New Concerns About Safety in Cancer Rehabilitation

Julie Silver, MD

Cancer rehabilitation is offered in many different settings and by many different types of healthcare providers. Although cancer rehabilitation may include exercise programs recommended by trained fitness professionals, there is concern about the safety of referring patients directly to people who are not trained specifically in rehabilitation medicine. Recent articles are highlighting important safety concerns in cancer survivors. For example, a new article titled “Patient Safety in Cancer Rehabilitation” was published in May 2012 by Cristian and colleagues in the Physical Medicine and Rehabilitation Clinics of North America.[1]

In a recent study evaluating weightlifting in breast cancer survivors who had lymphedema or were at risk to develop it, researchers found that approximately 21% of the participants in the weightlifting group reported a problem—such as a new injury–that required them to see their doctors or other healthcare providers and this resulted in stopping or changing their exercise regimen.[2] In this study published in The Oncologist, Brown and colleagues stated, “Despite the demonstrated efficacy of weightlifting, musculoskeletal injuries and other health problems did occur. Therefore, for the successful translation of this rehabilitative intervention into clinical practice, health and fitness professionals working with breast cancer survivors need the knowledge, skills and abilities that clarify their scope of practice to address these needs.”

In order to clarify the scope of practice in rehabilitation medicine, it is important to identify those healthcare professionals who have completed the appropriate training in order to be able to identify and treat cancer survivors’ impairments. Only professionals who are licensed and/or board certified in rehabilitation medicine should be treating patients for physical impairments. These healthcare professionals include physicians (e.g., physiatrists), rehabilitation nurses and physical, occupational and speech therapists. The training of fitness professionals is not sufficient to qualify these individuals to treat survivors’ impairments. Therefore, this is beyond their scope of practice. Moreover, sending survivors to fitness professionals without first identifying and treating their impairments is dangerous. In the cancer care continuum, the goal must be to screen all survivors for physical impairments and then appropriately triage those with identified problems to licensed and/or board certified rehabilitation professionals prior to referring them to fitness professionals.

[1] Cristian A, Tran A, Patel K. Patient safety in cancer rehabilitation. Physical medicine and rehabilitation clinics of North America. 2012;23(2):441-56. Epub 2012/04/28. doi: 10.1016/j.pmr.2012.02.015. PubMed PMID: 22537705.

[2] Brown JC, Troxel AB, Schmitz KH. Safety of weightlifting among women with or at risk for breast cancer-related lymphedema: musculoskeletal injuries and health care use in a weightlifting rehabilitation trial. The oncologist. 2012;17(8):1120-8. Epub 2012/07/04. doi: 10.1634/theoncologist.2012-0035. PubMed PMID: 22752068; PubMed Central PMCID: PMC3425531.