While physical therapy (PT) is more commonly thought of in relation to athletics or orthopedics, PT plays an essential part in the recovery from cancer treatment. Prehabilitation (prehab), is any type of rehabilitation before a specific event. At Roswell Park Comprehensive Cancer Center, this is typically done before surgery or chemotherapy to improve outcomes after procedures.
Here to discuss the benefits physical therapy services can provide a cancer patient, is Bryan Wittmeyer, MS, PT. He is the Director, Rehabilitation Therapy and Wellness Services at Roswell Park Comprehensive Cancer Center.
Selected Podcast
The Benefits of Physical Therapy During Cancer Care
Featured Speaker:
Bryan Wittmeyer, MS, PT
Bryan Wittmeyer, MS, PT is the Director, Rehabilitation Therapy and Wellness Services with Roswell Park Comprehensive Cancer Center. Transcription:
The Benefits of Physical Therapy During Cancer Care
Bill Klaproth (Host): Physical therapy is often required after cancer treatment, and the physical therapy staff at Roswell Park Cancer Institute offers a number of different services depending on the type of cancer being treated and a patients’ own individual needs. Here to talk with us about physical therapy and cancer, is Bryan Wittmeyer, Director of Rehabilitation Therapy and Wellness Services at Roswell Park Comprehensive Cancer Center. Bryan, thank you so much, for your time today. So when is physical therapy following cancer treatment necessary?
Bryan Wittmeyer (Guest): Well, physical therapy treatment following any sort of cancer treatment is necessary if a patient is dealing with a host of symptoms that could come either from the diagnosis itself or the associated treatments after the fact. A lot of the different symptoms that we will see here that patients will often report to their physician are pain, loss of mobility or range of motion, weakness, fatigue, loss of endurance, and even just difficulty with their day-to-day activities.
Bill: And what types of exercises are necessary then, following different types of treatment?
Bryan: Well, it’s very individualized to the individual patient, to be honest with you. Every patient who comes in for their first visit with us will be evaluated by one of our specially trained physical therapists who is trained to deal with a cancer diagnosis and the associated treatment. Based on that evaluation, it could be a host of different treatments, whether it’s manual therapy from our therapists itself, whether it’s strengthening exercises, endurance exercises. There are even different exercises and different programs that we may develop to help with fatigue or cognitive issues. Our actual occupational therapy staff who also see patients in the outpatient setting office deal with that. It’s very individualized programs dependent on the patient’s needs and tailored to their individual needs, and then progressed along so that we can get them back to whatever their goals are following their treatment with us.
Bill: Right, very important. Physical therapy is important for pain, regular function, what else? Why is physical therapy important then?
Bryan: Well, a big thing that we find is during the acute stage of cancer, patients are really dealing with that. They’re looking at their overall health and just basically trying to cure their cancer. After the fact, they have secondary issues again, whether it’s pain, whether its weakness, loss of motion, and initially, sometimes they feel that that’s just normal to feel and that’s just part of the deal, to be honest with you. What we want to let those patients know is that our physical therapists can do an evaluation of the patient and they can address a lot of those symptoms in a way that can improve their quality of life for the long-term.
Bill: Well, that makes sense. What technology is offered by Roswell Park Comprehensive Cancer Center?
Bryan: Well, what is nice about the timing of this interview is we actually just opened our brand new Rehabilitation Services Clinic about a week and a half ago – actually, on the 25th of September. We have all new exercise equipment ranging from treadmills, ellipticals, stationary bikes, we’ve got a fusion system that incorporates different strengthening exercises, and we actually even have a very state-of-the-art system – it’s called the Safe Gate, which is an overhead, mounted-to-the-ceiling, tracking unit that, with a harness – we can get the patients into the harness and we can do mobility exercises with them. For some of our lower-functioning patients, it may just be ambulating by taking off some of their body weight and allowing them to do things that they would not normally be able to do without the assistance of this device. And for some of our higher-functioning patients, we get them doing balancing exercises, strengthening exercises, unilateral exercises on one leg to get them to practice different activities that they might need to do in their daily routine and in the future. That is brand new technology that we have never had here before, and we’ve been happy to start utilizing on some of our patients already.
Bill: So Bryan, let’s talk about what a patient should expect before and after. Let’s talk about before. Can you tell us what pre-habilitation is and who a good candidate for prehab is?
Bryan: Sure, prehabilitation is somewhat a newer concept in the world of rehabilitation and especially in oncology rehabilitation. Really, what prehab is it’s doing an assessment of a patients’ functional status, strength, endurance, and other factors that will lead to how well they do immediately following a procedure – whether it’s a surgical procedure, whether it’s chemotherapy, whether it’s radiation therapy. Based on that assessment, if we find that a patient has weakness or difficulty with functional activities – we start them on a program to improve those things before they start their acute care treatment.
