the most common problems being dealt by patients with thoracic malignancies are dyspnea, excessive mucus secretion, and persistent cough. Weakness, lack of activity, and an inability to swallow saliva lead to chest infections, and these, aggravated by the inability to cough, and clear mucus, are distressing for patients and caregivers alike. To relief those symptoms, many approaches can be done including breathing exercise, postural drainage, inhalations, humidifiers, and nebulizers.
Dyspnea creates anxiety, and anxiety creates dyspnea. Breaking the cycle by a management strategy is necessary if any relief is to be provided. Patient can be taught to extend their activity range significantly if they follow a simple system involving breathing control, relaxation, organizing their activity into short periods with rest at regular intervals.
It is possible that oxygen supplementation could improve function in patients with cancer dyspnea, but such studies have not been conducted. The main objective of oxygen therapy in advanced cancer patients is symptomatic relief rather than prevention of long term complications; therefore, intermittent use can be acceptable and less psychologically burdensome in patients who present with intermittent exacerbation of dyspnea. Pulse oximetry is used to measure oxygen saturation, which will determine the effect of supplemental oxygen for patients with dyspnea.
