BARRIERS FACED BY PHYSIOTHERAPISTS IN THE TREATMENT OF POST-SURGICAL CANCER PATIENTS: AN OBSERVATIONAL STUDY

The term cancer refers to the abnormal growth of cells in our body, which can be local or not spread throughout rest part of other parts.(1) Cancer is not a single disease but a family of diseases and it can strike nearly any organ in the simplest sense cancer is a genetic disease where genes direct the function of our cells sometimes mutations to those genes will cause cells to malfunction or to grow or divide when they should not -or fail to die when they should, so these abnormal cells are capable of becoming cancer.(2)

Apoptosis resistance is a phenomenon taking part in the development of human cancers.(3)Cancer: One of the diseases that we had largely feared in the 20th century and more so now i.e. into second decade of 21st, even higher numbers being diagnosed with all continuance. In India, over 11 lakh new cases of cancer are recorded every year on the other hand in worldwide this figure is more than 14 million.(4)

Advanced cancer is also one of the matter of concern nowadays. Advanced cancer is a catchall term that can mean many things. It is often used by health care providers for cancer that cannot easily be cured. However, some advanced cancers are controllable for years with treatment and sometimes curable. Those that are untreatable are often referred to as end-stage cancer or terminal cancer. Advanced cancer may also refer to cancers that have spread to nearby tissues or other parts of the body.(5)

Certainly you can only understand this disease by understanding what causes genetic alteration in cells the other by on cancer statistics cancer statistics enable researchers to assess the societal impact of cancer statistics can bestow all the factual information such as how many people are diagnosed with and die of cancer each year and how many people are still alive after a diagnosis of cancer the progress scientists are looking for can be determined from changes of statistics over times.(2)

Coronaviruses are a highly diverse group of viruses dealing with human and animal species. Four most traditional coronaviruses result in usual symptom that is common cold, while others can trigger more severe health problems. A fresh strain has spread among people and kicked off a worldwide outbreak of respiratory illness. Researchers refer to this virus as SARS-CoV-2, and they call the sickness it causes coronavirus disease 2019, or COVID-19 for short. The spread of COVID-19 challenged human existence worldwide, and challenges presented by the disease may be tougher for cancer patients than for other patients and their families. Most of the patients would likely have various questions concerning COVID-19, and with this, likely public health emergency in general and their personal cancer treatment and normal lifestyle in particular.(6)

In the United States, the number of cancer survivors continues to rise due, chiefly, to the cumulative effects of a large and aging population and the increasing probability of surviving cancer due to advancing surveillance and treatment. Many cancer survivors must contend with the sequelae of cancer and cancer treatment in the physical realm which can result in functional impairment, cognitive impairment, and other psychological and economic sequelae. To assist the public health community to understand how best to serve this population, the American Cancer Society collaborates with the National Cancer Institute every three years to provide an estimate of full cancer prevalence in the United States, for all cancers and the most common cancers in the current year.(7)

Globally, cancer ranks among the top two causes of mortality in adults. The International Agency for Research on Cancer (IARC) estimated that around 635,000 people died of cancer in India in 2008, indirectly suggesting that this represents roughly 8% of the total of 7.6 million cancer deaths globally and approximately 6% of all deaths in India. Due to an increasing population and longer life expectancies, the absolute number of deaths from cancer in India is projected to increase, and death rates from cancer will also rise, as increase in age-specific cancer risks, especially risks from tobacco smoking will increase incidence for several cancers. India has a significant cultural diversity and significant differences from region to region, as well as urban/rural differences, in lifestyles, as well as in age-specific adult death rates. Therefore, it is essential to understand the geographic and social distribution of specific cancers in order to better structure cancer-related programs and initiate additional research into the causes of cancer.(8)

The word complication is often used by health care professional to refer to something that was ’unanticipated’ to have occurred. Post-operative complications are simply something that happened after your operation, despite the fact that you were not intended. Your doctor will recognize the risk of complication and has taken steps, before, during and after your operation, to reduce that risk of complication. As a result, while a complication may be common, the preemptive steps taken by your doctor to reduce that risk of complication may still mean that the circumstances of having the operation were reasonable. Some post-operative complications may relate to the surgery that occurred, while many post-operative complication, such as wound infection, could occur after any type of surgery.(9)

In spite of all the advancement in the early detection and management of cancer, improvement in the area of Cancer Pain management is often too limited. Cancer Pain continues to remain significant problem that impacts quality of life. Cancer pain often is complex and multi-dimensional in nature. It is comprised of physical, psychosocial, emotional, and spiritual aspects. Cancer pain may be caused by tumor involvement, evaluation and treatment intervention, or the effect or toxicity of cancer treatment. The issue of effective cancer pain management is still an issue facing us today. Practitioners often lack knowledge surrounding assessment and management of cancer pain.(10–14)

Individuals are at risk for infection but especially, cancer patients during chemotherapy or radiation therapy, Cancer patients have a number of different risk factors for infection including immune deficiencies, disease or organ dysfunction, concomitant illness or past infections, nutritional status, stressing events psychological stress, surgery, and other diagnostic or invasive procedures.(15)Infections in cancer patients are typically bacterial in nature, (for example, bacterial pneumonias). The severity of bacterial pneumonia depends on the underlying immune system deficit, the duration of the immune-compromised state, whether the infection was community-acquired or hospital-acquired, and the pathogen.(16) Cancer patients may experience pulmonary complications that are not associated with infection. These complications may be the result of the primary malignancy, metastasis, or treatment.(17)Metastatic disease is that complication of cancer when cancer cells have spread to a distant site or adjacent structure. Hematogenous, lymphatic, or direct invasion can lead to metastasis in the lungs. The lungs are the second most common site for metastasis.(18)

