Oncological rehabilitation remains a “luxury” for a few, but it is a necessity for almost all cancer patients – breaking latest news

Try asking a breast cancer operated woman who suffers from lymphedema to the arm how important, to recover his life, to have access to physiotherapy treatments that counteract the swelling. Or ask a patient who, after surgery for lung or head and neck cancer, struggles to swallow food and liquids due to dysphagia. Do you have problems chewing, swallowing, breathing: how necessary are the exercises that help you recover these functions? Post-cancer rehabilitation is a necessity for almost all patients, but in Italy it is still a luxury for a few. How come? Because it doesn’t come under the Lea – he replies Francis DeLorenzo, president of the Italian Federation of Volunteer Associations in Oncology (FAVO) -. The Essential Levels of Assistance (Lea) represent the benefits and services that the National Health Service is required to provide to all citizens, free of charge or upon payment of a participation fee (ticket), with public resources collected through taxes . In practice, what falls under the Lea must be guaranteed to everyone, by law. And rehabilitation for those who have had cancer not included in the list. As if it weren’t essential, exactly.

Ticket exemption

In reality, a form of coverage exists. Cancer patients have the right to exemption from co-payment (cod. 048): those who have had cancer do not have to pay for drugs, visits and tests related to the cancer and its complications, for rehabilitation and the prevention of aggravations. Unfortunately not everywhere the exemption is respected in its entirety and many people are not recognized for rehabilitation treatments – explains the oncologist Paola Varese, president of the Scientific Committee Favo -. Without considering that the offer of the various types of rehabilitation is still largely insufficient in our country today. Inclusion in the Lea is essential in order to be able to give patients an integrated rehabilitation process, i.e. a “package” that includes multiple skills and services designed for the individual patient. Over three million and 600 thousand people live in Italy with a previous diagnosis of cancer, over one million of whom can be considered definitively cured.

Individual projects

Physical and psychological support useful in practically every phase of the disease: during therapy and sometimes even before (especially after a demanding surgical procedure); after treatments, for a more complete recovery and for many who make the neoplasm chronic and live with it for years; and also in the palliative phase, to improve the quality of life in the more advanced stages. Rehabilitation in recent years has assumed an increasingly central role allowing the prevention and management of many side effects – explains the oncologist Paola Varese, president of the Committee Scientific of the Honeycomb -. It must be from diagnosis to therapy, up to palliative care with the aim of minimizing physical disability and deficits (functional, cognitive, nutritional, psychological, social and professional) and promoting recovery. The interventions can vary according to the type of tumor and the treatment performed, but also from person to person. This requires an individualization of the rehabilitation project.

Teamwork

Recent statistics have highlighted how, even after many years of treatment, one patient out of three suffers from physical and psychological consequences: from motor problems to sexual dysfunction, from anxiety about depressionfrom swallowing or speech disturbances to lymphedema (swelling in the arms and legs caused by surgery or radiation therapy), ostomy (i.e. an outlet on the abdominal wall of internal organs, such as the urinary tract or intestine) to incontinence or genitourinary problems (for example due to prostate, bladder or uterus cancer). And the long list because the obstacles to be faced depend largely on the type of neoplasm and the treatments made, but the final effect is always the same: the disorders significantly worsen people’s quality of life. We need multidisciplinary and multiprofessional teamwork based on the case of the individual patient – ​​continues the oncologist -. There are many experts who can be involved, alongside the surgeon, oncologist and radiotherapist: physiatrist, physiotherapist, nutritionist, psychologist, palliative care specialist. Nurses are indispensable, as are the various specialists: cardiologists, pulmonologists, gastroenterologists, internists, gynecologists, ear surgeons, for example.

Play early

We have learned that we don’t have to wait for the problems to manifest themselves, but that they can often be prevented by teaching patients useful exercises to alleviate the ailments – Varese continues -. Today, alongside health professionals, the role played by voluntary associations is also fundamental, very often already present in hospitals or in the city, with courses in physiotherapy, self-help groups and various initiatives to support the sick and their families. The final aim of the various rehabilitation interventions is to favor the autonomy and social reintegration of the sick person, with a benefit also for the state coffers which can save on the high costs of patients who are no longer self-sufficient and of workers who are unable to be productive. Rehabilitation has a strong social and economic value, deriving from a reduction in direct and indirect costs connected to the disability deriving from the tumor – underlines De Lorenzo, who for over 15 years has been fighting with Favo to favor the coverage by the State of all expenses necessary for the rehabilitation that an oncological patient is called upon to bear -. Yet it continues to be relegated to the margins of the care pathway, it is almost never guaranteed through the National Health Service, with the consequence that the various interventions are paid for by the sick. So they are only within the reach of those who can pay for them out of their own pocket.

Different rehabilitations for different types of tumor

The first step from which the oncologist starts to define a rehabilitation process is the type of disease that has affected the patient in front of him. After the surgical treatment of breast cancer, but also of melanomas or gynecological neoplasms with extensive removal of the locoregional lymph nodes and also treated with radiotherapy, rehabilitation is useful for preventing or in any case making lymphedema more manageable – Varese points out -. The new surgical methods are very attentive to prevention. But the first step to take is the education of the patient, who must be trained to avoid predisposing factors (neglected wounds) or to precociously intercept the very first symptoms (reddening of the skin, even minimal tissue swelling), as well as being encouraged to radically modify the lifestyle by carrying out regular physical activity (swimming allows for natural lymphatic drainage) and following a correct diet (with diets low in animal fats, ed). A different rehabilitation path is instead the one proposed to patients operated on or treated with radiotherapy for head and neck cancer, who may experience difficulties in chewing, swallowing, phonation and articulation of language. After the surgical treatment of lung cancer (although several studies show that in reality the outcomes improve by starting rehabilitation even before the operation), it is necessary to start a path of respiratory rehabilitation, while patients operated on for a form of throat cancer or of the esophagus may develop dysphagia: having difficulty swallowing food and liquids. Finally, the needs for patients operated on the brain (with different relapses depending on the area treated), on one of the limbs (in case of difficulty walking), on the bladder and on the prostate (rehabilitation aims at prevent and control urinary incontinence and sexual impotence) and rectum (faecal incontinence, especially in the elderly and after radiotherapy.