What the research has shown is that by improving strength, improving function, improving endurance, the outcomes after these procedures are often much better whether it’s the length of stay in the hospital, whether it’s their functional abilities immediately following a procedure or down the road. We have started different programs here with patients in our urology service and our thoracic service. We’ve been doing it for a long time with our bone marrow transplant patients, where we do a screening, and if we find some of those patients are deconditioned or weak, we get them on an exercise program that we supervise throughout the clinic, and we’ve seen some really good results from those patients after the fact.
Bill: So you get a benchmark before treatment and then that informs your treatment plan after?
Bryan: Absolutely. We’re always evaluating patients and reevaluating patients as they come in. Every patient, no matter what program they start within rehabilitation, gets a baseline measurement and then we look based on what we’ve been doing with those patients and what type of progress they’re making and also what other areas maybe we need to work a little bit harder in. Then, we use that to continue to progress them, and then eventually when we send them out on their own to have an independent program that they can continue to work on to continue to improve their quality of life.
Bill: Got you, so, what should a patient expect then after the treatment? Is it like a normal course of physical therapy? Is it like six weeks generally? I know it’s individualized, but in general, what should a patient expect?
Bryan: Yeah, I would say in general, the average times spent with us is about four to six weeks Again, as you mentioned, it’s definitely individualized. We have some patients who come in for a one-time visit, and we give them a program to do on their own at home. We might even keep in contact with them over the phone. We have other patients who are coming in two to three times a week. Again, on average, it’s probably about four to six weeks. The research shows that to build strength, to improve cardiovascular endurance, typically, you need to be on a program for about that four to six week period of time, and we want to be part of that, supervising it, progressing it accordingly, and making sure that the patients are reaching different benchmarks that are set on a daily and weekly basis. The average time is probably about four to six weeks.
Bill: When you think of cancer and treatment, you don’t necessarily think of physical therapy afterward. What else should we know about physical therapy and cancer, Bryan?
Bryan: Well, and again, I think it’s probably a point that I brought up earlier. You’re right, people don’t typically think of physical therapy as part of their overall treatment, and I think what happens a lot of times – understandably so – is patients think that “You know, I did that treatment for that acute case of cancer, and I’m okay dealing with back pain,” or, “I’m okay that I can’t lift my arm all the way up because I’m doing better from the cancer.” Those things still affect the quality of life, and those things can still be addressed by physical therapy and our occupational therapy staff, and they can be improved upon. There is research out there that suggests over 80% of cancer survivors have symptoms that can be modified in a beneficial way by therapy, and we want to see those patients. We want to improve their quality of life so that they can get back to activities that they thought they might never be able to do again.
Bill: Right, it’s treating the whole condition. Well, Bryan, thank you so much for your time today. For more information, you can visit RoswellPark.org, that’s RoswellPark.org. You’re listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I’m Bill Klaproth. Thanks for listening.
The Benefits of Physical Therapy During Cancer Care
Bill Klaproth (Host): Physical therapy is often required after cancer treatment, and the physical therapy staff at Roswell Park Cancer Institute offers a number of different services depending on the type of cancer being treated and a patients’ own individual needs. Here to talk with us about physical therapy and cancer, is Bryan Wittmeyer, Director of Rehabilitation Therapy and Wellness Services at Roswell Park Comprehensive Cancer Center. Bryan, thank you so much, for your time today. So when is physical therapy following cancer treatment necessary?
Bryan Wittmeyer (Guest): Well, physical therapy treatment following any sort of cancer treatment is necessary if a patient is dealing with a host of symptoms that could come either from the diagnosis itself or the associated treatments after the fact. A lot of the different symptoms that we will see here that patients will often report to their physician are pain, loss of mobility or range of motion, weakness, fatigue, loss of endurance, and even just difficulty with their day-to-day activities.
Bill: And what types of exercises are necessary then, following different types of treatment?
Bryan: Well, it’s very individualized to the individual patient, to be honest with you. Every patient who comes in for their first visit with us will be evaluated by one of our specially trained physical therapists who is trained to deal with a cancer diagnosis and the associated treatment. Based on that evaluation, it could be a host of different treatments, whether it’s manual therapy from our therapists itself, whether it’s strengthening exercises, endurance exercises. There are even different exercises and different programs that we may develop to help with fatigue or cognitive issues. Our actual occupational therapy staff who also see patients in the outpatient setting office deal with that. It’s very individualized programs dependent on the patient’s needs and tailored to their individual needs, and then progressed along so that we can get them back to whatever their goals are following their treatment with us.
Bill: Right, very important. Physical therapy is important for pain, regular function, what else? Why is physical therapy important then?