There exists a significant body of literature that supports the safety and appropriateness of physical exercise prior to, during and following active treatment. When embarking on exercise program, it is important to communicate to a doctor and medical team before intervention.(19–21)Physiotherapy primarily focuses on recovering from surgery by alleviating or otherwise avoiding addressing or preventing surgery and aiding patients in returning to pre-morbid levels of function. Even through physiotherapy focuses on physical rehabilitation, it may also influence other domains.(22)The American Cancer Society (ACS), American Society of Clinical Oncology (ASCO), and American College of Sports Medicine (ACSM) have all made recommendations for physical activity for cancer survivors after diagnosis which also take into consideration improvements in managing several common side effects and conditions, including fatigue and pain. The recommendations with the most agreement among collaborating organizations (ACS, ASCO, and ACSM) is that all patients should avoid being inactive and return to their usual daily routines as quickly as possible after diagnosis, engage in at least 150 minutes of moderate or 75 minutes vigorous aerobic exercise daily and two days each week of resistance-training exercise.(23,24)To improve flexibility the major muscle groups and tendons should be stretched on days when other types of activity are undertaken. Older adults also benefit from including balance exercises to maintain or improve balance performance.(25)

During and immediately after treatment (e.g., surgery, chemotherapy, and physical therapy) patients and many clinicians will state they feel unwell and are unable to engage in or perform regular activities not because of the action of exercise or engagement in other activities, but as a direct result of each treatment. Engaging in regular physical activity can address many both the physical and psychological conditions that patients often report: fatigue, feeling low in mood and stress, and an overall decreasing levels of conditioning/independence. There are also specific programs that provide benefit for a patient to engage in after treatment including post-surgical as well as lymphedema management. Additionally, there are benefits of exercise by helping to maintain healthy body weight, decreasing platelet adhesiveness (anti-thrombotic effect), improving endothelial function, increasing HDL cholesterol, decreasing risk of NIDDM, and decreasing risk of other disease: heart disease, diabetes, osteoporosis and hypertension.(26)

There is increasing evidence to suggest that physiotherapists play a role in the treatment of cancer patients by focusing on various aspects such as prevention through exercise to reduce the risk of cancer (especially colon and post-menopausal breast cancer). The link between obesity and the occurrence of types of cancer is well established (as fatty tissue provides a favorable environment for tumors). In situations physiotherapists can participate in preoperative assessments and support patients in their recovery, after surgery. Learning about how to prevent lymphedema and manage wounds through stretching and massage techniques while transitioning back, to work and engaging in physical activities. Rehabilitation after surgery often involves a focus, on recommending specific exercises to support recovery.(27)

Physiotherapists are crucial in enhancing care by focusing on improving quality of life and overall well being through physical and functional aspects of treatment within an interdisciplinary framework Study reveals positive outcomes of utilizing identified palliative care beds for pain management and psychological support, in a private provincial hospitals medical oncology department.(28) Experts performed an analysis using the AGREE II (Appraisal of Guidelines for Research and Evaluation) tool highlighting the crucial involvement of healthcare providers in assisting individuals with cancer at every stage of their illness journey The study recommended physical activity, for patients (70%) whether they have breast cancer or other forms of cancer emphasizing not just on rehab exercises but also on managing symptoms and providing care to survivors.(29)The research results discuss how patients perceive and appreciate physiotherapy in care and its importance to both patients and families as well, as physiotherapists themselves.(30)

Rehabilitation in relation to cancer can be of different natures such as prevention, restoration, support and palliation. Cancer patients referred for re habilitation services seem to have poor physical performance as compared with patients in control group. Thorsen et al. found that 63% of recruited cancer survivors reported a need for at least one rehabilitative service, most often physical therapy (43% need), while 40% reported that these needs were unaddressed. Some of the patients did not receive physiotherapy intervention prior to the commencement of the treatment for cancer and perhaps had seen the physiotherapist after surgery.(31)

In India, the scope of the physiotherapist’s practice has included assistance with respiratory, neurologic, lymphatic, orthopedic, musculoskeletal, hematologic conditions and impairment. Physiotherapy may involve many techniques- therapeutic exercise, active or passive mobilization, graded and constructive activity, relaxation and distraction, re-education of posture and position, transfer and movement, TENS, heat or cold application and massage.

In terms of lifetime care, cancer patients are the most underserved because they make up 51% of deaths in hospice and palliative care units, in which rehabilitation treatment modalities include transfer and mobility training, caregiver education, pain therapy and assistive devices to enhance and sustain the level of function.(32,33)Moderate aerobic exercise training is generally well tolerated by almost all the individuals and enhances physiology, psychology, as well as functional aspects themselves, upon doing it with a steady frequency. After a project aimed specifically at the recurrence rate, it was found that a 12-week exercise project is useful for alleviating fatigue and raising blood pressure, insomnia, physical abilities, and overall musculoskeletal problems, mental well-being and social support and level of activity in cancer survivors.(32,34,35)In India, referrals made by doctors who understand what physiotherapists do in cancer rehabilitation will help the patient receive care in a timely manner and regain function. It is equally important to point out that even patients themselves can raise the issue to the physicians’ attention claiming their referral for physiotherapy assisting in achieving an earlier outcome.(32,36)

The purpose of the present study therefore is to investigate the barriers faced by physiotherapists in the treatment of post-surgical cancer patients which will lead to better results and how to overcome them by various recent advances.