An increasing number of patients are living with or surviving cancer due to improvements in detection and treatment. However, patients who survive cancer may experience functional disabilities that impact on health, quality of life and ability to work. For example, physical disorders may include fatigue, reduced muscle strength, cognitive dysfunction, paresthesia or nutrition problems, while mental symptoms may include anxiety, depression, fear of relapse or insomnia. Multidimensional oncological rehabilitation programs have been developed to address these disabilities and to help cancer patients and long-term survivors to reduce morbidity and to improve quality of life. There has been evidence showing that multidisciplinary oncological rehabilitation interventions involving physical, psycho-educational and vocational components led to a better quality of life and a higher rate of return to work than just usual care. In Germany, oncological rehabilitation is an integral part of the healthcare system and part of a modern cancer treatment that immediately follows operation, medical treatment or radiotherapy. Furthermore, it can be used if functional disabilities still remain years after cancer treatment. This review describes the German history and legal basis of oncological rehabilitation as well as the contents of and the evidence for this comprehensive and interdisciplinary treatment.
The prognosis of cancer patients is constantly improving, which increases the importance of securing long-term quality of life. While therapy of treatment-related disability mostly succeeds a cancer-specific treatment, physicians' awareness of simultaneous supportive therapy is rising. Early interventions such as physical exercise during chemotherapy are effective in reducing conditions such as fatigue. Specific sensorimotor training is able to improve or even prevent impairment of balance caused by neurotoxic agents. Although targeted therapies reduce the risk of side effects, combinations with established drugs have to be monitored with regard to cardiotoxicity, which is already a concern in children's cancer therapy and is now also focused on in long-term adult survivors. Improvement in diagnosis und surgical procedures have reduced impairments such as lymphedema. Furthermore, management and quality of life of breast cancer patients benefit from evidence showing that physical exercise and resistance training do not increase the risk of developing lymphedema.
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