Bryan: Well, a big thing that we find is during the acute stage of cancer, patients are really dealing with that. They’re looking at their overall health and just basically trying to cure their cancer. After the fact, they have secondary issues again, whether it’s pain, whether its weakness, loss of motion, and initially, sometimes they feel that that’s just normal to feel and that’s just part of the deal, to be honest with you. What we want to let those patients know is that our physical therapists can do an evaluation of the patient and they can address a lot of those symptoms in a way that can improve their quality of life for the long-term.
Bill: Well, that makes sense. What technology is offered by Roswell Park Comprehensive Cancer Center?
Bryan: Well, what is nice about the timing of this interview is we actually just opened our brand new Rehabilitation Services Clinic about a week and a half ago – actually, on the 25th of September. We have all new exercise equipment ranging from treadmills, ellipticals, stationary bikes, we’ve got a fusion system that incorporates different strengthening exercises, and we actually even have a very state-of-the-art system – it’s called the Safe Gate, which is an overhead, mounted-to-the-ceiling, tracking unit that, with a harness – we can get the patients into the harness and we can do mobility exercises with them. For some of our lower-functioning patients, it may just be ambulating by taking off some of their body weight and allowing them to do things that they would not normally be able to do without the assistance of this device. And for some of our higher-functioning patients, we get them doing balancing exercises, strengthening exercises, unilateral exercises on one leg to get them to practice different activities that they might need to do in their daily routine and in the future. That is brand new technology that we have never had here before, and we’ve been happy to start utilizing on some of our patients already.
Bill: So Bryan, let’s talk about what a patient should expect before and after. Let’s talk about before. Can you tell us what pre-habilitation is and who a good candidate for prehab is?
Bryan: Sure, prehabilitation is somewhat a newer concept in the world of rehabilitation and especially in oncology rehabilitation. Really, what prehab is it’s doing an assessment of a patients’ functional status, strength, endurance, and other factors that will lead to how well they do immediately following a procedure – whether it’s a surgical procedure, whether it’s chemotherapy, whether it’s radiation therapy. Based on that assessment, if we find that a patient has weakness or difficulty with functional activities – we start them on a program to improve those things before they start their acute care treatment.
What the research has shown is that by improving strength, improving function, improving endurance, the outcomes after these procedures are often much better whether it’s the length of stay in the hospital, whether it’s their functional abilities immediately following a procedure or down the road. We have started different programs here with patients in our urology service and our thoracic service. We’ve been doing it for a long time with our bone marrow transplant patients, where we do a screening, and if we find some of those patients are deconditioned or weak, we get them on an exercise program that we supervise throughout the clinic, and we’ve seen some really good results from those patients after the fact.
Bill: So you get a benchmark before treatment and then that informs your treatment plan after?
Bryan: Absolutely. We’re always evaluating patients and reevaluating patients as they come in. Every patient, no matter what program they start within rehabilitation, gets a baseline measurement and then we look based on what we’ve been doing with those patients and what type of progress they’re making and also what other areas maybe we need to work a little bit harder in. Then, we use that to continue to progress them, and then eventually when we send them out on their own to have an independent program that they can continue to work on to continue to improve their quality of life.
Bill: Got you, so, what should a patient expect then after the treatment? Is it like a normal course of physical therapy? Is it like six weeks generally? I know it’s individualized, but in general, what should a patient expect?
Bryan: Yeah, I would say in general, the average times spent with us is about four to six weeks Again, as you mentioned, it’s definitely individualized. We have some patients who come in for a one-time visit, and we give them a program to do on their own at home. We might even keep in contact with them over the phone. We have other patients who are coming in two to three times a week. Again, on average, it’s probably about four to six weeks. The research shows that to build strength, to improve cardiovascular endurance, typically, you need to be on a program for about that four to six week period of time, and we want to be part of that, supervising it, progressing it accordingly, and making sure that the patients are reaching different benchmarks that are set on a daily and weekly basis. The average time is probably about four to six weeks.
Bill: When you think of cancer and treatment, you don’t necessarily think of physical therapy afterward. What else should we know about physical therapy and cancer, Bryan?
Bryan: Well, and again, I think it’s probably a point that I brought up earlier. You’re right, people don’t typically think of physical therapy as part of their overall treatment, and I think what happens a lot of times – understandably so – is patients think that “You know, I did that treatment for that acute case of cancer, and I’m okay dealing with back pain,” or, “I’m okay that I can’t lift my arm all the way up because I’m doing better from the cancer.” Those things still affect the quality of life, and those things can still be addressed by physical therapy and our occupational therapy staff, and they can be improved upon. There is research out there that suggests over 80% of cancer survivors have symptoms that can be modified in a beneficial way by therapy, and we want to see those patients. We want to improve their quality of life so that they can get back to activities that they thought they might never be able to do again.
Bill: Right, it’s treating the whole condition. Well, Bryan, thank you so much for your time today. For more information, you can visit RoswellPark.org, that’s RoswellPark.org. You’re listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I’m Bill Klaproth. Thanks for listening.