After cancer treatment, getting back into the swing of life – often involving getting back to work – can be tough. Why is it then that cancer survivors have less access to help with rehabilitation post-treatment?

Are cancer patients less worthy of rehabilitation?

Hopefully the overwhelming response to that question is 'absolutely not.' A patient recovering from an illness or treatment is surely worthy of rehabilitation no matter what the illness.

So why does the amount of time and money invested into cancer patient's rehabilitation seem to be lagging behind the amount dedicated to other illnesses?

Professor of Rehabilitation (AUT University, Auckland) Kath McPherson has dedicated her research to addressing this issue, after working with family and friends with cancer and noticing that after treatment an attitude prevailed among medical circles along the lines of, 'you've recovered now,' and this attitude was followed by very little in the way of help and advice post-treatment.

There is life after cancer. Three and a half to four per cent of the population is surviving with the disease – but surviving doesn't mean that all the issues go away. There seems to be insufficient interest shown in cancer patients' post-treatment progress. When people aren't 100 per cent well, or need advice and information, too often they don't know where to turn.

“Not much money is spent on people trying to live with survivor issues,” said Professor McPherson. “In New Zealand hardly anything is spent. There is very little for people once their treatment stops.”

Not enough research is being conducted – research that could allow us to better reach and help these patients post-treatment. The main gaps in knowledge of these patients (identified by the National Cancer Institute – see link below) include the health and quality of life of long-term survivors, the optimal type of post-treatment care for survivors, and the influence of family on survivors' health.

Life is often put on hold during chemo- or radio-therapy treatment, Professor McPherson explained. How then does a patient pick themselves up and know where to start with work, chores, routines, with daily life, afterwards?  There are issues and complexities in returning to work. Maybe they are more complex for cancer survivors than we have yet to understand.”

There is research to suggest that after cancer treatment, there are patients who take a long time to get back to work, and, once back, do not enjoy their job as much. It is difficult to re-engage after a year's absence. It is also difficult to deal with attitudes towards illness and expectations that might be beyond the recovering patient.

This trend could be turned around if there was more support for these patients, and better access to resources for assistance.

“There are unmet rehabilitation needs', she said. What can be done?

Professor McPherson has links with the Cancer Society, which normally stops support for people at the end of treatment, to improve rehabilitation services for people not only during treatment, but also in the longer term.

Another message to come out of her talk is the value of the patient staying visible at their workplace during the time that they are out of work. This can be difficult, but keeping in touch means returning to the workplace is less likely to seem a foreign environment and it might be easier to avoid any sense of distance with colleagues.

Professor McPherson referred to two major studies that look at the rehabilitation of cancer patients. One by Michael Feuerstein and Jos Berbneek which looked at cancer survivorship and rehabilitation together – a rare perspective on often separated areas; that work emphasised

• the value of a work-focused approach from treaters
• training and support for return to work
• the value of understanding patients within the framework of their life and participation, not just recovery from the disease

Alexander Ng's was the other study Professor McPherson mentioned. He identifies the physical and medical challenges as:

• management of symptoms and side effects
• accepting a stable disease as a desirable outcome
• fostering decisions about transition from curative to palliative pathways

He also suggests that ongoing approaches by health-care providers need to address the patient in terms of their psychological challenges, interpersonal, spiritual and existential challenges, and practical concerns.

Work and financial issues do not stop for cancer survivors at the stopping of treatment, said Professor McPherson, who put out a call for change to attitude and an improvement in dissemination of practical information to cancer survivors. “Changes to the way rehabilitation are provided are something we have to influence at a political level,” she said. We can get the ball rolling more locally, however, by being aware and outspoken about this lack in rehabilitation.

http://www.canceraustralia.gov.au/

http://www.cancer.gov/

www.lifeaftercancer.org.nz